Tiny Bumps, Big Questions: A Guide to Molluscum Contagiosum

Molluscum contagiosum is a frequently occurring skin infection caused by a virus with the same name. It usually shows up as small, raised, painless bumps on the skin. While it’s generally not harmful, it can be more of a worry for kids and people with weak immune systems. Around 122 million cases were reported in 2010. While it affects people globally, it tends to be more common in warm and humid regions. In this blog, we'll break down the symptoms, causes, and some easy steps you can follow as preventive measures.

Molluscum contagiosum, also known as "water warts," is a common skin infection that spreads easily. It causes tiny, elevated bumps on the skin, called "Mollusca." This infection often thrives in places where people are in close contact, like schools or during sports. While it's usually harmless and doesn't lead to serious health issues, the bumps can be itchy and may bother some people because of how they look. Molluscum contagiosum makes up about 1% of all skin conditions worldwide.

The causal agent belongs to the poxvirus family, the molluscum contagiosum virus. When this virus enters the body, it causes small bumps or papules to form on the skin. These can spread to other parts of the body or to others, making it contagious. There are at least four subtypes of the virus. The incubation period typically lasts about two weeks but can extend to six months.

Molluscum contagiosum can affect individuals of all ages, but it is most commonly seen in children under 10. Certain factors can greatly heighten the chances of infection, including having a weakened immune system or eczema, which makes the skin more vulnerable. Warm, humid climates can facilitate the spread of the virus, and crowded environments like daycare centres and schools can also increase the likelihood of transmission.

Bumps (Papules):

• Small, pearl-like lesions (two to five millimetres).
• Colours can range from white and pink to the same colour as your skin.
• Small dimple in the centre
• Initially firm, it may become soft over time
• Can drain a clear to white fluid

Itchiness:

• Bumps may be itchy, and scratching can spread the infection

Cluster Formation:

• Scratching can cause multiple papules to form in clusters or lines
• Inflammation around bumps can lead to redness and swelling

Larger Lesions:

• In individuals with weakened immune systems, lesions can grow larger than 5 mm

Common Locations:

• Bumps typically appear on the face, neck, arms, legs, genitals, abdomen, and inner thighs.

Appearance Timeline:

• Bumps usually appear two to eight weeks after exposure to the virus.

Duration:

• Lesions typically resolve within six to eighteen months, but some may take longer to clear.

Pain and Discomfort:

• Bumps are usually painless but can become sore or swollen with scratching.

The virus spreads through:

• Direct skin-to-skin contact
• Indirect contact via shared towels, clothing, or other personal items
• Auto-inoculation, where scratching or shaving spreads the virus to other areas of the body
• Sexual transmission in adults

The virus can be spread until the bumps disappear, though the contagious period is not precisely known. It is more likely to spread in wet environments like swimming pools or shared baths. Symptoms typically appear about two weeks after exposure but can take as long as six months. If the spots become painful, itchy, or crusted, or if they appear near the eyes, it’s important to consult a doctor. Despite its contagious nature, molluscum contagiosum is usually harmless and resolves within 18 months without treatment. Dr Kaliyadan adds, “Minimise contact, rubbing, and scratching, as these behaviours can promote the spread of the infection to other areas of the skin or other individuals. This measure is suggested especially for children.”

If not properly managed, molluscum contagiosum can lead to a few complications:

1. Secondary Infections: Scratching the bumps can introduce bacteria, resulting in localised infections.
2. Scarring: Some individuals may develop scars or skin discolouration after the bumps resolve, particularly if they are not treated appropriately.
3. Discomfort: The visible bumps may cause psychological distress or embarrassment, especially in adolescents and young adults.

Overall, while molluscum contagiosum is usually harmless, it should be managed carefully to avoid complications.

Molluscum contagiosum often resolves on its own, so treatment is rarely necessary. However, treatment may be recommended if the spots cause problems, such as infection or itching. Treatment is advised for those with chronic skin conditions like eczema, molluscum in the genital area, a weakened immune system with multiple bumps, or extremely bothersome lesions. Individuals living with HIV should consult a doctor regarding the preferred treatment to help clear the skin, especially if the bumps are extensive.

Dr Feroz Kaliyadan, Professor of Dermatology at Sree Narayana Institute of Medical Sciences, Chalakka, Ernakulam, advises, “The most effective treatment for molluscum contagiosum depends on several factors, such as the patient's age, the number of lesions, and any associated immunosuppression. Curettage seems to be the most effective treatment. Other treatments, like cryosurgery and potassium hydroxide, are also used depending on the severity. In children where extraction is not possible, exfoliating agents such as salicylic acid gel or tretinoin cream help.”

While there is no guaranteed way to prevent molluscum contagiosum entirely, you can significantly reduce the risk by practising good hygiene and taking specific measures. Here are some effective strategies:

1. Avoid skin-to-skin contact: Limit direct contact with infected individuals until their bumps have cleared.
2. Personal items: Towels, razors, or any other belongings that may come into contact with the skin should not be shared.
3. Hand hygiene: Especially after touching any lesions, wash your hands properly.
4. Symptom relief: To reduce the risk of spreading the infection and alleviate symptoms, apply a damp towel to the skin, take cool baths, or use an unperfumed moisturiser for dryness and itchiness.
5. Cover affected areas: Keep the affected area covered, particularly with waterproof bandages when swimming or in public places.
6. Safe practices during sexual activity: Use a condom during sexual activity if you are infected.
7. Avoid scratching: Do not squeeze or scratch the spots to prevent infection or scarring.

Molluscum bodies Molluscum bodies, also known as Henderson-Patterson bodies, are characteristic inclusion bodies that contain the molluscum contagiosum virus, and they appear in the central core of the skin bump as large, rounded structures. 

These inclusion bodies are highly infective, and exposure of these due to scratching or manipulating these bumps will lead to the spread of infection from one body part to another body part and also from one person to another person. Hence it becomes very important to avoid scratching these lesions.

The best treatment of molluscum contagiosum is to curette and extract these inclusion bodies from these bumps.

Molluscum contagiosum, while generally harmless, requires awareness and care to prevent its spread. By understanding the symptoms, causes, and preventive measures, individuals can effectively manage this condition and reduce the risk of transmission to others.

Molluscum contagiosum mainly affects children, but it can also affect adults, especially those who are immunocompromised. It spreads rapidly through direct skin-to-skin contact or contaminated objects, making it more common in communal settings like schools, daycare centres, and sports activities. It can also spread through sexual contact in adults, especially when lesions are present in the genital area. Individuals with skin conditions such as eczema are more susceptible because of their compromised skin barrier.

Children between one and 10 years old are most at risk. It makes up about one per cent of skin problems worldwide, and it's becoming more common in both kids and adults. It spreads easily in places like daycare centres or schools, where children are in close contact. Adults can also get it through activities like sports or sexual contact. You can catch the infection more than once if you're around someone who has it.

Molluscum contagiosum causes small, raised, flesh-coloured bumps to develop on the skin. These elevated bumps are typically painless, but they can become itchy, red, or inflamed, especially if scratched or irritated. In rare cases, scarring or secondary bacterial infections can cause complications if the bumps are damaged.

If you have molluscum contagiosum, you may notice small, dome-shaped bumps on your skin that can last for several months. In adults, these bumps usually appear on the thighs, buttocks, groin, and lower abdomen, while in children, they typically show up on the face, trunk, legs, and arms. New bumps may form as older ones heal, so it's important to avoid scratching or picking at them to prevent irritation or infection.

The bumps usually go away on their own without treatment, but it may take time for them to completely disappear. Lesions can last anywhere from two weeks to four years, with an average duration of about two years, but the healing process can vary from person to person. During this time, new bumps may appear while older ones heal. In some cases, it may take up to a few years for the virus to completely clear from the body.