Molluscum Contagiosum

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What is molluscum contagiosum?

pronounced (mol-us-kim con-tay-jee-o-zim)


Molluscum contagiosum is a viral infection which mainly affects children.  As the name suggests, it is contagious.  It is usually acquired through direct contact but may be contracted by sharing a bath, towels or clothing.  It is quite common in nursery schools, play groups and primary schools.  Children often pick up the infection while playing together.

It is not common in adults because of the higher immunity in this group.


click image to enlarge



Tiny skin coloured or white bumps are characteristic of molluscum contagiosum. 



The centre of the bumps have a little indentation referred to as an umbillication.


Does one always need to treat molluscum contagiosum?


Molluscum contagiosum is a self limiting condition and often goes away on its own within about 6 months in most children.  If there are only a few bumps, they could quite safely be ignored.


Active intervention may be necessary, however, under the following circumstances:


  1. •if the number of bumps are increasing


  1. •if steroid creams (cortisone / corticosteroids) are used eg. if there is underlying eczema.  In such a situation, the number of bumps can increase to several hundred as the immunity of the skin is further suppressed.


  1. •if the bumps begin to spread to other family members


How are viral infections treated?


  1. Antiviral medications:


  1. At present, there is no cream or oral medication which can kill viruses without harming the body.  Incidentally, there is no cure for any viral infection, unlike bacterial infections for which one uses antibiotics.  Examples of viral infections are chickenpox, measles, mumps, shingles, and warts.   All these conditions are treated only symptomatically and one relies on the body's immunity to get rid of the infection.  Antiviral medications only slow down the rate of growth of some of these viruses but do not kill the viruses.  Furthermore, antiviral medications are not available for every viral infection.  There is no antiviral medication for molluscum contagiosum.


  3. Vaccines:


  5. Immunisation in the form a vaccine is available for some viral infections eg measles and mumps.  When a vaccine is given, antibodies are made by the body against the virus.  If the body is subsequently exposed to the virus, the existing antibodies destroy the virus and the infection does not manifest itself.  No vaccine is available for molluscum contagiosum.


Imiquimod (Aldara cream)


This cream is used for the treatment of viral warts and is registered for use in this country for individuals over the age of 18.  Aldara does not kill viruses but stimulates the body to make Interferon, a chemical substance which destroys viruses.  It is especially useful for treatment of viral warts affecting the genitalia.


What treatments are available for molluscum contagiosum?


As there are no medications which can kill the virus, treatment is aimed at physically removing each bump.  The bump contains a white coloured blob (molluscum body) which is made of skin cells containing the virus.  Hence, the viral particles are removed along with the individuals skin cells which are infected.

The following methods are used to treat molluscum contagiosum:

removal of the molluscum body using a sharp instrument - the bump is opened up with the instrument and the white blob is then picked out.


  1. liquid nitrogen - this freezes the entire bump, inside which the viruses are found.   When liquid nitrogen is used, the molluscum body is not physically removed.  A blister forms within a day or two and the molluscum body usually comes off as the blister dries.  However, if the viral particles survive the freezing, the bump may remain.


  1. electrocautery and curettage - The bump is first cauterised with an electrical instrument and then opened up using a sharp instrument.  The molluscum body is then picked out.  Electrocautery makes it easier for the molluscum body to be removed.  Curettage refers to the act of scraping away the molluscum body.


Are these procedures painful?


Without anaesthesia, there could be some degree of pain.  While adults manage quite comfortably without any anaesthesia, these procedures are virtually impossible to perform in children without first making the skin numb.


How is the skin made numb?


The skin can be anaesthetised using a cream called EMLA (eutectic mixture of local anaesthetics).  EMLA is applied to the skin and covered with plastic and left on for at least 1 hour.  Once anaesthised, the bumps may be removed by any  of the methods outlined above.  This form of anaesthesia is effective if there are a few bumps and if the child  is coorperative (usually over the age of 5).  Below this age group, it is difficult to perform any procedure without a general anaesthetic.


When is a general anaesthetic used?


General anaesthesia involved putting the child off to sleep during the procedure.  It is the most humane way of treatment if:


  1. •there are numerous bumps

  2. •if the child is below the age of 5

  3. •If the child is terrified of procedures, irrespective of age


Which is the best treatment?


Electrocautery and removal of the molluscum bodies using a metal instrument is the treatment most frequently used in this practice as it results in a lower recurrence rate compared with liquid nitrogen.  


What about the use of Aldara?


There is some evidence that Aldara can be effective in the treatment of molluscum contagiosum.  The cream is applied three times a week on the molluscs for about three months.  For parents not keen on general anaesthesia, it is worth a try.  However, if the bumps increase in number, one should abandon this treatment.


Which treatment is used if a general anaesthetic is administered?


If a general anaesthetic is used, the aim is usually to remove all visible molluscs.  Electrocautery is the method of choice.


Does the procedure leave scars?


Scars are possible with any of the treatment methods outlined.


Can the bumps recur after removal?


Recurrence of individual bumps is not common after removal with electrocautery and curettage, but can occur.  Furthermore, the "seeds" of the virus may still be present in the skin and it is possible for these to grow later.  


What happens if there is a recurrence after removal under general anaesthetic?


Make an appointment and come back to the rooms as soon as new bumps are noticed.  Usually there would be only a few and these would be easy to remove with EMLA without a general anaesthetic.


Is a repeat treatment under general anaesthetic ever necessary?


Rarely, kids who develop masses of new bumps may need to undergo general anaesthesia for a second time.  Fortunately, this is not common.  A third treatment under general anaesthetic has so far never been required in this practice.

What is the procedure for removal of molluscs under general anaesthesia?

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