Molluscum Contagiosum

The lesion that you are looking at in the lead picture is called molluscum contagiosum.  These funky looking little guys are a specific kind of wart caused by a skin infection from a variety of viruses in the pox family.  They are exceedingly common and in almost all instances are exceedingly unserious.  All age groups can be affected but they do seem to have a predilection for children aged 1-5 ( under age one seem to be protected by maternal immunity).

They can occur anywhere on the body; thankfully in my experience facial lesions are relatively rare.  They do pop up more in dry, irritated areas so people with conditions like eczema are at greater risk.  Usually a person will develop a few lesions although it is not rare for a crop of many to erupt on contiguous skin as a person can self inoculate via scratching.  Molluscum don’t erupt suddenly like a mosquito bite but rather grow over a period of days or weeks and spread more slowly–if at all–over a few months.  They are usually no bigger than 2-4 mm, pearly white to pinkish-red and the hallmark of molluscum is they are “umbilicated”–the center is depressed giving the appearance of mini-volcanoes.  They are filled with a hard whitish material if broken open but don’t worry: they don’t “erupt” like volcanoes, don’t drain or weep fluid.

As their name implies, they are contagious by direct person to person contact.  But given their typically extremely benign nature there is little that must be done other than keeping lesions covered where possible, careful hand washing, keeping surfaces cleaned, and avoid the sharing of clothing, towels, etc.

As I’ve stated, in most instances this is a very mild condition and the warts will typically resolve (“involute”) spontaneously in 18-24 months on their own without any treatment.  It is not rare for them to sometimes last for 5 years, however.  The skin usually heals completely leaving no mark or scar.  As such, I generally try and reassure parents and follow a course of watchful waiting only.  If necessary, scraping, burning, or freezing will remove them but these procedures can leave scars.  I usually reserve removing them to  warts located on the face and given the scar potential in their removal I prefer that these procedures be performed by dermatologists or plastic surgeons–specialists trained to minimize scars. A variety of “off label” oral treatments  have been tried over the years to make them melt away but to date none of those approaches has ever been shown to be more effective than placebo so I never recommend them.white molluscum

red molluscum

Please send along questions or comments and thanks for following.


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