Derm Cases · Dermatology / Paediatrics / Infectious Diseases
OSCE — umbilicated pearly papules in a child: molluscum contagiosum
An 8-minute OSCE station on molluscum recognition, expectant versus active treatment options, HIV red flags in adults, secondary infection and eczema, school advice, and safeguarding considerations for genital lesions in children.
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Study tools
Target exams
NEET-PGINICETUSMLEPLABMRCP
Prompt
An 8-minute OSCE station on molluscum recognition, expectant versus active treatment options, HIV red flags in adults, secondary infection and eczema, school advice, and safeguarding considerations for genital lesions in children.
Brief (to candidate)
A 7-year-old boy has multiple 2–4 mm pearly, dome-shaped papules with central umbilication on the trunk and antecubital fossae for 3 months. Some lesions are surrounded by eczematous plaques; he is well and HIV-unrelated history is negative. Parents want treatment so he can swim at school. You have 8 minutes to diagnose, counsel natural history, offer management options, and safety-net red flags.
[1]Candidate instructions
- Recognise molluscum contagiosum clinically.
- Explain natural history and transmission.
- Offer expectant versus active treatment options with risks/benefits.
- Manage molluscum dermatitis and secondary bacterial infection.
- Identify red flags (HIV/giant lesions, ocular, genital in child).
- School/activity advice and follow-up.
Examiner checklist (mark each domain / 10)
| Domain | Key actions expected |
|---|---|
| Recognition | Pearly dome-shaped papules with central umbilication ± expressible white core; poxvirus (MCV); common in children; autoinoculation and fomites[1][2] |
| Natural history | Often self-limited over months to ~1–2 years; individual lesions resolve after local immune response; new lesions can appear while older ones clear |
| Expectant care | Reasonable first option in healthy child if not bothersome: avoid scratching, keep skin moisturised, treat concurrent eczema; no need for routine antibiotics |
| Active Rx | Discuss cantharidin 0.7% in-clinic (wash off per protocol), cryotherapy, curettage, or other local destructive/immunotherapy options per availability and pain tolerance; shared decision with parents[3][4] |
| Complications | Treat molluscum dermatitis with emollients ± mild topical steroid; impetiginisation with topical/oral anti-staphylococcal agents as indicated |
| Red flags | Extensive/giant/facial refractory disease in adult → HIV test / immunocompromise; periorbital → ophthalmology; genital lesions in child → consider autoinoculation but safeguard if concerning context |
| Public health & communication | Cover lesions for swimming where possible; avoid sharing towels; usually no school exclusion; set expectations that treatment may need repeat sessions |
Model key actions
- Diagnose molluscum contagiosum from umbilicated pearly papules.[1]
- Offer watchful waiting or cantharidin/cryotherapy/curettage based on parent preference and lesion burden.[3][4]
- Treat surrounding eczema; safety-net giant/adult disseminated disease for HIV testing.
Common errors
- Aggressive curettage without consent/pain plan in a young child.
- Assuming genital molluscum in children always equals abuse (autoinoculation common) — but failing to consider safeguarding when indicated.
- Missing HIV workup for extensive adult facial molluscum.
- Unnecessary systemic antivirals (no role for aciclovir).
- Rigid school exclusion policies not supported by evidence.
References4ShowHide
- [1]Hebert AA, Bhatia N, Del Rosso JQ. Molluscum Contagiosum: Epidemiology, Considerations, Treatment Options, and Therapeutic Gaps. The Journal of clinical and aesthetic dermatology, 2023.PMID 37636018
- [2]Leung AKC, Barankin B, Hon KLE. Molluscum Contagiosum: An Update. Recent patents on inflammation & allergy drug discovery, 2017.PMID 28521677
- [3]Meza-Romero R, Navarrete-Dechent C, Downey C. Molluscum contagiosum: an update and review of new perspectives in etiology, diagnosis, and treatment. Clinical, cosmetic and investigational dermatology, 2019.PMID 31239742
- [4]Ulrych JM, Krupa J, Malinowski M, et al. Molluscum contagiosum: a comprehensive review of treatment modalities. Wiadomosci lekarskie, 2025.PMID 40847879