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 login to view 2 more bullets adolescents and young adults login to view 1 more bullet immunocompromised individuals login to view 1 more bullet 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 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 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 login to view 2 more bullets topical podophyllotoxin 0.5% cream indication login to view 1 more bullet cantharidin indication login to view 2 more bullets Operative curretage indication login to view 3 more bullets Complications Secondary bacterial infection