Multiple, scattered, flesh-colored papules in a child.

MOLLUSCUM CONTAGIOSUM

Molluscum contagiosum (MC) is a common viral infection of the skin. Small, delled, flesh-colored bumps in children and immunocompromised individuals, e.g., HIV, are characteristic. MC may be transmitted sexually in adults.

• The molluscum contagiosum virus is a double-stranded DNA poxvirus.
• It tends to affect children 2-6 years of age.
• Infants do not get it probably from maternal immunity.
• It is associated with swimming pools and eczema. Prolonged water immersion seems to help spread the virus (autoinnoculation).
  
• Patients with atopic dermatitis may not be more likely to get MC but they may have it longer.
• Untreated, the average duration is around 1-1.5 years, but can last 3-5 years.
  
• About half of kids with molluscum live in households that support co-bathing.
• Most adults probably have been exposed and have immunity but they may also be affected.
• If a child has had MC for 2-3 years and is particularly severe, consider an immunodeficiency, e.g. Dock8.
• If the child's parents call and say s/he has developed "hundreds of new molluscum lesions," consider Gianotti-Crosti syndrome-like reaction to molluscum.
• “There is a phenomenon called “beginning of the end” (BOTE) sign, which refers to clinical erythema and swelling of an MC skin lesion when the regression phase begins.
• It is estimated that the prevalence of MC in HIV patients is close to 20%.
• Studies have found an increased risk of MC in patients with atopic dermatitis, with prevalence rates of AD patients with MC of up to 62%.
• A tendency for cutaneous infections, such as molluscum, is a minor criterion for the diagnosis of atopic dermatitis.

Molluscum appears as multiple flesh-colored to pink papules. A white area or dell in the center is classic. There may be only a few or over 50. They may be grouped or scattered. Often, the surrounding skin is irritated and red. Molluscum does not affect palms and soles, and involvement of oral mucosa is rare.

Inflammatory Reactions to Molluscum

• Eczema
• "Infected Lesions" (not really infected--just appear that way)
• Gianotti-Crosti syndrome
• Unilateral Laterothoracic Exanthem
• Cellulitis (rarely, molluscum lesions may become secondarily infected with a cellulitis.)

Atopic Dermatitis and Molluscum

The prevalence of molluscum is higher in patients with atopic dermatitis. Molluscum can actually cause a dermatitis in itself. “Patients may develop eczematous plaques around one or more lesions, a phenomenon known as ‘molluscum dermatitis,’ which is more frequent in patients with atopic dermatitis.” It is estimated that 9-47% of patients with molluscum develop molluscum dermatitis.

BOTE sign. The BOTE sign (beginning of the end) refers to clinical erythema and swelling of an MC skin lesion when the regression phase begins.

Multiple delled papules in the groin of a sexually active adult is one typical presentation.

Multiple grouped papules in a young child is the other typical presentation.

This solitary red papule in a child was thought to be a Spitz Nevus and was surgically removed. (Molluscum on histology).

Giant Molluscum in HIV\

The classic dell.

RegionalDerm

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