Molluscum: Small bumps, big questions

The full term for molluscum is another of those scary medical names: molluscum contagiosum (MC), suggesting that it is highly contagious and has something to do with molluscs (snails, slugs, conchs, oysters, clams, mussels, octopuses, etc.). Well, the illness does have somewhat of a relationship with water.

Molluscum comes from the Latin word mollis, meaning “soft”. It was initially used in dermatology to describe soft, smooth skin tumours.

The second word is also Latin: contagiosum, meaning “contagious” or capable of being transmitted by contact.

Molluscum is simple-looking: tiny, skin-coloured bumps on the skin (see picture). The bumps are firm and rounded, with a smooth, shiny, umbilicated surface. They can be confused with warts, but warts are ugly-looking, rough, grainy bumps resembling tiny cauliflowers.

The lesions may be single, multiple or form clusters. Sometimes they itch, but itching is not a hallmark. In fact, nothing is; the bumps are just there and, if they are tiny, may not be noticed. In children, the main affected areas are sites of exposed skin, such as the trunk, extremities, areas of the body where two surfaces touch or rub against each other (armpits, groin, inner thighs, etc.), the genitals and the face but, unlike warts, never the palms and soles.

MC occurs worldwide and is more frequent in children, affecting anywhere from one in ten to one in 20 children. It is more frequent in warm climates. It typically affects children between two and five years old, being rare under the age of one. There are no gender differences. It can also affect adolescents and adults.

It is caused by a virus called, yes, you guessed it, the molluscum contagiosum virus. It is easily spread through direct skin-to-skin contact with infected skin, which can be non-sexual, sexual or through autoinoculation.

Non-sexual transmission simply means touching an infected person’s skin—such as through hugging, wrestling or normal everyday contact. That is enough for you to break out in a rash. You can also contract the virus by touching objects that have come into contact with an infected person’s skin. There seems to be an association with swimming pools. It does not spread directly through pool water itself but through contact with contaminated items, including towels, goggles, kickboards, bath sponges, clothing, washcloths, bedding, toys, pool decks or pool equipment. Softer or damp skin after swimming appears to make it slightly easier for the virus to enter tiny micro-abrasions.

Molluscum spreads in gyms in the same way it does in pools, through contact sports such as wrestling and martial arts, and through sharing unwashed towels, clothing, gym mats, weights or benches.

In adults, lesions often appear on the lower abdomen, thighs, groin or genitals because the virus is mainly spread through intimate or sexual skin-to-skin contact. This can become a major cause of marital friction. When a spouse discovers bumps in their partner’s genital region, the immediate, often incorrect, assumption is infidelity.

The third way you can get molluscum is through autoinoculation or self-transmission. Scratching or touching a bump and then touching another part of your body can spread the rash. This also explains the frequency with which it is seen in body areas where two surfaces touch or rub against each other.

There are two particular conditions closely associated with molluscum. Children or adults with atopic dermatitis (eczema) are at a significantly higher risk. Eczema creates micro-breaks in the skin barrier, making it much easier for the virus to take hold and spread.

Because of the importance of the immune system in controlling the rash, immunocompromised individuals, such as those with HIV or undergoing chemotherapy for cancer, are more susceptible to extensive, persistent cases, regardless of age.

For the vast majority of people, molluscum is a self-limiting rash. If you leave it alone, it goes away once your immune system kicks in and gets it under control, usually within six to nine months.

Because of this self-limiting course, and because treatment is not easy or very effective, treatment is controversial. Most people, however, want to get rid of it. Yet mild cases require only observation and good hygiene. People can swim in swimming pools and go to the gym, provided they follow proper hygiene and take precautions to cover the lesions. This means staying away if there are open lesions, such as sores, covering the bumps with waterproof bandages, and not sharing personal items.

Treatment usually focuses on scraping out the core (curettage), freezing the lesions (cryotherapy) or applying topical blistering agents (such as cantharidin) to trigger an immune response.