Molluscum Contagiosum

Patients might report small, painless, dome-shaped lesions that appear over weeks, with potential itching or irritation. These bumps often spread through close contact, especially in children or sexually active adults. Patients might note recent exposure in communal settings or intimate encounters. Risk factors include immunosuppression, close contact sports, and environments with high transmission potential. 

Examine for small, round, flesh-colored or white lesions with a characteristic central dimple (umbilicated center). Lesions are typically 2–5 mm in diameter and may appear as groups or isolated spots on the face, trunk, limbs, or genital area. In Black skin, the lesions may present as hyperpigmented or hypopigmented nodules. 

While molluscum contagiosum is self-limiting and may resolve within 6–12 months, treatments can aid in symptom management and reduce transmission risk:

1. Topical Therapies:

   • Cantharidin (0.7% solution) can be applied to lesions in the clinic, causing blistering and destruction of lesions. Treatment is applied every 3–4 weeks until lesions resolve.

   • Tretinoin cream (0.025% or 0.05%), applied at night, may help but may cause irritation, especially on sensitive skin.

2. Cryotherapy: Liquid nitrogen application every 2–3 weeks can effectively freeze and destroy lesions. This may require multiple sessions and can occasionally cause hypopigmentation in darker skin tones.

3. Oral Medications:

   • Cimetidine (20–40 mg/kg per day), although used off-label, has shown promise, especially for children with widespread lesions.

4. Laser Therapy: Pulse dye laser treatments are available but often reserved for resistant or cosmetically concerning cases.

5. Prevention: Advise on avoiding skin-to-skin contact in affected areas to limit spread, especially in communal environments.

Risk Factors, Prognosis, and Complications

Prognosis is favorable, with most cases resolving within a year. Complications include secondary bacterial infections or post-inflammatory hyperpigmentation, especially in Black patients following lesion resolution or inflammation.