Molluscum Contagiosum on Palms and Soles
Yes, molluscum contagiosum can appear on the palms and soles, though this is an uncommon and atypical presentation that occurs primarily in adults rather than children.
Distribution Patterns
Molluscum contagiosum typically affects the trunk, face, and extremities in children, with palmar and plantar involvement being distinctly rare 1, 2. The characteristic presentation consists of skin-colored, whitish, or pink papules with a shiny surface and central umbilication 1, 2.
Evidence for Plantar/Palmar Involvement
Plantar molluscum contagiosum, while uncommon, is well-documented in the medical literature. A comprehensive review identified 34 previously reported cases of plantar MC, with patients being predominantly immunocompetent and having a median age of 21 years 3. Key features of plantar presentations include:
- Giant lesions are characteristic: More than 75% of plantar cases presented with giant MC (≥1 cm in diameter), which is notably larger than typical lesions 3
- Pain is a common presenting symptom: Unlike typical MC which is asymptomatic, plantar lesions frequently cause pain while walking 3
- Diagnostic confusion is common: Plantar verruca (warts) is often initially suspected, with definitive diagnosis requiring histopathologic confirmation 3, 4
- Number of lesions varies: Patients typically present with 1-3 lesions, though some have more than 5 3
Additional case reports confirm plantar MC can occur even in elderly patients, presenting as pale, pearly, verrucoid lesions on the heel 4.
Clinical Implications
When evaluating suspected plantar or palmar MC, consider the following diagnostic approach:
- Examine for the characteristic umbilicated appearance, though this may be less obvious on thickened palmar/plantar skin 1, 3
- Look for the shiny, dome-shaped quality of lesions even without clear umbilication 2
- Consider biopsy if clinical diagnosis is uncertain, as plantar warts are the primary differential diagnosis 3, 4
- Assess for immunocompromised status if lesions are multiple and large, as this may indicate underlying HIV or other immunodeficiency 2, 5
Treatment Considerations
Physical removal methods remain first-line therapy for symptomatic plantar/palmar lesions 2, 5. Options include:
- Incision and curettage 5
- Simple excision or excision with cautery 5
- Cryotherapy with liquid nitrogen 2, 5
Removal or destruction of plantar lesions results in definitive treatment, with resolution of associated pain 3.
Common Pitfalls
- Do not dismiss atypical locations: While uncommon, palmar and plantar MC does occur and should be included in the differential diagnosis of papular lesions in these locations 3, 4
- Do not assume immunocompromise: Most reported cases of plantar MC occurred in immunocompetent individuals 3
- Do not confuse with plantar warts: The verrucoid appearance on weight-bearing surfaces can mimic warts, but histopathology will show characteristic intracytoplasmic inclusion bodies 3, 4