Molluscum contagiosum and viral warts

Overview & Definition

A parent brings a four-year-old to clinic worried about a cluster of small, shiny, pearly bumps in the armpit that have spread over several months, and a rough knob on the side of a thumb that will not go away. Both are everyday primary-care presentations, and both are benign, self-limiting viral infections of the skin. Molluscum contagiosum is a cutaneous infection by a DNA poxvirus that produces smooth, dome-shaped, umbilicated papules, while viral warts are benign epidermal growths driven by human papillomavirus that produce rough, keratotic papules. [2]

The unifying principle is that both conditions are common, contagious but harmless, and resolve spontaneously through cell-mediated immunity in the great majority of children. The central clinical decision is therefore not how aggressively to eradicate them but whether to treat at all: expectant, conservative management is the default, and active treatment is reserved for lesions that are symptomatic, spreading, or genuinely bothersome. A 2015 UK community cohort showed that molluscum has a measurable but modest effect on quality of life, framing reassurance and watchful waiting as a legitimate first choice rather than a default of omission. [3]

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2. [2]Schaffer JV, Berger EM Molluscum Contagiosum JAMA Dermatol, 2016.PMID 27627044
3. [3]Olsen JR, Gallacher J, Finlay AY, et al Time to resolution and effect on quality of life of molluscum contagiosum in children in the UK: a prospective community cohort study Lancet Infect Dis, 2015.PMID 25541478
4. [4]Giner-Soriano M, Teixidó C, Marsal JR, et al Randomized placebo-controlled clinical trial on efficacy and safety of topical 10% Potassium hydroxide for molluscum contagiosum treatment in children J Dermatolog Treat, 2019.PMID 30668179
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8. [8]Kwok CS, Gibbs S, Bennett C, et al Topical treatments for cutaneous warts Cochrane Database Syst Rev, 2012.PMID 22972052
9. [9]Stefanaki C, Lagogiani I, Kouris A, et al Cryotherapy versus imiquimod 5% cream combined with a keratolytic lotion in cutaneous warts in children: A randomized study J Dermatolog Treat, 2016.PMID 25886088
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11. [11]Stamuli E, Cockayne S, Hewitt C, et al Cost-effectiveness of cryotherapy versus salicylic acid for the treatment of plantar warts: economic evaluation alongside a randomised controlled trial (EVerT trial) J Foot Ankle Res, 2012.PMID 22369511
12. [12]Loo SK, Tang WY Warts (non-genital) BMJ Clin Evid, 2014.PMID 24921240