Molluscum contagiosum is an infection caused by a poxvirus (molluscum contagiosum virus). The result of the infection is usually a benign, mild skin disease characterized by lesions (growths) that may appear anywhere on the body. Within 6-12 months, Molluscum contagiosum typically resolves without scarring but may take as long as 4 years.

The lesions, known as Mollusca, are small, raised, and usually white, pink, or flesh-colored with a dimple or pit in the center. They often have a pearly appearance. They’re usually smooth and firm. In most people, the lesions range from about the size of a pinhead to as large as a pencil eraser (2 to 5 millimeters in diameter). They may become itchy, sore, red, and/or swollen.

Mollusca may occur anywhere on the body including the face, neck, arms, legs, abdomen, and genital area, alone or in groups. The lesions are rarely found on the palms of the hands or the soles of the feet.

Transmission
The virus that causes molluscum spreads from direct person-to-person physical contact and through contaminated fomites. Fomites are inanimate objects that can become contaminated with virus; in the instance of molluscum contagiosum this can include linens such as clothing and towels, bathing sponges, pool equipment, and toys. Although the virus might be spread by sharing swimming pools, baths, saunas, or other wet and warm environments, this has not been proven. Researchers who have investigated this idea think it is more likely the virus is spread by sharing towels and other items around a pool or sauna than through water.

Someone with molluscum can spread it to other parts of their body by touching or scratching a lesion and then touching their body somewhere else. This is called autoinoculation. Shaving and electrolysis can also spread mollusca to other parts of the body.

Molluscum can spread from one person to another by sexual contact. Many, but not all, cases of molluscum in adults are caused by sexual contact.

Conflicting reports make it unclear whether the disease may be spread by simple contact with seemingly intact lesions or if the breaking of a lesion and the subsequent transferring of core material is necessary to spread the virus.

The molluscum contagiosum virus remains in the top layer of skin (epidermis) and does not circulate throughout the body; therefore, it cannot spread through coughing or sneezing.

Since the virus lives only in the top layer of skin, once the lesions are gone the virus is gone and you cannot spread it to others. Molluscum contagiosum is not like herpes viruses, which can remain dormant (“sleeping”) in your body for long periods and then reappear.

Who is at risk for infection?
Molluscum contagiosum is common enough that you should not be surprised if you see someone with it or if someone in your family becomes infected. Although not limited to children, it is most common in children 1 to 10 years of age.

People at increased risk for getting the disease include:

  • People with weakened immune systems (i.e., HIV-infected persons or persons being treated for cancer) are at higher risk for getting molluscum contagiosum. Their growths may look different, be larger, and be more difficult to treat.
  • Atopic dermatitis may also be a risk factor for getting molluscum contagiosum due to frequent breaks in the skin. People with this condition also may be more likely to spread molluscum contagiousm to other parts of their body for the same reason.
  • People who live in warm, humid climates where living conditions are crowded.

In addition, there is evidence that molluscum infections have been on the rise in the United States since 1966, but these infections are not routinely monitored because they are seldom serious and routinely disappear without treatment.

What are the treatment options?
Because molluscum contagiosum is self-limited in healthy individuals, treatment may be unnecessary. Nonetheless, issues such as lesion visibility, underlying atopic disease, and the desire to prevent transmission may prompt therapy.

Treatment for molluscum is usually recommended if lesions are in the genital area (on or near the penis, vulva, vagina, or anus). If lesions are found in this area it is a good idea to visit your healthcare provider as there is a possibility that you may have another disease spread by sexual contact.

Be aware that some treatments available through the internet may not be effective and may even be harmful.

Physical removal
Physical removal of lesions may include cryotherapy (freezing the lesion with liquid nitrogen), curettage (the piercing of the core and scraping of caseous or cheesy material), and laser therapy. 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.

It is not a good idea to try and remove lesions or the fluid inside of lesions yourself. By removing lesions or lesion fluid by yourself you may unintentionally autoinoculate other parts of the body or risk spreading it to others. By scratching or scraping the skin you could cause a bacterial infection.

Oral therapy
Gradual removal of lesions may be achieved by oral therapy. This technique is often desirable for pediatric patients because it is generally less painful and may be performed by parents at home in a less threatening environment. Oral cimetidine has been used as an alternative treatment for small children who are either afraid of the pain associated with cryotherapy, curettage, and laser therapy or because the possibility of scarring is to be avoided. While cimetidine is safe, painless, and well tolerated, facial mollusca do not respond as well as lesions elsewhere on the body.

Topical therapy
Podophyllotoxin cream (0.5%) is reliable as a home therapy for men but is not recommended for pregnant women because of presumed toxicity to the fetus. Each lesion must be treated individually as the therapeutic effect is localized. Other options for topical therapy include iodine and salicylic acid, potassium hydroxide, tretinoin, cantharidin (a blistering agent usually applied in an office setting), and imiquimod (T cell modifier). These treatments must be prescribed by a healthcare professional.

Therapy for immunocompromised persons
Most therapies are effective in immunocompetent patients; however, patients with HIV/AIDS or other immunosuppressing conditions often do not respond to traditional treatments. In addition, these treatments are largely ineffective in achieving long-term control in HIV patients.

Low CD4 cell counts have been linked to widespread facial mollusca and therefore have become a marker for severe HIV disease. Thus far, therapies targeted at boosting the immune system have proven the most effective therapy for molluscum contagiosum in immunocompromised persons. In extreme cases, intralesional interferon has been used to treat facial lesions in these patients. However, the severe and unpleasant side effects of interferon, such as influenza-like symptoms, site tenderness, depression, and lethargy, make it a less-than-desirable treatment. Furthermore, interferon therapy proved most effective in otherwise healthy persons. Radiation therapy is also of little benefit.

How can I keep it from spreading?
The best way to avoid getting molluscum is by following good hygiene habits. Remember that the virus lives only in the skin and once the lesions are gone, the virus is gone and you cannot spread the virus to others.

Wash your hands
There are ways to prevent the spread of molluscum contagiosum. The best way is to follow good hygiene (cleanliness) habits. Keeping your hands clean is the best way to avoid molluscum infection, as well as many other infections. Hand washing removes germs that may have been picked up from other people or from surfaces that have germs on them.

Don’t scratch or pick at molluscum lesions
It is important not to touch, pick, or scratch skin that has lesions, that includes not only your own skin but anyone else’s. Picking and scratching can spread the virus to other parts of the body and makes it easier to spread the disease to other people too.

Keep molluscum lesions covered
It is important to keep the area with molluscum lesions clean and covered with clothing or a bandage so that others do not touch the lesions and become infected. Do remember to keep the affected skin clean and dry.

Any time there is no risk of others coming into contact with your skin, such as at night when you sleep, uncover the lesions to help keep your skin healthy.

Be careful during sports activities
Do not share towels, clothing, or other personal items.

People with molluscum should not take part in contact sports like wrestling, basketball, and football unless all lesions can be covered by clothing or bandages.

Activities that use shared gear like helmets, baseball gloves and balls should also be avoided unless all lesions can be covered.

Swimming should also be avoided unless all lesions can be covered by watertight bandages. Personal items such as towels, goggles, and swimsuits should not be shared. Other items and equipment such as kick boards and water toys should be used only when all lesions are covered by clothing or watertight bandages.

Other ways to avoid sharing your infection
Do not shave or have electrolysis on areas with lesions.

Don’t share personal items such as unwashed clothes, hair brushes, wrist watches, and bar soap with others.

If you have lesions on or near the penis, vulva, vagina, or anus, avoid sexual activities until you see a healthcare provider.

What are the long-term effects?
Recovery from one molluscum infection does not prevent future infections. Molluscum contagiosum is not like herpes viruses which can remain dormant (“sleeping”) in your body for long periods of time and then reappear. If you get new molluscum contagiosum lesions after you are cured, it means you have come in contact with an infected person or object again.

Complications
The lesions caused by molluscum are usually benign and resolve without scarring. However scratching at the lesion, or using scraping and scooping to remove the lesion, can cause scarring. For this reason, physically removing the lesion is not often recommended in otherwise healthy individuals.

The most common complication is a secondary infection caused by bacteria. Secondary infections may be a significant problem in immunocompromised patients, such as those with HIV/AIDS or those taking immunosuppressing drug therapies. In these cases, treatment to prevent further spread of the infection is recommended.