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An 8-year-old girl is brought to the office because of an outbreak of bumps on her face for the past 3 months (Figure 130-1). Occasionally she scratches them, but she is otherwise asymptomatic. The mother and child are unhappy with the appearance of the molluscum contagiosum and chose to try topical imiquimod 5% cream. Fortunately, her health insurance covered this expensive treatment. A topical treatment was chosen to avoid the risk of hypopigmentation that can occur in dark-skinned individuals with cryotherapy.

Figure 130-1

Molluscum contagiosum on the face of an 8-year-old girl. (Courtesy of Richard P. Usatine, MD.)

An 11-year-old girl was also seen with molluscum on her face. The child and her mother decided to try cryotherapy as her treatment. She very bravely tolerated the treatment with liquid nitrogen in a Cryogun (Figure 130-2). The molluscum disappeared without scarring or hypopigmentation after two treatments.

Figure 130-2

Cryotherapy of molluscum on the face of an 11-year-old girl. The central umbilication is easily seen in the two papules that were just frozen. (Courtesy of Richard P. Usatine, MD.)

Molluscum contagiosum is a viral skin infection that produces pearly papules that often have a central umbilication. It is seen most commonly in children, but can also be transmitted sexually among adults.

  • Molluscum contagiosum infection has been reported worldwide. An Australian seroepidemiology study found a seropositivity rate of 23%.1
  • Up to 5% of children in the United States have clinical evidence of molluscum contagiosum infection.2 It is a common, nonsexually transmitted condition in children (Figures 130-1, 130-2, 130-3, 130-4).
  • The number of cases in U.S. adults increased in the 1980s, probably as a result of the HIV/AIDS epidemic. Since the introduction of highly active antiretroviral therapy (HAART), the number of molluscum contagiosum cases in HIV/AIDS patients has decreased substantially.3 However, the prevalence of molluscum contagiosum in patients who are HIV-positive may still be as high as 5% to 18% (Figures 130-5 and 130-6).4,5
  • In adults, molluscum occurs most commonly in the genital region (Figure 130-7). In this case, it is considered a sexually transmitted disease. Subclinical cases may occur and may be more common in the general community than is generally recognized.

Figure 130-3

A group of molluscum contagiosum lesions on the abdomen of a 4-year-old boy. (Courtesy of Richard P. Usatine, MD.)

Figure 130-4

Molluscum contagiosum under the eye of a young girl with central umbilication. (Courtesy of Richard P. Usatine, MD.)

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