Snapshot A 3-year-old girl presents to her pediatrician’s office with several pink spots on her body. Her parents report that she seems mostly unbothered by these lesions but occasionally scratches at them. Several of her friends have similar lesions. On physical exam, there are several 2-3 mm flesh-colored papules with central umbilication. Her pediatrician counsels them that this viral infection is benign and self-resolves. However, if the lesions seem to bother the patient, then there are treatment options such as cryotherapy or topical cantharidin. Introduction Clinical definition painless and umbilicated cutaneous lesions caused by the molluscum contagiosum virus Epidemiology incidence up to 30% in patients with HIV demographics school-aged children most common the children are typically immunocompetent 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 immunocompromised states Etiology molluscum contagiosum virus an enveloped DNA poxvirus Pathogenesis the molluscum contagiousum 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 Associated conditions if patient has genital molluscum other sexually transmitted infections may be found in adults may be an indicator of HIV Prognosis lesions resolve spontaneously within 9 months no scarring 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 pearly flesh-colored location trunk extremities head neck genitals immunocompromised patients > 30 lesions > 1 cm lesions lesions on the eyelid Studies Dermatoscope exam central umbilication Biopsy indication confirms the diagnosis when it is clinically uncertain Histology molluscum bodies Henderson-Patterson bodies large cells with granular eosinophilic cytoplasm that contain accumulated virons 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 well tolerated in adolescents and adults can be too painful for young children, especially with multiple lesions topical podophyllotoxin 0.5% cream indication ideal for genital lesions cantharidin indication treatment is applied topically in the office and blistering occurs hours later ideal for children with multiple lesions Operative curretage indication well tolerated in adolescents and adults can be too painful for young children, especially with multiple lesions ideal for those who wish for more immediate resolution Complications Secondary bacterial infection