Molluscum Contagiosum

Key Points

• Molluscum contagiosum is caused by the molluscum contagiosum virus (MCV), most commonly MCV-1 subtype in children ages 2 to 5 years.
• Spread occurs through direct skin-to-skin contact, indirect contact (towels, toys), or vertical transmission.
• Lesions are round, firm, dome-shaped papules (white to pink to purple) that are usually painless.
• Self-limited (resolves in 6 to 12 months) but treatment may be sought for cosmetic or spread-prevention reasons.

Pathophysiology

The molluscum contagiosum virus (a poxvirus) infects keratinocytes in the epidermis. The virus induces epithelial cell proliferation, producing characteristic dome-shaped papules with a central umbilication containing a waxy core of viral particles (molluscum bodies). The infection is confined to the epidermis and does not cause systemic illness. Autoinoculation (self-spread by scratching) is common, and the virus can spread to others through fomites or direct contact.

Clinical Manifestations

• Round, firm, dome-shaped papules ranging from 2 to 5 mm in diameter.
• Color ranges from white to pink to purple.
• Central umbilication (dimple) is a distinguishing feature.
• Usually painless; may be mildly pruritic.
• Commonly located on the trunk, extremities, face, and axillae; can occur on any body area.

Nursing Assessment

• Assess lesion characteristics: number, distribution, size, and presence of central umbilication.
• Evaluate for secondary bacterial infection (erythema, warmth, purulent drainage around lesions).
• Identify immunocompromised clients who may have more extensive or persistent lesions.
• Assess psychosocial impact, especially in school-age children (self-consciousness, peer reactions).

Nursing Interventions

• Educate families that the condition is self-limited and typically resolves without treatment in 6 to 12 months.
• Teach clients to cover infected areas to prevent spread to others.
• Discourage scratching and picking to prevent autoinoculation and secondary infection.
• If treatment is pursued, topical medications must be applied to every individual lesion.
• Emphasize hand hygiene and avoidance of sharing towels, clothing, and personal items.
• Physical removal methods (curettage, cryotherapy) may be offered but can cause discomfort and scarring.

Related Concepts

• impaired-skin-and-tissue-integrity - Skin assessment and lesion identification.
• infection-control - Prevention of spread through contact precautions.
• impetigo - Bacterial skin infection in the differential diagnosis.
• Warts - Another viral skin lesion to differentiate.
• Immunodeficiency - Extensive disease in immunocompromised clients.

Self-Check

1. What is the distinguishing clinical feature of molluscum contagiosum lesions?
2. How does autoinoculation contribute to the spread of molluscum contagiosum?
3. Why is treatment of molluscum contagiosum often not necessary in healthy children?