QuestionSBA
QuestionChoice
Aciclovir is not used to treat molluscum contagiosum, steroid creams are used, whilst antibiotics may be indicated if secondary infection occurs.
10015854
d
Trial a course of aciclovir
QuestionChoice
Whilst cryotherapy may be used for molluscum contagiosum, this option does not address the possible immunocompromise.
10015853
c
Refer for excision and cryotherapy
QuestionChoice
The history and examination describe molluscum contagiosum, caused by the poxvirus. Whilst harmless in children, in adults when they persist and are widespread in the manner described they are suggestive of underlying immunocompromise, therefore HIV testing is indicated.
10015851
a
Arrange HIV testing
QuestionChoice
This is inappropriate due to widespread nature of the rash and lengthy duration.
10015852
b
Discharge with reassurance
QuestionChoice
This is not appropriate as we are not concerned about a dermatological malignancy.
10015855
e
2 week referral to dermatology
QuestionComment
He waited 2 years…
37758
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subscriber
Retrograde Embolism
QuestionComment
My God, These Derm Questions Are  Absolute AIDS
39804
QuestionComment
Nobody's got aids, and I don't want to hear that word in here again!
46965
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Amnesia Gland
QuestionComment
literally he has aids
53870
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Positive Whiff Test
QuestionComment
People downvoting me clearly aren't cultured Sopranos fans...
60072
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Amnesia Gland
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Axillary Myotonia
QuestionComment
my thought process was "might as well test for HIV before telling him to go home"
44983
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Serpiginous Defibrillator
QuestionComment
i htought becuase hes worried about them - to use cryotherapy 

59700
User
subscriber
Hypertension Kinase
Concept
Chapter
# Summary


Molluscum contagiosum, a viral skin infection caused by the molluscum contagiosum virus (MCV), primarily presents as small, pearly papules with central umbilication, often occurring on the genitals. Diagnosis is usually made through visual inspection, and a full STI screen is advised for patients with genital manifestations. While the infection typically resolves spontaneously within 18 months, distressing cosmetic implications may warrant treatment such as cryotherapy.


# Definition


Molluscum contagiosum is a common, contagious skin infection caused by the molluscum contagiosum virus, a member of the poxvirus family.


# Epidemiology


Molluscum contagiosum exhibits a worldwide distribution with an estimated prevalence of about 8000 cases per 100,000 population annually. The infection is particularly prevalent among children and adolescents. In the UK, the incidence of new cases was reported to be 261 per 100,000 in 2015.


# Aetiology


The aetiologic agent of molluscum contagiosum is the molluscum contagiosum virus (MCV), a virus from the poxvirus family. Transmission occurs primarily through direct skin-to-skin contact.


# Signs and Symptoms


Clinical manifestations of molluscum contagiosum include:


- Small, smooth, pearly-colored papules with a central area of umbilication
- These lesions can occur anywhere on the body, but they are most commonly found on the genitals
- In immunocompromised patients, lesions can be extra-genital and particularly prevalent on the face
- When the lesions are present on the eyelid margin, they can cause irritation, redness and follicular conjunctivitis, characterised by small lymphoid tissue elevations on the tarsal conjunctiva.


# Differential Diagnosis


The main differential diagnoses for molluscum contagiosum include:


- **Basal cell carcinoma**: Presents as pearly nodules with telangiectasia, often on sun-exposed skin
- **Genital warts**: These typically appear as flesh-coloured, cauliflower-like growths in the genital area
- **Herpes simplex virus infection**: Characterised by painful clusters of vesicles, usually on an erythematous base
- **Keratoacanthoma**: Rapidly growing, keratin-filled nodule that may resemble a volcano


# Investigations


Diagnosis of molluscum contagiosum is primarily clinical, made using visual inspection. However, in case of genital molluscum, a full sexually transmitted infection (STI) screen is advised for all presenting patients to rule out co-existing STIs.


# Management


Molluscum contagiosum is usually self-limiting and clears up spontaneously within 12-18 months. However, management strategies can be employed to speed up recovery and limit the spread of the virus. These include:


- Cryotherapy: This involves freezing the lesions with liquid nitrogen, which can speed up lesion clearing. 
- Topical treatments: These aim to stimulate an immune response or directly disrupt the virus, and include ingredients such as salicylic acid, potassium hydroxide, and imiquimod. 
- Curettage: This involves scraping off the lesions under local anaesthesia, but is usually reserved for smaller outbreaks due to the risk of scarring.


Patient education on avoiding direct skin-to-skin contact and sharing personal items can help prevent the spread of the virus. Patients at higher risk of complications (for example, ocular molluscum contagiosum or immunocompromise) should be referred to secondary care.


# NICE Guidelines


[NICE Information on Molluscum Contagiosum](https://cks.nice.org.uk/topics/molluscum-contagiosum/)
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An example of the typical appearance of molluscum contagiosum in an infant.
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Topic
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Dermatology
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An example of the typical appearance of molluscum contagiosum in an infant.
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Molluscum Contagiosum
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Dermatology
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Persistent and widespread molluscum contagiosum in an adult may indicate underlying immunosuppression, requiring consideration for HIV testing.
Presentation
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Chronic rash
UkmlaTopic
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Dermatology
Presentation
157
Chronic rash
UkmlaTopic
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General practice and primary healthcare
A 35 year old man comes to the GP with widespread raised papules with a central umbilication on his trunk, face, hands, legs and feet. He reports they have been present for the last 2 years without improvement and he is worried about them.

What is the most appropriate course of action?
a