Molluscum contagiosum: Diagnosis and treatment

If you have bumps on your skin, the U.S. Food and Drug Administration (FDA) recommends that you to see a health care professional like a board-certified dermatologist

The FDA cautions, “You might do more harm than good” if you try to diagnose or treat yourself.

How do dermatologists diagnose molluscum contagiosum?

A board-certified dermatologist can often diagnose this condition by looking at the bumps on your skin. For most patients, that’s all that’s required.

Occasionally, your dermatologist will need more information and will scrape off a bit of the infected skin so that it can be examined under a microscope. Your dermatologist can scrape off what’s needed during your office visit.

Molluscum contagiosum doesn’t always require treatment

If you have molluscum, your dermatologist may recommend letting this condition clear on its own rather than treating it. When you have a healthy immune system, the body will get rid of the virus. Once this happens, the skin will clear.

Clearing can take time. For many children, the body clears the infection within 6 to 9 months. Sometimes, it takes longer.

When do dermatologists recommend treating molluscum contagiosum?

Treatment may be recommended for patients who have:

• A chronic skin condition, such as eczema

• Molluscum in the genital area

• A weakened immune system and numerous bumps

• Extremely bothersome molluscum

Treatment is recommended for people who have molluscum and are living with HIV infection. If someone is living with HIV, the bumps can grow big and cover large areas of skin. Starting antiretroviral therapy (ART) can help clear the skin. ART is considered the treatment of choice for anyone who is living with HIV and has molluscum.

Do not buy or use non-prescription products to treat molluscum without your dermatologist’s approval

The FDA says companies are selling unapproved products to treat molluscum

Some of these companies even include a misleading statement on the product that suggests the FDA has endorsed or approved the product.

The FDA says that on unapproved products sold to treat molluscum contagiosum, you may see one of the following misleading claims:

• FDA approved

• FDA registered

• Made in an FDA-registered facility

• Complies with FDA Current Good Manufacturing Practices (or CGMPs)

The truth is the FDA has not approved any product that you can buy without a prescription to treat molluscum.

“It’s unlikely that unapproved products marketed to treat molluscum do what they claim, and the ingredients in them could cause adverse effects (bad reactions),” according to the FDA.

On its website the FDA says that it “has received reports of side effects in children and adults associated with some of these products, including skin reddening, abrasion (rub or wear away) from skin scratching, and permanent scarring.”

The FDA adds that many of these unapproved products contain essential oils. “Even essential oils may cause an allergic reaction or irritate sensitive skin,” the FDA says.

Protect your health and that of your family by seeing a board-certified dermatologist for treatment.

How do dermatologists treat molluscum contagiosum?

Dermatologists choose treatment based on many considerations, such as a patient’s overall health, number of molluscum bumps, and where the bumps appear. For children, age is also an important consideration.

Your dermatologist may recommend treatment that you:

• Receive in your dermatologist’s office

• Apply at home

• Take for a prescribed amount of time

No matter which treatment is used, treatment takes time. The following explains the different treatments and what each involves.

Treatment you receive in a dermatologist’s office

The goal of this treatment is to destroy the bumps without harming the skin. To do this your dermatologist may use:

Cantharidin (beetle juice): This FDA-approved treatment is made from blister beetles. It’s approved to treat adults and children two years of age and older.

Dermatologists have been using cantharidin to treat warts and molluscum since the 1950s. When treating molluscum bumps, your dermatologist applies the beetle juice to each bump. Your dermatologist will apply it to each bump in such a way that a water blister later forms.

You will likely see a blister on each treated bump within 24 to 48 hours. As the skin heals, the bumps clear. This usually occurs within 2 weeks.

To be effective, most patients need at least 2 in-office treatments.

Wash off cantharidin after treatment

When your dermatologist uses cantharidin (beetle juice) to treat molluscum, you need to wash it off at home with soap and water, within the time frame that your dermatologist gives you. This helps prevent excessive blistering that could lead to serious skin irritation.

When applied by a dermatologist, cantharidin is a safe and effective treatment for molluscum. It’s often used to treat young children because it is painless when applied.

Cryosurgery: Seeing “surgery” in the name of this treatment may have you wondering if your dermatologist will cut into the skin. No cutting is involved. This treatment is a procedure that your dermatologist can perform during an office visit.

To perform cryosurgery, your dermatologist applies an extremely cold substance like liquid nitrogen to each molluscum bump. This extreme cold can effectively destroy the bumps. Because new molluscum bumps can form, you will need to return for treatment every 2 to 3 weeks until the bumps clear.

Cryosurgery can be painful, so it’s not recommended for young children. Due to the pain, it’s seldom used to treat patients who have many molluscum bumps.

Curettage: During this treatment, your dermatologist uses a medical device called a curette to remove the molluscum bumps from the skin. In skilled hands, this is an effective treatment that causes little or no bleeding.

Because your dermatologist cuts into the skin, this treatment can be frightening for young children. As such, curettage is usually only performed on older children, teens, and adults.

Pulsed dye laser (PDL): This may be a treatment option for someone who has many molluscum bumps. It’s also recommended for patients with difficult-to-treat molluscum, including those who are immunosuppressed.

Studies show that PDL can effectively treat dozens of bumps. During one such study, 43 patients who had many molluscum bumps were treated with the PDL. In 42 of these patients, all the bumps cleared within one month of PDL treatment.

The treated skin tends to heal completely in 1 to 2 weeks on the face. When treating other areas of the body, the skin tends to heal completely in 2 to 4 weeks.

If you are considering PDL, it’s important to know the following:

• Insurance rarely covers the cost of this treatment, which tends to be expensive.

• PDL has been safely and effectively used on children as young as 8 years old, but it may be difficult to treat younger children with PDL.

• People who have darker skin tones can develop temporary (lasting 6 weeks to 6 months) lighter or darker spots on the skin treated with the PDL.

• Not every dermatology office offers PDL, so you may be referred to another dermatologist for treatment.

Use forceps or a scalpel to remove the core: During this procedure, your dermatologist squeezes each molluscum bump to remove the cheesy substance inside, which contains the virus. This can be painful, so medication is first applied to numb the skin.

You should not try this at home. Without proper technique, you can cause a serious infection and spread the virus to other parts of your body.

Treatment you apply at home

Sometimes, molluscum is best treated with a medication that you apply at home. While you will find many treatments sold online, the following are the ones that a dermatologist may recommend.

See a board-certified dermatologist for treatment instead of buying treatment for molluscum online

Some molluscum treatments that you can buy online without a prescription may not work and could be harmful, according to the Centers for Disease Control and Prevention (CDC).

Imiquimod cream: This medication helps stimulate the body’s immune system so that it will clear the bumps. You apply the cream as directed to the bumps, usually 2 or 3 times a week. After the cream sits on the bumps for a prescribed amount of time, you wash it off.

You must continue to apply imiquimod until the bumps clear, which is usually about 16 weeks.

It’s important to know that no one treatment works for everyone. Signs that imiquimod is working include swelling and irritated skin.

The CDC does not recommend imiquimod for children. Some studies show that this medication doesn't work well for children who have molluscum contagiosum.

Prescription required: Yes.

Salicylic acid: Often used to treat warts, this can be effective for molluscum as well. Your dermatologist can tell you how often to apply it. The goal is to continue using it until you get a reaction.

Prescription required: No. While this is a non-prescription treatment, you should only use it if your dermatologist recommends it. No treatment is right for everyone.

Sinecatechin (green tea): This botanical, which is made from green tea, has been approved by the FDA to treat genital and anal warts. It’s reported that this may also effectively treat molluscum bumps in the genital and anal areas.

Prescription required: Yes.

Tretinoin: To get results, you must apply this correctly. Your dermatologist can show you how to apply it by using a toothpick to get the reaction you need. The goal is to irritate the surface of the skin, which can help the body’s immune system clear the virus.

Prescription needed: Yes.

Medication you take at home

Cimetidine: This medication is used to treat ulcers and conditions that cause the stomach to produce too much acid, such as heartburn.

It may also be a treatment option for a patient who has severe eczema (atopic dermatitis) and molluscum that covers most of the body. Dermatologists recommend it only when other treatments fail to work.

Prescription needed: No. While this is a non-prescription treatment, you should only use it if your dermatologist recommends it. No treatment is right for everyone.

What is the outcome for someone who has molluscum contagiosum?

For most people the skin will clear without treatment, usually within 18 months. A few people continue to have bumps for longer.

Treating molluscum may clear the skin more quickly; however, the bumps can return after treatment. It’s also possible to pick up the virus again, which can cause new bumps.

Following the self-care that dermatologists recommend can help prevent new bumps. You’ll find these recommendations at, Molluscum contagiosum: Self-care.

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References
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Centers for Disease Control and Prevention (CDC). “Molluscum contagiosum: Risk factors.” Page last reviewed May 2015. Page last accessed March 22, 2019. Centers for Disease Control and Prevention (CDC). “Molluscum contagiosum: Treatment options.” Page last reviewed October 2017. Page last accessed November 1, 2023.

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Tom W, Fallon Friedlander S. “Poxvirus infections.” In: Wolff K, Goldsmith LA, et al. Fitzpatrick’s Dermatology in General Medicine (seventh edition). McGraw Hill Medical, New York, 2008: 1911-13.

U.S. Food and Drug Administration.

• “FDA approves first treatment for molluscum.” Last updated 7/24/2023. Last accessed 8/24/2023.

• “Safely treating molluscum, a common skin condition.” Last updated 8/23/2023. Last accessed 8/24/2023.

van der Wouden JC, van der Sande R, et al. “Cochrane Review: Interventions for cutaneous molluscum contagiosum.” Cochrane Database Syst Rev. 2017;5:CD004767.

Written by:
Paula Ludmann, MS

Reviewed by:
Elaine T. Kaye, MD, FAAD
Ata Moshiri, MD FAAD
J. Klint Peebles, MD, FAAD

Last updated: 11/6/23