What are the physical exam findings of molluscum contagiosum?

Physical Examination Findings of Molluscum Contagiosum

Molluscum contagiosum presents as skin-colored papules that develop a characteristic central umbilication as they age. 1

Key Physical Examination Findings

• Skin-colored, whitish, or pink papules with a shiny surface and central umbilication (depression) 1
• Typically 2-5 mm in size, though can vary 2
• Most commonly affects the trunk, face, and extremities in children 1
• Lesions are firm, rounded, and dome-shaped 3
• Multiple lesions are often present, sometimes clustered 2

Dermoscopic Findings

• Yellowish-white polylobulated structures with peripheral telangiectasia can be seen on dermoscopy 2
• This is a useful clinical tool for diagnosis when available 3

Distribution Patterns

• In children: commonly affects trunk, face, and extremities 1
• In adults: genital areas may be involved if sexually transmitted 4
• In immunocompromised patients: can be more extensive with atypical presentations 1
• Eyelid involvement may cause associated conjunctivitis 1

Associated Findings

• Mostly asymptomatic but may present with pain, itching, redness 1
• Occasional bacterial superinfection 1, 3
• May have associated inflammatory reactions such as:
  • Perilesional eczema 2
  • Erythema around lesions (BOTE sign - Beginning Of The End) 2
  • Follicular reactions 2

Atypical Presentations

• Giant molluscum: larger than typical lesions, may be ulcero-proliferative 5
• In immunocompromised patients (especially HIV): multiple, large lesions that may resemble other conditions 1
• Umbilicated papules resembling molluscum contagiosum can be seen in cryptococcal infections in HIV patients 1

Diagnostic Clues

• The central umbilication is pathognomonic 3
• When examining eyelid lesions, look for associated conjunctivitis which may be mild to severe with follicular reaction 1
• In children with unexplained eczematous patches, examine for molluscum lesions within or near the patches 2

Clinical Course

• Lesions typically persist for 6-12 months but can last up to 4 years 1
• In immunocompetent individuals, they are generally self-limited 3
• In immunocompromised patients, lesions may persist longer and be more extensive 1

Remember that diagnosis is typically clinical based on the characteristic appearance of umbilicated papules, but dermoscopy or skin biopsy may be used in atypical cases 3, 2.