Comprehensive Management of Molluscum Contagiosum: Assessment of Clinical Associations, Comorbidities, and Management Principles

Abstract

Despite its high global prevalence, molluscum contagiosum (MC) is not well understood outside of dermatology. Due to the potential self-limiting nature of MC, a common clinical approach in management is to wait for the papules to resolve spontaneously over several weeks to months, without medical intervention. However, this "watch and wait" approach increases risk of spreading the virus to others, extending the duration of the infection, and emergence of several psychosocial issues (e.g., anxiety, embarrassment, isolation). Molluscum contagiosum can be particularly challenging to treat in immunocompromised patients (e.g., human immunodeficiency virus [HIV], organ transplant recipients). This article reviews diagnostic characteristics and treatment options for MC, as well as associated risk factors and comorbidities. Treatment of immunocompromised individuals, in whom the risks of diffuse MC with persistence and spread are relatively high, is emphasized. The authors highlight the importance of actively treating the MC papules, as opposed to letting the virus "run its course" with no active intervention, with the goals of reducing the risk of spreading infection to others, shortening the duration of infection, and decreasing adverse psychosocial sequelae commonly associated with MC.

FIGURE 1.

Typical presentation of multiple molluscum contagiosum papules: 2– 5mm, dome-shaped, pink- or skin-colored, discrete, shiny papules, pictured here on Caucasian skin. (Photograph courtesy of Adelaide Hebert, MD)

FIGURES 2A AND 2B.

Signs of the “beginning of the end” or BOTE in molluscum contagiosum (MC)—Individual lesions become erythematous and swollen due to the inherent host immune response mounted to induce spontaneous resolution. Note that some MC papules can show signs of BOTE while others remain unaffected. (Photographs courtesy of Adelaide Hebert, MD)

FIGURES 3.

Molluscum dermatitis in a child involving the right axilla and adjacent upper arm and lateral chest—Note that this eruption occurs in association with molluscum contagiosum papules involving the same anatomic region. (Photograph courtesy of Adelaide Hebert, MD)

FIGURES 4.

An adolescent patient with a concurrent flare of atopic dermatitis, molluscum contagiosum papules, and secondary impetiginization, an infection that developed after vigorous scratching and excoriation due to severe pruritus (Photograph courtesy of Adelaide Hebert, MD)

FIGURES 5.

Cycle of adverse consequences related to untreated molluscum contagiosum, especially visible lesions, in children