Section 5: Viral Diseases

Molluscum contagiosum This condition is a benign viral infection that appears as crops of discrete, slightly umbilicated, flesh-colored, or shiny papules. It is extremely common among children and may be seen in several children within a family. The lesions may become inflamed if traumatized or infected and sometimes become inflamed spontaneously as they resolve.

The lesions tend to be grouped, and the average size of a lesion is 2 to 3 mm in diameter and height. The trunk, face, genitalia, and intertriginous areas are the most common sites of infection. Pruritus is an occasional symptom and an eczematous eruption may develop in the area of the molluscum.

Molluscum contagiosum This viral infection is self-limited, but treatment is often required because of discomfort or out of concern for appearance. Treatment should be individualized to the age and extent of involvement in each patient.

As the infection is self-limited, observation is an acceptable option. In the cooperative patient, destruction of lesions with curettage or light cryotherapy may be attempted for treatment of limited lesions. Some dermatologists treat this disorder with the office application of topical cantharidin. The child with numerous lesions poses a particular therapeutic challenge.

Molluscum contagiosum Occasionally, a lesion of molluscum contagiosum may grow to as large as 3 cm in diameter. Two photos of such “giant mollusca” are shown in Figs. 5-5 and 5-6. The diagnosis is usually suggested by the presence of more typical, smaller lesions on adjacent or distant skin surfaces. Note the presence of a central umbilication in Fig. 5-5. Treatment is by surgical removal when possible.

Molluscum contagiosum When molluscum contagiosum appear in the groin or especially the intergluteal cleft area, they may be misdiagnosed as warts. Molluscum in the intergluteal cleft area may appear like “fleshy” skin tags, and upon close examination that can be aided by magnification, a central umbilication can be seen. If the diagnosis is in question, a biopsy would yield the diagnosis.

Some patients with molluscum contagiosum will develop scarring from this viral infection. Large and even small molluscum may scar even without any treatment. Figure 5-8 shows a patient who developed scarring without any treatment given for the molluscum.