Molluscum contagiosum

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Molluscum Contagiosum

Overview - Molluscum contagiosum

Molluscum contagiosum (MC) is a viral infection that affects the skin. Around 9 out of 10 cases happen in children although it can occur at any age.

MC is generally a harmless condition that normally gets better in a few months without any specific treatment.

However, it's common for the condition to spread around the body, so it can take up to 18 months or more for the condition to clear completely.

Symptoms of molluscum contagiosum (MC)

Usually, the only symptom of MC is a number of small, firm, raised papules (spots) on the skin with a characteristic small dimple in the middle. The spots are not painful, but can be itchy.

The spots may develop in small clusters and can be spread across different parts of the body. They're most often found in the armpit, behind the knees or on the groin.

MC can affect a person on more than 1 occasion, but this is uncommon.

Image of MC spots, which are usually firm and dome-shaped, with a small dimple in the middle. They're usually less than 5mm (0.5cm) across, but can sometimes be bigger
Credit:

DR P. MARAZZI/SCIENCE PHOTO LIBRARY

When to seek medical advice

See a GP if you notice the spots associated with MC. They're usually easy to recognise, so they should be able to diagnose the condition without the need for further tests.

If the GP thinks the infection may be caused by something other than MC, they may want to:

They may refer you to a specialist in hospital if you have:

  • spots on your eyelids, near your eye, or your eye is red or painful
  • HIV and your symptoms are severe
  • a weakened immune system for another reason – such as receiving chemotherapy

Causes of molluscum contagiosum (MC)

MC is caused by a virus known as the molluscum contagiosum virus (MCV).

This virus can be spread through:

  • close direct contact – such as touching the skin of an infected person
  • touching contaminated objects – such as towels, flannels, toys and clothes
  • sexual contact – this includes intimate physical contact as well as sexual intercourse

If you become infected by the virus and spots appear on your skin, the virus can also spread to other areas.

It's not known exactly how long someone with MC is contagious for, but it's thought the contagious period may last up until the last spot has disappeared.

Treating molluscum contagiosum (MC)

Routine treatment for MC, particularly in children, is generally not recommended because:

  • the infection usually clears up on its own
  • the infection does not normally cause any symptoms other than the spots
  • the infection does not usually interfere with everyday activities, such as going to work, swimming or playing sports
  • treatments can be mildly painful and may cause scarring or damage to the surrounding skin

Treatment is usually only recommended for older children and adults when the spots are particularly unsightly and affect quality of life, or for people with weakened immune systems.

In such cases, treatments that may be offered include:

  • liquids, gels or creams that are applied directly to the skin
  • minor procedures such as cryotherapy (where the spots are removed by freezing them)

Preventing the spread of molluscum contagiosum (MC)

Although MC is infectious, the chance of passing it on to others during normal activities is small.

It's not necessary for you to stay away from work or your child to stay away from school or nursery, or to stop doing activities such as swimming if you have MC.

However, you should take some steps to avoid spreading the virus to other people. You should:

  • avoid sharing towels, flannels and clothing
  • avoid squeezing or scratching the spots – as well as increasing the risk of the infection spreading, this can cause pain, bleeding and can lead to scarring
  • keep affected areas of skin covered with clothing whenever possible – a waterproof bandage can be put over the area if you go swimming
  • avoid sharing baths

Using a condom while having sex can reduce the risk of passing on MC during sexual contact.

Complications of molluscum contagiosum (MC)

MC rarely causes any other problems but complications can occasionally occur. These include:

  • the spots may become infected by bacteria – which may require treatment with antibiotics
  • scarring – after MC has healed and cleared, small patches of paler skin or tiny indented scars may be left behind; this is more likely if the spots became infected or after treatment
  • eye problems – a secondary eye infection may develop, such as conjunctivitis or keratitis, which may cause your eyes to become sore and sensitive to light

See a GP if you suspect a bacterial infection or experience any eye problems such as eye pain or redness. Signs of a bacterial infection can include redness, swelling and pain in the skin and underlying tissue.

Page last reviewed: 6 February 2020
Next review due: 6 February 2023

Symptoms - Molluscum contagiosum

The main symptom of molluscum contagiosum (MC) is a number of small spots on the skin.

The spots are usually firm and dome-shaped, with a small dimple in the middle. They're usually less than 5mm (0.5cm) across, but can sometimes be bigger.

They're typically pink or red on white skin or a beige colour on darker skin, although they may have a tiny white or yellow head in the centre. If this head splits (ruptures), a thick yellowy-white substance will be released, which is highly infectious.

Picture of molluscum contagiosum rash
Credit:

DR P. MARAZZI/SCIENCE PHOTO LIBRARY

It's important not to squeeze the spots, as this will increase the risk of the infection spreading to other parts of the body.

The spots associated with MC are usually painless, although they can sometimes be itchy and some people develop areas of red, dry and cracked skin around them.

Most people have between 20 and 30 spots, although people with a weakened immune system often have more. The spots may develop in small clusters and can be spread across different parts of the body.

They're most often found in the armpit, behind the knees or on the groin.

In a few cases, particularly when it's spread during sexual contact, spots can develop on the genitals and nearby skin.

How the condition progresses

In many cases, the individual spots will start to crust over and heal within 2 months. Some people may experience mild swelling and redness around each spot as it begins to heal.

The spots do not usually leave scars, but they may leave a small area of lighter skin or a tiny pitted mark, particularly if treatment was needed.

As the virus that causes MC can spread to other parts of the body, new spots may develop as the old ones are disappearing. This can result in an episode of MC lasting for quite a long time.

Most cases clear up within around 6-18 months, but the condition can, occasionally, persist for several years.

Page last reviewed: 6 February 2020
Next review due: 6 February 2023

Treatment - Molluscum contagiosum

Treatment for molluscum contagiosum (MC) is not routinely recommended because most cases clear up on their own in around 6 to 18 months.

If left alone, MC does not tend to result in scarring or cause any symptoms other than spots. Squeezing or scratching the spots can cause pain and bleeding and may increase the chances of scarring. It also increases the risk of spreading the infection.

Many of the treatments available for MC can be painful or upsetting for young children and some may increase the chances of permanent scarring.

Treatment is usually only recommended for adults and older children who have spots that are particularly unsightly and are affecting their quality of life.

Treatment is also be recommended for people with weakened immune systems, as the condition can take several years to clear in these cases.

Topical treatments

There are a number of topical treatments (creams, lotions and ointments) that can be used to treat MC, although there's not enough evidence to know if any particular treatment is more effective than the others.

Potassium hydroxide

Potassium hydroxide is a medicine available in liquid form that can improve MC by breaking down the skin cells infected by the virus, allowing the immune system to tackle it.

The liquid is applied twice a day on each spot. The spots should eventually become inflamed, before healing and disappearing within the next few weeks.

You should stop using the medicine once the spots have started to become inflamed, or after 14 days if the medicine does not seem to be working.

Side effects of potassium hydroxide can include redness and a slight burning or itching sensation, which usually only lasts for a few minutes after the medicine is applied.

Podophyllotoxin

Podophyllotoxin comes in liquid form and poisons the cells of the spots. A special application stick is used to draw up the correct dosage of liquid, which is then dripped onto each spot. You may experience some mild irritation.

The treatment needs to be applied for a few days, followed by a few days without treatment. This is referred to as a treatment cycle.

Imiquimod

Imiquimod is a cream that can be used to treat larger spots or large clusters of spots.

Some studies have found that imiquimod is usually only effective when it is used by people with a weakened immune system. It works by stimulating your immune system into attacking the spots.

You apply the cream to the spots, then wash it off after 6-10 hours. This should be done 3 times a week.

It may take several weeks of treatment before you notice an improvement. Common side effects of imiquimod include:

  • hard and flaky skin
  • redness and swelling of the skin
  • a burning or itching sensation after applying the cream
  • headache

These side effects are usually mild and should pass within 2 weeks of stopping treatment.

Benzoyl peroxide

Benzoyl peroxide is usually available in cream or gel form. It's applied to the spots once or twice a day, after washing and drying the affected area. Use benzoyl peroxide sparingly, because too much can harm your skin.

Benzoyl peroxide makes your skin more sensitive to sunlight, so either avoid excessive exposure to sunlight and ultraviolet (UV) light, or wear sun cream. Avoid getting the medicine on hair and clothes, as it can bleach them. Wash your hands thoroughly after you finish applying the medicine.

Common side effects of benzoyl peroxide include:

  • dry and red skin
  • a burning, itching or stinging sensation
  • some peeling of the skin

These side effects are usually mild and should resolve after the treatment has finished.

Tretinoin

Tretinoin is available as a liquid that's applied once or twice a day to individual spots. As with benzoyl peroxide, tretinoin can make your skin sensitive to sunlight and UV light.

Tretinoin is not suitable for use during pregnancy because it can cause birth defects. It's important to use a reliable method of contraception while taking tretinoin if you're a sexually active woman.

The most common side effects of tretinoin are mild irritation and stinging of the skin. It may take several months before you notice an improvement in your symptoms.

Other treatments

There are a number of minor procedures that can help remove or destroy MC spots.

They can be painful, so are not generally suitable for children. They must always be carried out by a suitably qualified healthcare professional.

Cryotherapy

Cryotherapy involves freezing the spots with liquid nitrogen to remove them. Each spot is frozen for 5-10 seconds, so that a layer of ice forms over the spot and surrounding skin.

You may need several sessions of cryotherapy before each spot clears completely. You'll need to wait 2 to 3 weeks between each treatment session.

Diathermy

Diathermy uses heat to remove the spots. The area being treated is numbed with a local anaesthetic and a heated electrical device is used to burn off the spots.

Curettage

Curettage removes spots by scraping them off with a thin, metal, spoon-like instrument called a curette. As with diathermy, you may have a local anaesthetic before having this type of treatment.

Pulsed-dye lasers

Pulsed-dye laser treatment is a relatively new type of treatment for MC. It uses a powerful beam of light to destroy the cells that make up each spot. 

You may experience some skin discolouration and discomfort in the treated areas, but this should improve within a few weeks. The procedure may need to be repeated several times to clear all of your spots.

Pulsed-dye laser treatment uses expensive equipment and its availability on the NHS is limited. You'll probably have to pay privately for the treatment, which can be expensive.

Page last reviewed: 6 February 2020
Next review due: 6 February 2023