GPAtlas🧭 When to suspect
Molluscum contagiosum is a common, benign, self-limiting viral skin infection caused by the molluscum contagiosum virus (MCV), a poxvirus of the Molluscipox genus. It mainly affects young children under 10 (rarely under one year), with a smaller second peak in young adults, some of whom acquire it through sexual contact. In immunocompetent hosts it is harmless and clears without treatment, though this typically takes up to 18 months and occasionally longer.
Suspect it on the characteristic lesion: discrete, firm, dome-shaped pearly or flesh-coloured papules, 2–6 mm, with a tell-tale central umbilication (dimple) from which a white core can be expressed. There may be a handful or several hundred. They cluster in warm, moist sites – trunk, axillae, antecubital and popliteal fossae, and the groin – but characteristically spare the palms and soles. Spread is by skin-to-skin contact, fomites (shared towels, sponges, baths) and autoinoculation, which classically produces a linear row of papules. Lesions are more numerous and more persistent in atopic eczema and in immunocompromise.
The clinical skills are to diagnose confidently on sight, reassure and resist over-treatment, and recognise the few situations that change management: eyelid-margin disease, marked immunocompromise, a safeguarding-aware assessment of anogenital lesions in a child, and an adult with anogenital lesions who needs a sexual health screen.
| Looks like molluscum, but consider… | Distinguishing feature |
|---|---|
| Common wart / verruca | Rough, keratotic surface; no central umbilication and no expressible core. |
| Milia | Tiny (1–2 mm) white keratin cysts; no umbilication and no inflammatory phase. |
| Basal cell carcinoma (adults) | A solitary, slowly enlarging pearly papule with telangiectasia – never label a single new lesion on sun-exposed adult skin as molluscum. |
| Disseminated fungal infection | In marked immunocompromise, umbilicated papules (often facial) may be cryptococcosis or histoplasmosis – biopsy if atypical. |
Source: DermNet
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