Molluscum Contagiosum

NICE CKS Molluscum contagiosum. Last revised: Mar 2022. BASHH Molluscum Contagiosum 2021. Last updated: Mar 2022.

Background Information

Viral skin infection caused by molluscum contagiosum virus (family of poxviruses - Poxviridae)

  • Warm climates
  • Swimming
  • Close contact with an infected person
  • Atopic dermatitis
  • Immunocompromise (e.g. HIV, solid organ transplants, ummunosuppressive therapy)

Features of the lesions:
  • Smooth-surfaced firm dome-shaped papules with a central umbilication
  • Flesh coloured or pearly white
  • Usually 1-30 lesions at a time as clusters
  • Location
    • Can affect almost any part of the body, apart from the soles and palmsoral mucosa
    • Children: more common on trunk and flexures
    • Adults: sexual contact may lead to anogenital lesions

Symptoms:
  • Often asymptomatic
  • Pruritus, erythema possible
  • Koebner phenomenon: new skin lesions appearing at site of a skin injury (e.g. scratch or a cut)

Guidelines

Clinical diagnosis based on clinical features (see above).

  • HIV with extensive lesions → refer to HIV specialist
  • Eyelid / ocular lesions + red eye → refer to opthalmology
  • Anogenital lesions → refer to genito-urinary medicine for STI screening

1st line: expectant management 
  • Reassure molluscum contagiosum is a self-limiting condition
  • Tends to spontaneously resolve within 18 months
  • Advise NOT to scratch of squeeze the lesions
  • Explain that the lesions are contagious, avoid sharing towels / clothing / bedding until lesions resolve

Other treatment options (no strong evidence)
  • Cryothreapy (liquid nitrogen)
  • Podophyllotoxin 0.5%
  • Imiquimod 5% cream

 

Bursting or squeezing molluscum lesions were previously practiced but no longer recommended due to risk of viral spread, superinfection, and scarring

References

Author: Adams Lau
Reviewer: 
Last edited: 14/07/25