Molluscum Contagiosum: Causes, Symptoms, and How to Treat Those Tiny Bumps

You noticed a cluster of small, shiny bumps on your child's skin, or maybe your own, and now you are wondering if it is something to worry about. Take a breath. Molluscum contagiosum is a common, harmless viral skin infection that almost always clears on its own, without scarring.

It can be persistent and a little annoying, and yes, it can spread, but it is rarely a medical emergency. Here is what those bumps actually are, how long they tend to stick around, and when it makes sense to treat them.

What is molluscum contagiosum?

Molluscum contagiosum is a benign, superficial skin infection caused by a poxvirus called the molluscum contagiosum virus (genus Molluscipoxvirus), which has at least four viral subtypes. The virus infects the top layers of the skin and produces small bumps, but it does not spread internally or cause serious illness in people with healthy immune systems.

It is very common, especially in children ages 1 to 10, and it occurs worldwide. It tends to be more common in warm climates and crowded environments. In adults, it can also appear, often in people with weakened immune systems or after sexual contact.

What do the bumps look like?

The hallmark of molluscum contagiosum is a distinctive bump that is easy to recognize once you know what to look for. The lesions are dome-shaped, firm, round, and pearly or flesh-colored, with a tiny dent or dot in the center (called central umbilication). They are usually painless.

The bumps can range in size from a pinhead to a pencil eraser. From the center, a small white core known as a molluscum body can sometimes be expressed. They may appear alone or in clusters anywhere on the skin.

• Small, dome-shaped, pearly or flesh-colored papules
• A central dimple, dent, or dot in the middle
• Size ranges from a pinhead to a pencil eraser
• Usually firm and painless, may itch
• Often appear in small groups or clusters

How long does molluscum contagiosum last?

This is the question most parents and patients want answered, and the reassuring news is that molluscum contagiosum is self-limited. In people with healthy immune systems, the bumps typically clear on their own and go away without leaving a trace.

Estimates of exactly how long this takes vary by source, but they all point to the same picture: it resolves over months, not days. The American Academy of Dermatology notes that untreated bumps clear in an average of 6 to 18 months. The CDC describes typical spontaneous resolution within 6 to 12 months, though some cases take as long as 4 years. Mayo Clinic states that, left untreated, bumps usually disappear in 6 months to 2 years.

• AAD: average clearance in 6 to 18 months
• CDC: usually within 6 to 12 months (occasionally up to 4 years)
• Mayo Clinic: usually 6 months to 2 years

How does it spread?

Molluscum contagiosum spreads through direct contact with the virus. The most common route is touching the bumps of an infected person, but it can also spread through contaminated objects such as towels, goggles, pool kickboards, and toys.

It can also spread on the same person through a process called autoinoculation, which happens when someone scratches a bump and moves the virus to nearby skin. In adults, the infection is frequently passed through sexual contact. Because scratching spreads it, gentle care and resisting the urge to pick can make a real difference in keeping the bumps from multiplying.

How is molluscum contagiosum treated?

Because the infection usually clears on its own and rarely causes harm, dermatologists often recommend watchful waiting for healthy children and adults. Treatment is considered when the bumps are painful, itchy, or infected, when the person has eczema, or when they are likely to spread the infection to others.

When treatment is chosen, there are several FDA-approved options. In-office cantharidin is approved for adults and children ages 2 and older. At-home prescription options include imiquimod cream, typically applied 2 to 3 times weekly, and berdazimer gel, approved for patients 1 year and older. In the phase 3 B-SIMPLE4 trial, the largest molluscum contagiosum medication trial to date with 891 patients across 55 US clinics, berdazimer 10.3% gel achieved complete lesion clearance at week 12 in 32.4% of patients compared with 19.7% on the vehicle. Your clinician can help you decide whether to treat at all, and which approach fits your situation.

When should you see a doctor?

Most cases of molluscum contagiosum do not need urgent care, but there are times when checking in with a clinician is the right move. See a doctor if the bumps become painful, red, swollen, or look infected, if they spread widely, or if they are bothering you cosmetically or emotionally.

People with weakened immune systems, including those with HIV or other immune deficiencies, can develop extensive or troublesome cases and should be evaluated. It is also worth a visit if you are unsure whether the bumps are actually molluscum, since a clinician can confirm the diagnosis. If you would like a convenient way to get your skin reviewed, a personalized assessment through a clinician-overseen service like Nolla can help you decide on next steps.