The lesions appear in the form of small papules of 2-5 mm size. Papules of size greater than 15 mm diameter are rarely seen. These papules are spherical or round in shape, firm, smooth- surfaced and have a characteristic central dimpling.

The sites of these papules are different for children and adults. Although the papules are red and swollen in appearance but no local tenderness has been noted. In children, the lesions commonly occur on the chest, arms, legs, and face. Lesions on the mucous membranes such as nose, lips and buccal mucosa are rare. The genitalia, gluteal areas, perineum and inguinal areas are mainly affected in adults as the lesions are mostly sexually transmitted.

These lesions are severe and extensive in individuals with a compromised immunity such as in HIV. The infection lasts for around 2 months but the disease in general takes about 2 years to resolve completely [7].

• Pain

  Treatments that cause minimal pain (eg, tretinoin, tazarotene, cantharidin) are used first, especially in children. [msdmanuals.com]

  If you or someone in your care has chest pains, difficulty breathing, or severe bleeding, it could be a life-threatening emergency. Call 9-1-1 or the local emergency number immediately. [healthlinkbc.ca]

  These options are rapid and require a trained health care provider, may require local anesthesia, and can result in post-procedural pain, irritation, and scarring. [web.archive.org]

• Swelling

  At least one third of patients will develop symptoms of local erythema, swelling or pruritus. Diagnosis is usually clinical. Children are primarily managed conservatively. [bestpractice.bmj.com]

  Epididymo-orchitis Epidiymo-orchitis is a serious condition that affects men and is characterised by pain and swelling inside the scrotum (ball bag), usually caused by an infection. [thinkcontraception.ie]

  Usually, there is no inflammation (swelling and redness) and no redness unless they have been irritated by rubbing or scratching. In adults, the lesions are commonly seen on the genitals, abdomen, and inner thigh. [nlm.nih.gov]

  Signs of a bacterial infection can include redness, swelling and pain in the skin and underlying tissue. ^^ Back to top Symptoms The main symptom of molluscum contagiosum (MC) is a number of small spots on the skin. [nhsdirect.wales.nhs.uk]

• Fatigue

  Fever, nausea and fatigue are not common in this condition. Patients with certain skin conditions such as eczema or psoriasis are more likely to have more spread of the viral infection. [lecturio.com]

  […] subjects included: Application Site Disorders: burning, hypopigmentation, irritation, itching, pain, rash, sensitivity, soreness, stinging, tenderness Remote Site Reactions: bleeding, burning, itching, pain, tenderness, tinea cruris Body as a Whole : fatigue [web.archive.org]

• Weight Loss

  Through medical intervention, including insulin and fenofibrate therapy, and dietary modification with weight loss, the xanthomas cleared during the subsequent months, and his serum triglyceride levels nearly normalized. [ncbi.nlm.nih.gov]

  Through medical intervention, including insulin and fenofibrate therapy, and dietary modification with weight loss, the xanthomas cleared during the subsequent months, and his serum triglyceride levels nearly normalized. behavior eating BMI dermatology [pediatrics.aappublications.org]

• Common Cold

  However, like the common cold, there is no permanent immunity to the virus, and it is possible to become infected again in the future upon exposure to an infected person. Top ^ [adultandpediatricdermatology.com]

• Overeating

  […] rus ( mol-lusk'e-poks-vī'rus ), A genus in the family Poxviridae; causes localized wartlike skin lesions. molluscum contagiosum [məlus′kəm] Etymology: L, molluscus, soft a disease of the skin and mucous membranes caused by a poxvirus, which occurs all over [medical-dictionary.thefreedictionary.com]

  Avoid shaving over, or sexual contact, with areas that have molluscum. If treatment is desired for children, a common in-office therapy is cantharidin (“blister beetle juice”). [jamanetwork.com]

  After about 6 to 12 weeks, the Mollusca will crust over and then heal. A tiny patch of lighter skin or a pitted mark may remain, but there will not usually be any scars. [medicalnewstoday.com]

• Nausea

  Fever, nausea and fatigue are not common in this condition. Patients with certain skin conditions such as eczema or psoriasis are more likely to have more spread of the viral infection. [lecturio.com]

  Usually, there is no itching or tenderness, and there are no generalized symptoms such as fever, nausea, or weakness. People with weakened immune systems can develop widespread large lesions that can be persistent and rapidly spreading. [emedicinehealth.com]

  Systemic signs and symptoms may include malaise, fever, nausea, myalgias and rigors. [web.archive.org]

  Symptoms that are worrisome for systemic accumulation include gastrointestinal (GI) side effects (nausea, vomiting and diarrhea), neurological side effects (confusion, loss of reflexes and coordination) and psychiatric side effects (irritability and hallucinations [clinicaladvisor.com]

• Vomiting

  Other infections such as tonsillitis, verrucas, chickenpox, impetigo, ringworm, threadworms, ear infections, diarrhoea and vomiting are also common for your child to catch during school. [madeformums.com]

  Symptoms that are worrisome for systemic accumulation include gastrointestinal (GI) side effects (nausea, vomiting and diarrhea), neurological side effects (confusion, loss of reflexes and coordination) and psychiatric side effects (irritability and hallucinations [clinicaladvisor.com]

  Headache 11 ( 5%) 7 ( 3%) Carcinoma Squamous 8 ( 4%) 5 ( 2%) Diarrhea 6 ( 3%) 2 ( 1%) Eczema 4 ( 2%) 3 ( 1%) Back Pain 3 ( 1%) 2 ( 1%) Fatigue 3 ( 1%) 2 ( 1%) Fibrillation Atrial 3 ( 1%) 2 ( 1%) Infection Viral 3 ( 1%) 2 ( 1%) Dizziness 3 ( 1%) 1 ( Vomiting [web.archive.org]

• Myalgia

  Systemic signs and symptoms may include malaise, fever, nausea, myalgias and rigors. [web.archive.org]

  In addition, there have been case reports of adverse events such as fever, arthralgia, headache, myalgia, lymphadenopathy, febrile seizures and hypopigmentation scars when treating with imiquimod [22] – [24]. [journals.plos.org]

• Skin Disease

  The result of the infection is usually a benign, mild skin disease characterized by lesions (growths) that may appear anywhere on the body. [cdc.gov]

  They can also catch or spread the disease by touching surfaces and objects such as toys and towels. © Dr. P. Marazzi / Science Source What causes molluscum contagiosum? A virus (the molluscum contagiosum poxvirus) causes this skin disease. [babycenter.com]

  In MG Lebwohl et al., eds., Treatment of Skin Disease: Comprehensive Therapeutic Strategies, 3rd ed., pp. 442-445. Edinburgh: Mosby Elsevier. Habif TP (2010). Sexually transmitted viral infections. [healthlinkbc.ca]

  […] molluscum [ mŏ-lus´kum ] 1. any of various skin diseases marked by the formation of soft rounded cutaneous tumors. 2. molluscum contagiosum. adj., adj mollus´cous. molluscum contagio´sum a common, benign, usually self-limited viral disease of the skin [medical-dictionary.thefreedictionary.com]

• Dermatitis

  Dermatitis and itch can occur around the lumps, particularly in children with atopic eczema. [dermcoll.edu.au]

  A total of 30% of the included children had concomitant atopic dermatitis. We did not observe an increased occurrence of MCV infection in patients with atopic dermatitis. All patients were treated with curettage of the lesions. [ncbi.nlm.nih.gov]

  Secondary dermatitis may be treated symptomatically with a mild topical topical corticosteroid such as hydrocortisone cream. Dermatitis is unlikely to fully resolve until the molluscum infection has cleared up. [dermnetnz.org]

  Molluscum contagiosum virus infection with surrounding dermatitis in the popliteal region and legs in a child with atopic dermatitis. [mdedge.com]

• Skin Rash

  About Molluscum Contagiosum Molluscum contagiosum is a viral infection that causes a mild skin rash. The rash looks like one or more small growths or wart-like bumps (called mollusca) that are usually pink, white, or skin-colored. [rchsd.org]

• Pruritus

  The evolution of the rash and pruritus was rapidly favourable. After 3 months, the rash and pruritus had regressed. There was no molluscum contagiosum or clear halo. [ncbi.nlm.nih.gov]

  In children with atopic dermatitis, infection can be widespread and prolonged, since the altered epidermal barrier leads to increased susceptibility to viral skin infections, to pruritus leading to scratching and autoinoculation, and to long-term treatment [nejm.org]

  At least one third of patients will develop symptoms of local erythema, swelling or pruritus. Diagnosis is usually clinical. Children are primarily managed conservatively. [bestpractice.bmj.com]

• Insect Bite

  Insect bites may be another potential mimicking lesion depending on the time of year. Age and patient information regarding living situation and lifestyle should aid in the diagnosis. If removed surgically, diagnosis may be confirmed by pathology. [healio.com]

• Tingling

  Rhodes LE, Tingle MD, Park BK, Chu P, Verbov JL, Friedmann PS. Cimetidine improves the therapeutic/toxic ratio of dapsone in patients on chronic dapsone therapy. Br J Dermatol 1995;132(2):257-62. 56. [web.archive.org]

• Pruritus Vulvae

  Micheline Moyal-Barracco, Pruritus Vulvae, Pruritus, 10.1007/978-1-84882-322-8_37, (243-252), (2009). Jacquelyn Coloe, Craig N. Burkhart and Dean S. Morrell, Molluscum Contagiosum: What’s New and True?, Pediatric Annals, 38, 6, (321), (2009). [doi.org]

Molluscum contagiosum is diagnosed through clinical presentation and physical examination alone. The hallmark of diagnosis is done by identification of the molluscum contagiosum inclusion bodies from the specimen of the lesion obtained, through histopathological examination. The blood tests are usually not required except in suspected cases of HIV, where in it is the only symptom.

As it is a self limiting disease, treatment is not required and in healthy subjects, the lesions disappear in a 3 month period.

Treatment is advised to prevent autoinoculation and limit the transmission of the infection. This is achieved by various methods such as curettage, cryotherapy, topical antiviral applications and surgery.

In immunocompromised patients, treatment is difficult and laser techniques, antiviral therapy along with imiquimod is recommended. Imiquimod application causes stimulation of immune response by producing interferons [8] [10]. The ointment of 1% concentration is to be applied 3 times daily for 4 weeks on the lesions and that of 5% once daily at bedtime. In patients with HIV, antiretroviral therapy is found to be much more efficient and useful. The drugs are mainly ritonavir, cidofovir and zidovudine. A new drug called Veregen is prepared from the extract of the green tea. This drug is available in an ointment form and is to be applied on the affected areas 3 times daily [6].

In a study conducted in children for treatment of molluscum contagiosum, few children were treated with cantharidin, few others had undergone curetting, few with imiquiod and the rest with salicylic acid. Of these, curettage therapy was found to be more efficient and acted well. This is because cantharidin has a strong vesicant action and acts by exfoliating the entire lesion. This treatment has also not been acknowledged by the FDA.

Salicylic acid is a caustic agent hence results in inflammation and desquamation. It also has the quality to adhere and coat the lesion, and therefore the infection doesn’t spread and remains limited to that area itself.

Cryotherapy is frequently used by many therapists, especially in elderly age group. This procedure involves freezing of the lesions which causes thinning of the adjacent skin. This is repeated after a few weeks until the disease disappears. Cryotherapy leads to loud sounds and so could be frightening to younger children. Also, the pain element is relatively high during the procedure. Pulse dye laser (PDL) therapy is found to be successful and is routinely performed. This treatment proves to be very efficient and there have been drastic reductions in the number of molluscum contagiosum lesions.

Molluscum contagiosum is a self remitting disease; hence the prognosis is very good. The rate of recovery is different for different individual. In healthy immunocompetent individuals, the recovery occurs by approximately 2 years. There is no death noted till date.

The morbidity percentage is higher, especially in HIV or other immunocompromised patients as they have extensive and wide spread areas infected. Though there is a complete remission; chances of recurrence of the infection is about 40%, which is also estimated due to aggravation of the current infection or new lesions appearing after an extended no infection period.

The lesions regress totally with no long lasting skin defect; however skin scarring and disfiguring of skin has been noted [6].

Molluscum contagiosum is caused by Molluscum Contagiosum virus (MCV). This virus has a high molecular weight and is a DNA virus. After reaching the epithelium, it enters the cytoplasm and multiplies in it. It is found that MCV can survive and develop only in human skin and not in any tissue culture or eggs.

Personal contact with the infected objects such as personal items, razors, beddings, towels, napkins spreads the infection. Also, the lesion spreads locally if the lesions are touched or manipulated. This phenomenon is called as autoinoculation. Spread via swimming pools has been reported [1].

Molluscum contagiosum infection is prevalent throughout the world and is one of the most common skin infections. In the United States, it occupies 1% of all skin infections. Studies reveal that the rate of this infection has been increasing.

The tropical regions show the highest infection rates. Mali has been reported to have about 5% of total prevalence with maximum age group of children getting affected [3]. The incidences grow with increasing age; lowest in children up to 2 years and high in adults more than 40 years. Certain areas like Fiji, and Africa, are repeatedly affected.

Studies have associated climatic seasonal factors such as humidity and warmth as the likelihood to the prevalence of this infection, as there is a possibility of young age group being moderately dressed and hence the chances of them transmitting the infection rise. Men are frequently affected. Infants are hardly infected and those more than 5 years are highly infected [4].

Mollluscum contagiosum virus produces cytoplasmic inclusions and enlargement of the cells in the epithelial layer of the skin. The virus disperses the infection from the basal layer of epidermis to the spindle and the granular layers of the epidermis during the 8 weeks of the infection period.

At the cellular level, the infected cells undergo intense destruction and distortion resulting in formation of huge hyaline bodies called molluscum bodies or Henderson-Paterson bodies [5]. These bodies have a typical structure which looks like a smooth papule with a central white dimple. It has been noted that these lesions have a possibility to get inflamed and develop edema with proliferation of blood vessels and monocytic and lymphocytic infiltration.

Self manipulation or scratching of the lesions should be avoided as it causes local spread. Observe self hygiene and repel from any physical contact. Molluscum contagiosum is transmitted through sexual route, so care must be taken and abstinence is recommended or possibly to use a condom. The disease is transmitted even though fomites like cupboards etc., so direct contact with it must be avoided.

Patients are advised to maintain usual hygiene and avoid physical contact with other individuals. They are informed not to share beddings, bath towels, sports equipment, and swimming pools with other people. Touching or scrapping of the local lesions should be avoided to minimize autoinoculation [1] [8].

Molluscum contagiosum is a common cutaneous viral infection. It was discovered in the early nineteenth century by Dr. Bateman. Molluscum contagiosum is an infection which spreads from person to person and it is prevalent worldwide. This infection is found in the adult age group as well as in children.

The virus invades the host from the epidermal layer of the skin through small breaks appearing in the hair follicles. As only the epidermis is involved, it is also called as epithelioma contagiosum or dimple warts. The lesions appear as papules which are pearly and smooth occurring in clusters.

Like all contagious infections, molluscum contagiosum also gets transmitted from person to person. Care must be taken to avoid physical contact with family and other members. The area should be enclosed in a thicken gauze piece or bandage; scrapping or touching must be avoided in order to avoid the local spread. Individual must refrain from sexual activity during the infection if the lesions involve the genital area.

Molluscum contagiosum is a self remitting disease, so if left untreated it will resolve on its own. Complete recovery takes about 6 months. The lesions can culminate into deep scarring after the disease remission. Local surgery, lasers, curetting are different recommendations for treating in order to cut the duration and prevent disfiguring of the skin [11].

1. Connell CO, Oranje A, Van Gysel D, Silverberg NB. Congenital molluscum contagiosum: report of four cases and review of the literature. Pediatr Dermatol. Sep-Oct 2008;25(5):553-6.
2. Niizeki K, Kano O, Kondo Y. An epidemic study of molluscum contagiosum: relationship to swimming. Dermatologica. 1984;169(4):197-98.
3. Castilla M. Molluscum contagiosum in children and its relationship to attendance at swimming-pools: an epidemiological study. Dermatology. 1995;191(2):165.
4. Choong KY, Roberts LJ. Molluscum contagiosum, swimming and bathing: a clinical analysis. Australas J Dermatol. 1999 May;40(2):89-92.
5. Dai NT, Yeh MK, Liu DD, Adams EFet al. A co-cultured skin model based on cell support membranes. Biochem Biophys Res Commun. 2005 Apr 15;329(3):905-908.
6. Howell MD, Jones JF, Kisich KO, Streib JE, et al. Selective killing of vaccinia virus by LL-37: implications for eczema vaccinatum. J Immunol. 2004 Feb 1;172(3):1763-7.
7. Gottlieb SL, Myskowsi PL. Molluscum contagiosum. Int J Dermatol. 1994 Jul;33(7):453-461.
8. Buckley R, Smith K. Topical imiquimod therapy for chronic giant molluscum contagiosum in a patient with advanced human immunodeficiency virus 1 disease. Arch Dermatol. 1999 Oct;135(10):1167-9.
9. Hanson, Daniel; & Diven, Dayna G. Molluscum contagiosum. Dermatology Online Journal 2003 9(2). 
10. Cohen JI, Davila W, Ali MA, Turk S, et al. Detection of Molluscum Contagiosum Virus (MCV) DNA in the Plasma of an Immunocompromised Patient and Possible Reduction of MCV DNA With CMX001. J Infect Dis. 2012 Mar 1;205(5):794-97
11. Phelps A, Murphy M, Elaba Z, Hoss D. Molluscum Contagiosum Virus Infection in Benign Cutaneous Epithelial Cystic Lesions—Report of 2 Cases With Different Pathogenesis? Am J Dermatopathol. 2010 Oct; 32(7):740-2.