Molluscum contagiosum

Bateman, 1817

Dell warts.

A self-limiting, very common disease caused by the epidermotropic, highly contagious poxvirus, which occurs mainly in children, atopics and immunodeficiencies.

Occurring mainly between 3-10 years of age.

• Incubation period: 2-7 weeks, occasionally up to 6 months
• Transmission occurs via skin contact or dusts. The possibility of autoinculation has also been described

Whitish, centrally dented, broad-based papules. The content of the papules is highly contagious.

Clinic, biopsy if necessary.

Basophilic virus-infected epidermal cells (molluscum corpuscles), epithelial hyperplasia.

• High spontaneous healing rates.
• Stop scratching! If necessary, put on gloves when sleeping
• If there are only a few molluscs, a wait-and-see attitude is possible

• Curettage, prior application of lidocaine/prilocaine patch
• Cryotherapy (CAVE: hypopigmentation), prior local anaesthesia with lidocaine/prilocaine patch

Tretinoin (cream 0.05% or lotion 0.05% 1-2x daily)

• off-label use
• Application 1-2x daily, if necessary 1x daily or every 2nd day for sensitive skin. Application should be carried out for at least 6-14 weeks
• KI: acute dermatitis, rosacea, pregnancy, lactation

Podophyllin/podophyllotoxin

• Apply 2 times daily for 3 consecutive days. Repeat if necessary
• off-label use:
  • Apply 2x daily for 3 consecutive days, protecting surrounding skin. Repeat if necessary
• KI: < 12y., open wounds, women of childbearing age, contraception recommended until 30 days after therapy, pregnancy, lactation

Immune modulators

• Imiquimod
• Application: 5x weekly for several weeks, max. 16 weeks
• off-label use
• Necessary before ablation of the wart surface
• NWW: redness, itching, burning, erosion of the skin. Patients must be informed about this before the start of therapy!

Apply KOH solution 2 x daily to molluscs

• Available in Germany. Order via international pharmacy
• KI: < 2y., in case of immunosuppression, No occult application or application to mucous membranes as well as to open wounds.keratoses incl. corns, verrucae vulgares and tendency to scar atrophy/keloids. Exacerbated neurodermatitis.
• NW (strongly corrosive): redness, itching, revers. Hypo- or hyperpigmentation, rarely scarring

1. Au WY, Lie AKW, Shek TW. Fulminant molluscum contagiosum infection and concomitant leukaemia cutis after bone marrow transplantation for chronic myeloid leukaemia. British Journal of Dermatology 2000;143:1097-8. 
2.  Gottlieb SL, Myskowski PL. MOLLUSCUM CONTAGIOSUM. International Journal of Dermatology 1994;33:453-61. 
3.  Hanna D, Hatami A, Powell J, et al. A Prospective Randomized Trial Comparing the Efficacy and Adverse Effects of Four Recognized Treatments of Molluscum Contagiosum in Children. Pediatric Dermatology 2006;23:574-9. 
4.  Hengge UR, Cusini M. Topical immunomodulators for the treatment of external genital warts, cutaneous warts and molluscum contagiosum. Br J Dermatol 2003;149:15-9. 
5.  Hengge UR, Esser S, Schultewolter T, et al. Self-administered topical 5% imiquimod for the treatment of common warts and molluscum contagiosum. British Journal of Dermatology 2000;143:1026-31. 
6.  Skinner RB, Ray S, Talanin NY. Treatment of Molluscum Contagiosum with Topical 5% Imiquimod Cream. Pediatric Dermatology 2000;17:420-. 
7.  Smith KJ, Col, Usa MC, et al. Molluscum contagiosum: its clinical, histopathologic, and immunohistochemical spectrum. International Journal of Dermatology 1999;38:664-72. 
8.  Smith WA, Siegel D, Lyon VB, Holland KE. Psoriasiform eruption and oral ulcerations as adverse effects of topical 5% imiquimod treatment in children: a report of four cases. Pediatr Dermatol 2013;30:e157-60. 
9.  van der Wouden JC, van der Sande R, van Suijlekom-Smit LWA, Berger M, Butler CC, Koning S. Interventions for cutaneous molluscum contagiosum.  Protocols: Wiley-Blackwell; 2009.