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Molluscum contagiosum, caused by a poxvirus, presents as single or multiple dome-shaped, waxy papules 2–5 mm in diameter that are umbilicated (Figure 6–30) (eFigure 6–68). Lesions at first are firm, solid, and flesh-colored but upon reaching maturity become soft, whitish, or pearly gray and may suppurate. The principal sites of involvement are the face, lower abdomen, and genitals.

Figure 6–30.

Umbilicated—molluscum. (Used, with permission, from Richard P. Usatine, MD, in Usatine RP, Smith MA, Mayeaux EJ Jr, Chumley H. The Color Atlas of Family Medicine, 3rd ed. McGraw-Hill, 2018.)

The lesions are autoinoculable and spread by wet skin-to-skin contact. In sexually active individuals, they may be confined to the penis, pubis, and inner thighs and are considered a sexually transmitted infection.

Molluscum contagiosum is common in patients with AIDS, usually with a helper T-cell count less than 100/mcL. Extensive lesions tend to develop over the face and neck as well as in the genital area.

The diagnosis is easily established in most instances because of the distinctive central umbilication of the dome-shaped lesion. Estimated time to remission is 13 months. The best treatment is by curettage or applications of liquid nitrogen as for warts—but more briefly. When lesions are frozen, the central umbilication often becomes more apparent. Light electrosurgery with a fine needle is also effective. Cantharadin (applied in the office and then washed off by the patient 4 hours later) is a safe and effective option. Ten percent potassium hydroxide solution applied twice daily until lesions clear is another treatment option. Salicylic acid, podophyllotoxin, tretinoin, imiquimod, and pulsed dye laser are additional treatment options. Lesions are difficult to eradicate in patients with AIDS unless immunity improves; however, with highly effective antiretroviral treatment, molluscum will usually spontaneously clear.

Forbat  E  et al. Molluscum contagiosum: review and update on management. Pediatr Dermatol. 2017 Sep;34(5):504–15.
[PubMed: 28884917]
Handjani  F  et al. Comparison of 10% potassium hydroxide solution versus cryotherapy in the treatment of molluscum contagiosum: an open randomized clinical trial. J Dermatolog Treat. 2014 Jun;25(3):249–50.
[PubMed: 23924070]
Martin  P. Interventions for molluscum contagiosum in people infected with human immunodeficiency virus: a systematic review. Int J Dermatol. 2016 Sep;55(9):956–66.
[PubMed: 26991246]
Vakharia  PP  et al. Efficacy and safety of topical cantharidin treatment for molluscum contagiosum and warts: a systematic review. Am J Clin Dermatol. 2018 Dec;19(6):791–803.
[PubMed: 30097988]
van der Wouden  JC  et al. Interventions for cutaneous molluscum contagiosum. Cochrane Database Syst Rev. 2017 May 17;5:CD004767.
[PubMed: 28513067]

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