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# Molluscum contagiosum

Molluscum contagiosum is a common viral [skin](https://durgical.com/en/anatomy/skin/) infection causing small pearly bumps with a central dimple. It is frequent in children and usually clears alone.

Updated 2026-11-01

## Structures involved

Tap one to see what it is and open it in 3D.

- [Skin](https://durgical.com/en/anatomy/skin/)
- [Eyelids](https://durgical.com/en/anatomy/superior-tarsus/)

## Microorganisms that cause it

- [Molluscum contagiosum virus](https://durgical.com/en/microbiology/molluscum-contagiosum-virus/)

## Why it happens

- [Keratinocytes, melanocytes, Langerhans and Merkel cells](https://durgical.com/en/histology/keratinocytes-melanocytes-langerhans-and-merkel-cells/)
- [Skin: epidermis layers, dermis, hypodermis](https://durgical.com/en/histology/skin-epidermis-layers-dermis-hypodermis/)

## What it is

A benign infection of the epidermis caused by the molluscum contagiosum virus, a poxvirus. It produces small, firm, dome-shaped, skin-coloured or pearly papules with a central umbilication. It affects mainly children; in adults it is often sexually transmitted, and extensive or giant lesions suggest immunosuppression.

## Who gets it

Very common worldwide, especially in children aged 1–10 years, in warm humid climates and in crowded settings. In adults it appears on the genitals as a sexually transmitted infection, and in people with advanced HIV it can be widespread on the face. It is frequently seen in paediatric and dermatology clinics in Colombia.

## Causes

- Molluscum contagiosum virus (MCV), a DNA poxvirus that infects only humans
- Spread by direct skin-to-skin contact, sexual contact and contaminated objects (towels, toys, sponges)
- Autoinoculation by scratching or shaving spreads lesions on the same person

## Risk factors

- Childhood, attending day care or school
- Atopic dermatitis (broken skin barrier and scratching)
- Swimming pools, shared towels and contact sports
- Sexual activity (genital lesions in adults)
- Immunosuppression, especially HIV with low CD4 counts, transplant or immunosuppressive drugs

## Pathophysiology

The virus infects keratinocytes and replicates in their cytoplasm, forming large eosinophilic inclusion bodies (molluscum or Henderson-Patterson bodies). Infected cells proliferate into a lobulated papule that opens at the centre, which explains the umbilication and the cheesy core. Viral proteins block local inflammation, so lesions persist until the immune system recognises them; redness around a lesion often signals the start of clearance.

## Symptoms and signs

- Small (2–5 mm), firm, smooth, dome-shaped, pearly or skin-coloured papules
- Central dimple (umbilication) that may release a white, waxy material
- In children: trunk, armpits, face, arms and folds; often grouped or in lines from scratching
- In adults: lower [abdomen](https://durgical.com/en/anatomy/region/abdomen/), pubic area, inner thighs and genitals
- Usually painless; itch or eczema around the lesions (molluscum dermatitis)
- Redness and swelling of a lesion when it begins to resolve

## Red flags

- Many, large (giant, over 1 cm) or facial lesions in an adult: test for HIV or other immunosuppression
- Genital lesions in an adult: screen for other sexually transmitted infections
- Genital lesions in a young child: consider sexual abuse in the right context
- Lesions on the eyelid edge with red eye: chronic conjunctivitis needing ophthalmology
- Painful, warm, spreading redness or pus: secondary bacterial infection

## Diagnosis

**Clinical**
Clinical diagnosis from the pearly umbilicated papules. Dermoscopy shows a central white-yellow structure with a crown of vessels at the edge.

**Tests**
If in doubt, curetted material or biopsy shows molluscum bodies on microscopy. Adults with genital lesions should be offered HIV, syphilis and other STI testing; HIV testing is advised in adults with extensive facial lesions.

**Imaging**
Not needed.

## Differential diagnosis

- Viral warts (rough surface, no central dimple)
- Varicella or herpes simplex vesicles (fluid-filled, painful, acute)
- Basal cell carcinoma (pearly papule in older adults)
- In advanced HIV: disseminated cryptococcosis, histoplasmosis or talaromycosis that mimic molluscum
- Milia, folliculitis and sebaceous hyperplasia

## Goal of treatment

Allow spontaneous clearance when lesions are few, reduce spread to other sites and contacts, treat genital or troublesome lesions, and identify underlying immunosuppression.

## Treatment

**Conservative**
Watchful waiting is reasonable in healthy children, because lesions clear by themselves; treat the surrounding eczema.

**Procedure**
Physical removal by curettage or cryotherapy with liquid nitrogen; cantharidin applied in the clinic; these can hurt and may scar.

**Medical**
Topical agents such as potassium hydroxide or podophyllotoxin in selected patients; in people with HIV, antiretroviral therapy that restores immunity is the most effective treatment.

**Lifestyle**
Do not scratch or squeeze lesions, cover them, avoid sharing towels, sponges and clothes; avoid shaving affected areas; condom use and abstaining while genital lesions are present.

## Complications

- Spread of lesions through scratching (autoinoculation)
- Molluscum dermatitis around lesions
- Secondary bacterial infection
- Chronic follicular conjunctivitis from eyelid lesions
- Small pitted scars after inflammation or procedures

## Prognosis

In immunocompetent people each lesion lasts weeks to months and the infection usually clears without treatment in 6–12 months, sometimes up to several years. In advanced immunosuppression lesions can be extensive and persistent until immunity improves.

## Prevention

- Avoid touching other people's lesions and sharing towels, sponges or clothing
- Cover lesions during swimming and contact sports
- Hand washing after touching lesions
- Safer sex practices

## Test yourself

Think of the answer, then tap the question to see it.

## Which virus family causes molluscum contagiosum?

Poxvirus (molluscum contagiosum virus).

## What is the typical lesion?

A small, firm, pearly, dome-shaped papule with a central umbilication.

## What do numerous large facial molluscum lesions in an adult suggest?

Immunosuppression, typically advanced HIV infection; HIV testing is indicated.

## What is the histological hallmark?

Large eosinophilic intracytoplasmic inclusion bodies (molluscum or Henderson-Patterson bodies).

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## Related conditions

- [HIV infection and AIDS](https://durgical.com/en/conditions/hiv-infection-and-aids/)
- [Atopic dermatitis](https://durgical.com/en/conditions/atopic-dermatitis/)
- [Viral warts (verruca)](https://durgical.com/en/conditions/viral-warts/)
- [Varicella (chickenpox)](https://durgical.com/en/conditions/varicella/)
- [Genital herpes (herpes simplex infection)](https://durgical.com/en/conditions/genital-herpes/)
- [Conjunctivitis](https://durgical.com/en/conditions/conjunctivitis/)
- [Basal cell carcinoma](https://durgical.com/en/conditions/basal-cell-carcinoma/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Molluscum contagiosum](https://medlineplus.gov/ency/article/000826.htm) (MedlinePlus, US National Library of Medicine, 2026); [About Molluscum Contagiosum](https://www.cdc.gov/molluscum-contagiosum/about/index.html) (Centers for Disease Control and Prevention (CDC), 2026).

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Source: https://durgical.com/en/conditions/molluscum-contagiosum/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/molluscum-contagiosum/