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 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 molluscum contagiosum virus an enveloped DNA poxvirus 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 Associated conditions if patient has genital molluscum may be associated with other sexually transmitted infections in adult 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 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 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 Procedural 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 Comlications Secondary bacterial infection