Molluscum contagiosum is a common, self-limited viral infection seen most frequently in children and can occur anywhere on the body; most often on the trunk, face, and extremities. In adults, mollusca are considered sexually transmitted and occur in the genital region or lower abdomen. Infection occurs through direct skin-to-skin contact or indirect contact with fomites. The typical molluscum lesion is a pink to flesh-colored, firm, smooth, dome-shaped papule with central umbilication (Fig. 33-60). A white material
can sometimes be visualized in the umbilication and can be easily expressed. This caseous material is teeming with viral particles. Lesions are usually 2 to 5 mm in diameter and number less than 30, but can number in the hundreds. Particularly in immunocompromised patients, the infection may be much more extensive, may fail to resolve spontaneously, and may be resistant to treatment. Over months to years, lesions of molluscum normally resolve spontaneously.
Some patients or parents desire treatment, and cryotherapy, cantharidin, trichloroacetic acid (TCA), tretinoin (Retin-A), or imiquimod may be effective. Cantharidin is most easily given to young children because its application is painless.
Cryotherapy is another good option, but many young children will not willingly submit to this therapy, which is painful. Often it is best to reassure parents that molluscum is not harmful and will eventually resolve, although with or without treatment, lesions can leave pitted scars.
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