Molluscum Contagiosum: Causes, Symptoms, and Treatment

Molluscum contagiosum (water warts) are benign skin growths caused by the molluscum contagiosum virus (MCV) from the poxvirus family. Despite the name, they are not true warts (which are caused by HPV). Typical are small, 2–5 mm, pearly nodules with a characteristic central dimple (umbilication). Molluscum contagiosum primarily affects children between 2 and 12 years but can occur at any age — in adults, they are frequently sexually transmitted.

The virus is transmitted through direct skin contact or via contaminated objects (towels, toys, swimming pool items). In children, infection often occurs during play, in swimming pools, or when sharing objects. Auto-inoculation — spreading to other body sites through scratching — is common.

In adults, sexual transmission is a prevalent route. Atopic dermatitis (eczema) is a significant risk factor, as the impaired skin barrier gives the virus easy access.!!

Molluscum contagiosum appear as round, smooth, pearly or skin-colored papules with a characteristic central indentation (umbilication). When compressed, a whitish, cheesy mass emerges — the so-called molluscum body, which contains massive amounts of virus particles. Size ranges from 1–5 mm, rarely up to 1–2 cm (giant molluscum in immunodeficiency).

Favored sites in children are the trunk, extremities, axillae, and face. In adults with sexual transmission, lesions are found in the genital and inguinal region.

Diagnosis is clinical, based on the typical appearance — pearly papules with central dimple. Dermoscopy shows a typical pattern with central pore or polychromatic amorphous structure surrounded by radial vessels (crown sign). Differential diagnoses include common warts, milia, corns, histoplasmosis, and in immunosuppressed patients cryptococcosis. Biopsy is rarely needed but can help with atypical presentations.

Since molluscum contagiosum are self-limiting, watchful waiting is acceptable in uncomplicated cases in children. Active treatment is recommended for: spreading, itching, cosmetic distress, sexual transmission in adults, or immunodeficiency. Options include: curettage (scraping out nodules — fast but may require topical anesthesia in children), cryotherapy, potassium hydroxide solution (KOH 5–10% topical), cantharidin (blister beetle extract, available in some countries), and topical immunomodulators such as imiquimod.

Untreated, molluscum contagiosum resolve in immunocompetent individuals within 6–18 months (sometimes up to 4 years). Before disappearing, lesions may become inflamed — a sign of activated immune response (BOTE reaction: Beginning Of The End).!! Prevention: avoid direct skin contact with lesions, don't share towels and swimming gear, cover lesions and don't scratch. Children with molluscum should not be excluded from swimming, but lesions should be covered.

Parents often notice small bumps on their child's skin and aren't sure what they are — molluscum, warts, milia, or something else. Skinscanner analyzes the shape, surface characteristics, and the telltale central dimple to help identify whether the bumps are consistent with molluscum contagiosum. This initial assessment can reduce parental anxiety and help you decide whether watchful waiting is appropriate or whether treatment should be pursued.

Regular photo tracking is valuable for monitoring the spread of lesions, documenting new ones, and detecting the inflammation phase (BOTE reaction) that signals the immune system is clearing the virus. For adults with genital molluscum, the app can help with initial identification before seeking medical confirmation. Skinscanner does not replace clinical diagnosis, but it provides accessible guidance for a common childhood condition that often causes more worry than it warrants.