Background Information

Definition

Viral skin infection caused by molluscum contagiosum virus (family of poxviruses – Poxviridae)

Risk Factors

• Warm climates
• Swimming
• Close contact with an infected person
• Atopic dermatitis
• Immunocompromise (e.g. HIV, solid organ transplants, immunosuppressive therapy)

Clinical Features

Features of the lesions:

• Smooth-surfaced firm dome-shaped papules with a central umbilication
• Flesh coloured or pearly white
• Usually 1-30 lesions at a time as clusters
• Location
  • Can affect almost any part of the body, apart from the soles and palms, oral mucosa
  • Children: more common on trunk and flexures
  • Adults: sexual contact may lead to anogenital lesions

Symptoms:

• Often asymptomatic
• Pruritus, erythema possible
• Koebner phenomenon: new skin lesions appearing at site of a skin injury (e.g. scratch or a cut)

Guidelines

Investigation and Diagnosis

Clinical diagnosis based on clinical features (see above).

Management

Referral Criteria

• HIV with extensive lesions → refer to HIV specialist
• Eyelid / ocular lesions + red eye → refer to ophthalmology
• Anogenital lesions → refer to genitourinary medicine for STI screening

Definitive Management

1st line: expectant management 

• Reassure molluscum contagiosum is a self-limiting condition
• Tends to spontaneously resolve within 18 months
• Advise NOT to scratch or squeeze the lesions
• Explain that the lesions are contagious, avoid sharing towels / clothing / bedding until lesions resolve

Other treatment options (no strong evidence)

• Cryotherapy (liquid nitrogen)
• Podophyllotoxin 0.5%
• Imiquimod 5% cream

References

Original Guideline