Photo Rounds Friday Archive
Bumps on abdomen
Post Date: 10/16/2009
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A 4-year-old boy was brought into the office because of bumps that had broken out on his abdomen 3 months earlier. He occasionally scratched them, but they were otherwise asymptomatic. His mother was unhappy with the appearance of the bumps and wanted them removed.
What's your diagnosis?
The physician diagnosed molluscum contagiosum. FIGURE 1 shows multiple firm 2- to 5-mm pearly dome-shaped papules. Some of them have a characteristic umbilicated center (FIGURE 2). Not all of the papules, though, have a central umbilication, so when confronted with this possible diagnosis, it helps to take a moment and look for a papule that has this characteristic morphology.
Molluscum contagiosum is a benign condition that is often transmitted through close contact in children and through sexual contact in adults. Molluscum contagiosum is a large DNA virus of the Poxviridae family of poxvirus. Treatment of nongenital lesions is usually unnecessary since the infection tends to be self-limited and spontaneously resolves after a few months. Patients and parents of children often want treatment for cosmetic reasons and when watchful waiting fails.
Excisional curettage or cryotherapy can be effective. Genital lesions should be treated to prevent spread by sexual contact. Curettage, cryotherapy, imiquimod 5%, cantharidin, tretinoin cream 0.1% or gel 0.025%, trichloroacetic acid, and laser therapies are commonly used. Note, though, that there are no medications that are FDA-approved for molluscum.
In this case, the mother was not willing to wait for the molluscum to resolve on its own, so the physician gave the patient a prescription for topical tretinoin cream to be applied nightly until resolution. While the evidence for imiquimod is stronger, the cost is over $500 for treatment.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Mayeaux, EJ. Molluscum contagiosum. In: Usatine R, Smith M, Mayeaux EJ, Chumley H, Tysinger J, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:518-521.
To learn more about The Color Atlas of Family Medicine, see: