Dear Dr. Jeff: I've had some funny looking bumps on my belly for a few weeks now. I've done some research on line, and think it may be molluscum. What should I do? -J.S.
Dear J.S.: Molluscum is a fairly common skin infection, and we've seen a lot of it over the years at the Health Center. So, first of all, come on in! Let one of us take a look, and if it is molluscum that's causing those funny looking bumps, we can discuss various treatment options.
Molluscum is a skin infection caused by a member of the pox virus family, Molluscipoxvirus (MCV), one of the largest DNA viruses known. Infection of skin cells causes a "bump" or papule to form, typically 2 to 4 mm in size (but ranging from 1 mm to 15 mm), typically "umbilicated" (dimpled in the middle), and initially firm, flesh-colored, pearl-like, and dome-shaped.
The lesions are painless (though sometimes itchy), and are usually clumped together in groups. Older lesions may contain a pale, waxy core, much like a "blackhead."
Molluscum used to be most commonly seen in children, on the face, arms and legs, but has come to be an infection more often found in sexually active adults. MCV can infect "regular" skin as well as mucous membranes?in fact anywhere on the body except the palms and soles. Because it is spread via skin-to-skin contact, and often through intimate contact, molluscum can be considered an STD.
Except in people who are immunocompromised (from HIV infection or e.g. chemotherapy), molluscum is a completely benign, self-limited infection of little medical consequence beyond its further spread.
Incubation of MCV averages 2 to 3 months, and ranges from a few weeks to more than 6 months. Untreated, molluscum lasts 6 to 12 months, or longer. Auto-inoculation (spreading MCV from one part of your body to another by scratching) is common.
Diagnosis of molluscum is made from its appearance, or by what radiologists sometimes call the "Aunt Bessie technique" (you recognize your Aunt Bessie as your Aunt Bessie because she looks like your Aunt Bessie!) If uncertain, diagnosis can be confirmed by biopsy. Early genital lesions can look a lot like herpes or warts, but unlike herpes, MCV lesions are painless.
A variety of treatments for molluscum are available. Most involve destroying or removing the infected papules, by freezing, burning, scraping, or chemical peeling. Others involve provoking and augmenting a localized immune response. Left alone, molluscum papules will eventually resolve on their own without leaving a scar. More aggressive treatments (especially surgical debridement) may remove the lesions sooner, but may also leave scars.
Preventing the spread of molluscum is pretty straightforward: no skin-to-skin contact with MCV lesions. Of course, this may prove challenging during the incubation period, when the virus is present but inapparent. If molluscum has infected genital skin, latex condoms will offer very effective protection against further spread.
Be well!
Jeff Benson, MD
Dudley Coe Health Center