Molluscum

 Molluscum Contagiosum (MC) 

Evaluation/Diagnostic Protocol

Subjective

History: Where—What area of the body affected, skin folds, genital region, chest, abdomen, arms, buttocks, face, eyelids?;  How long—months, weeks, days, years?; Symptoms—painful, pruritic, bleeding;  Quality—red, puffy, pearly papules?; Severity—good/bad day?;  Mod. Factors—previous treatment?  Context—associations, daycare? Timing—when most often occurs?

Objective: 

Physical: complete skin exam. Lesions classically are flesh colored to pearly white raised papules with central umbillicated papules.  The papules have a small indentation in the center, sometimes containing a core.  Assess severity in terms of number and also location. MC are usually found in areas of skin that touch each other such as folds in the arm or groin

Lab: none; Consider biopsy if in doubt of diagnosis.

Differential Diagnosis

Warts (verrucae), basal cell carcinoma, melanocytic nevi, appendageal tumors, papular granuloma annulare, pyogenic granuloma, pyoderma.  In immunocompromised patients, infectious processes such as cryptococosis or histoplasmosis may mimic MC.