Snapshot A 30-year-old man presents to his primary care clinic for a new rash. He reports that the rash appeared about a week ago and is easily irritated. His history includes multiple sexually transmitted infections, intravenous drug use, and past incarcerations. On physical exam, he has dozens of 5-15 mm pink or flesh-colored papules and plaques with central umbilication. Some are erythematous, as if someone had scratched or rubbed at the lesions. He is immediately sent to the laboratory for further workup for causes of immunosuppression. Introduction Clinical definition painless and umbilicated cutaneous lesions caused by the molluscum contagiosum virus Associated conditions if patient has genital molluscum may be associated with other sexually transmitted infections in adult may be an indicator of HIV Epidemiology Incidence up to 30% in patients with HIV Demographics school-aged children most common transmitted via physical contact with other children adolescents and young adults transmitted via sexual contact and can present as genital lesions immunocompromised individuals transmitted via physical or sexual contact Risk factors atopic dermatitis immunocompromise Etiology Pathogenesis the molluscum contagiosum virus is transmitted via autoinoculation physical and sexual contact from an infected person after the virus invades epidermal cells, it proliferates and creates lobulated epidermal growths Molluscum contagiosum virus an enveloped DNA poxvirus Presentation Symptoms primary symptoms usually asymptomatic may have pruritus and/or tenderness Physical exam immunocompetent patients single or grouped lesions .1-1 cm papules with central umbilication login to view 2 more bullets location login to view 5 more bullets immunocompromised patients > 30 lesions > 1 cm lesions lesions on the eyelid Studies Dermatoscope exam central umbilication Biopsy indications confirmation of diagnosis if clinical diagnosis is uncertain Histology central umbilication molluscum bodies Henderson-Patterson bodies large cells with granular eosinophilic cytoplasm, containing accumulated virions Making the diagnosis a clinical diagnosis Differential Chicken pox Verruca vulgaris Milia Treatment Management approach treatment is usually not necessary as lesions resolve within 6-9 months multiple first-line therapies are available and chosen based on shared-decision making by the physician and the patient or the patient's family Medical cryotherapy indications login to view 2 more bullets topical podophyllotoxin 0.5% cream indication login to view 1 more bullet imiquimod indication login to view 1 more bullet cantharidin indication login to view 2 more bullets Procedural curretage indication login to view 3 more bullets Complications Secondary bacterial infection Prognosis Lesions resolve spontaneously within 9 months No scarring