- Medical Dermatology
Molluscum Contagiosum
Board-certified in both dermatology and pediatrics, Dr. Craig Singer evaluates and treats molluscum contagiosum at his Bingham Farms practice.
Quick facts
No
On its own (months to years)
What is Molluscum Contagiosum?
MC typically presents as flesh-colored to slightly pink, 1–5mm bumps with umbilication (a central depression). Lesions occur most often in moist areas of friction such as the armpits, groin, elbows, behind the knees, and the sides of the abdomen. They may also appear on the genital region, face and eyelids. They often occur in groups, clusters, or a line (from scratching). Reassuringly, the MC virus never spreads inside the body.
What does molluscum contagiosum look like?
Molluscum shows up as small, smooth, dome-shaped bumps, usually flesh-colored to pink and 1 to 5 mm across. Each often has a tiny central dimple (umbilication). They tend to appear in clusters, commonly on the trunk, armpits, behind the knees, and on the face, and can spread in a line where the skin has been scratched. Some develop surrounding eczema, called molluscum dermatitis.
Clinical photos are blurred. Hover over an image to view it (or tap on mobile).
Umbilicated papules on a child's neck
Molluscum dermatitis (with eczema)
Frequently asked questions
How to get rid of molluscum, whether heat helps, what it means when bumps turn red, whether it is dangerous, and the in-office and at-home treatment options.
How do you get rid of molluscum contagiosum?
There are several effective options. In the office, Dr. Singer uses cantharidin (a painless blister-beetle extract and preferred first-line agent), liquid nitrogen (freezing), curettage, Candida antigen immunotherapy, and trichloroacetic acid (TCA) for facial lesions. At-home options that have been studied include salicylic acid, retinoids, and Imiquimod, though most cause local irritation. In a healthy child with no symptoms, it is also reasonable to wait for the infection to clear on its own.
Does a heating pad or heat help molluscum?
Possibly. A small study found about a 50% response rate after exposure to infrared heat (44 degrees Celsius) for 30 minutes once weekly for up to 12 weeks, and a heating pad may create similar conditions.
What does it mean when molluscum turns red?
When molluscum bumps turn red, it is usually a good sign that the immune system is starting to recognize and clear the infection. If there is no pain or fever, a secondary bacterial infection is unlikely.
Is Molluscum Contagiosum (MC) dangerous?
No, it is not. MC does not spread inside the body. Molluscum contagiosum infection occurs most commonly in healthy children and having the virus does not mean there is something wrong with your child’s immune system.⁵
What are the symptoms of Molluscum Contagiosum (MC)?
Many lesions of MC have no symptoms and are usually painless. Other times, lesions may be itchy or irritated and may be surrounded by eczema (“molluscum dermatitis”). Scratching causes MC to spread and multiply. When molluscum lesions turn red in color, it’s usually a good sign that the immune system is starting to clear the infection. If there is no pain or fever, secondary bacterial infection is unlikely.⁵
What happens if I choose not to treat molluscum contagiosum?
Most healthy people eventually develop spontaneous immunity against the virus, though it may take months to years to occur. It is impossible to predict how long it will take an individual child (or adult) to develop immunity. If your child has no symptoms, it is reasonable to wait for spontaneous clearance. Since molluscum contagiosum is a “pox” virus, there is a low risk (6–7% chance) of “pock-like” scarring when MC heals.⁶
A recently published study (Olsen JR Lancet 2015) states that:
70% of Molluscum Contagiosum lesions resolve spontaneously within 18 months
30% of cases persist beyond 18 months
13% of cases persist beyond 24 months
Should my child be treated for molluscum contagiosum?
There is no clear-cut answer to this question, but there are certain situations in which treatment is preferred.
First off, if your child has patches of eczema or is itching, it is imperative to control the skin rash, as scratching will cause further spread of the MC bumps.
Some parents choose to treat because the MC bumps are bothering the child, because of cosmetic concerns, and to prevent spread to other family members.
In-office treatments
What is blistering beetle juice? (Cantharadin)
Cantharidin is a chemical agent derived from a blister beetle extract. It is a preferred first-line agent for the treatment of molluscum due to its painless application and high rate of parental satisfaction.⁷ Cantharidin works by inducing a blister, with resolution of the molluscum bump when the blister heals. The process involves in-office application of a tiny amount of beetle juice (using a wooden toothpick) to each individual bump. Care is taken to avoid application to normal surrounding skin. The beetle juice is dried using a fan and postoperative instructions are provided. Parents must observe the sites for the next few hours and thoroughly wash off the beetle juice once blistering develops (usually no more than 4 hours after application). Side effects include blistering (expected), temporary burning and discomfort (approximately 10% incidence), as well as temporary discoloration, especially in darker-pigmented patients. Treatment with cantharidin for MC lesions on the face, diaper area and certain folds of skin is not recommended.
What is freezing? (Liquid Nitrogen)
Liquid nitrogen (cryotherapy) involves the application of a cold substance (cryogen) to the skin, leading to localized blistering and destruction of the molluscum bump. Liquid nitrogen is frequently used in the treatment of warts but is painful to apply, limiting its use in younger children. Typically, children require pretreatment at home with numbing cream (EMLA or LMX-4) for one hour before the appointment. Distraction techniques are often necessary to keep the child calm. Although there is a paucity of scientific studies published on the use of liquid nitrogen, in Dr. Singer’s experience it can be an effective treatment. Side effects include pain, blistering (expected), discoloration (sometimes permanent), and scarring.
What is curettage?
Curettage involves physically removing the core of the molluscum with a metal loop device. Though effective, this can be a painful and scary process for many children. Pretreatment with numbing cream (EMLA or LMX-4) for one hour before the appointment is a must, and distraction techniques are preferable. Some children simply do not tolerate this treatment without sedation. Side effects include pain and bleeding, though infection and scarring are uncommon. Modified techniques have been described to reduce pain.⁸
What is Candida Antigen? (Immunotherapy)
Immunotherapy is a way to train the body’s immune system to fight the molluscum contagiosum virus. In most people it takes months to years to develop an immune response; with immunotherapy, this process is accelerated. A small amount of an antigen (such as Candida antigen) is injected into the skin where the MC resides. This triggers the immune system to attack the MC virus, promoting rapid immunity.
The unique feature about this treatment is that only a small handful of the MC bumps are treated. Once the immune system starts to recognize those few bumps, it also starts to fight the untreated lesions as well. Advantages include lack of scarring, lack of discoloration, probable reduction in recurrence, and no need to treat every single lesion.
In a small study of 29 patients, 55% of children had complete clearance after three sessions of Candida antigen injection, four weeks apart.⁹ Dr. Singer typically uses a tiny 31-gauge needle and pretreats with topical lidocaine. Most children tolerate this treatment very well.
When the molluscum lesions turn red, it means the injections are working and the immune system is attacking the virus!
What is Trichloroacetic Acid (TCA)?
Trichloroacetic acid (TCA) is a safe and effective chemical agent that denatures protein and, at low concentrations, causes injury localized to the epidermis. TCA is not absorbed systemically. It has utility for treatment of molluscum contagiosum lesions on the face. Application produces a mild stinging only and is generally well tolerated by children. Scarring and permanent discoloration are extraordinarily rare.⁴
At-home treatments
A variety of small studies have examined several treatments applied in the home by the patient or parent. These include salicylic acid, lactic acid, hydrogen peroxide, retinoids (e.g. tretinoin), Imiquimod, and others. Some studies have shown good efficacy, however virtually all of these are limited by local reactions including itching, irritation, burning, redness, scabbing and crusting.
Recently, a small Chinese prospective study demonstrated about a 50 percent response rate of molluscum after exposure to infrared-generated heat (44 degrees Celsius) for 30 minutes once weekly, for a maximum of 12 weeks. Use of a heating pad may generate similar conditions (AAD meeting news, August 3, 2017).
Society of Pediatric Dermatology: video on Molluscum Contagiosum and Warts
Sources
- Fam Pract. 2014 Apr;31(2):130-6. Epidemiology of molluscum contagiosum in children: a systematic review. Olsen JR1, Gallacher J, Piguet V, Francis NA.
- J Am Acad Dermatol. 2006 Jan;54(1):47-54. The epidemiology of molluscum contagiosum in children. Dohil MA1, Lin P, Lee J, Lucky AW, Paller AS, Eichenfield LF.
- Pediatr Dermatol. 2005 Jul-Aug;22(4):287-94. Epidemiology and impact of childhood molluscum contagiosum: a case series and critical review of the literature. She Braue A1, Ross G, Varigos G, Kelly H.
- Pediatr Dermatol. 2009 Jul-Aug;26(4):425-6. Treatment of facial molluscum contagiosum with trichloroacetic acid. Pediatr Dermatol. 2009 Jul-Aug;26(4):425-6. Bard S, Shiman MI, Bellman B, Connelly EA.
- Society of pediatric dermatology molluscum contagiosum parent handout.
- Int J Dermatol. 2006 Feb;45(2):93-9. Childhood molluscum contagiosum. Brown J, Janniger CK, Schwartz RA, Silverberg NB.
- J Am Acad Dermatol. 2000 Sep;43(3):503-7. Childhood molluscum contagiosum: experience with cantharidin therapy in 300 patients. Silverberg NB, Sidbury R, Mancini AJ.
- Pediatr Dermatol. 2007 Mar-Apr;24(2):192-4. Modified curettage technique for molluscum contagiosum. Martín-García RF, García ME, Rosado A.
- Pediatr Dermatol. 2011 May-Jun;28 Intralesional immunotherapy with Candida antigen for the treatment of molluscum contagiosum in children. Enns LL1, Evans MS.
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About Dr. Craig Singer MD Dermatology
Located in Bingham Farms, Craig Singer MD Dermatology was founded in 2017 by Dr. Craig Singer, a board-certified dermatologist.
We specialize in medical, surgical and cosmetic dermatology, treating patients of all ages, newborn through elderly. We have expertise in a wide variety of skin conditions including eczema, acne, and warts as well as complicated dermatological issues that include hair loss and autoimmune disease. In addition, we are highly skilled in the evaluation of moles and skin cancer.
For more than 20 years, Dr. Craig Singer has helped thousands of patients look and feel their best.
20+ Years
Trusted by Thousands
Board-Certified
Dermatologist & Pediatrician
