Molluscum Contagiosum: How to Treat It in Children — Cantharidin, Cryotherapy, Waiting It Out | Siam Derm IOD
Molluscum contagiosum is a viral skin infection of the top layer of the skin, caused by a poxvirus called the molluscum contagiosum virus (MCV). It causes skin-coloured or pearly-white, smooth, shiny bumps 2–5 mm across, each with a tiny dimple in the centre. It is not cancer and it is not the HPV virus behind common warts. In people with a normal immune system it usually clears on its own within 6–18 months, but it spreads through skin contact and shared towels, and in adults it can spread through sexual contact.
This article explains how molluscum contagiosum in children, in adults, in the genital area and in people with a weakened immune system differ, which cases can be watched and which should see a doctor, and which medicines and procedures doctors actually use, with the time frame in which you should expect results.
What is molluscum contagiosum, and how is it different from common warts?
Many people hear the word "wart" and assume it is the same condition as warts on the hands or genital warts. In fact they are caused by different viruses, look different and are treated differently.
Cause: Molluscum contagiosum is caused by a poxvirus. Common warts and genital warts are caused by HPV (human papillomavirus).
Appearance: Molluscum bumps are smooth and shiny with a dimple in the centre (central umbilication). HPV warts are rough, hard or fleshy like a cauliflower.
Cancer risk: Molluscum does not turn into cancer and has nothing to do with cervical cancer, unlike some HPV types.
Inside the bump: If a bump breaks open, you will see white material like cooked rice or cheese, which is where the Thai name comes from. This material contains a lot of virus, so it is the part that spreads the infection most.
Vaccine: There is no vaccine against molluscum, and the HPV vaccine does not protect against it.
For a comparison of the different types of warts, read What causes warts, and how to tell the 5 types apart.
What causes molluscum contagiosum, and how does it spread?
Molluscum spreads when virus from a bump touches someone else's skin, or another area of the same person's skin. The most common routes are:
Direct skin contact, such as children playing closely, hugging or sleeping together, or adults having sex.
Shared items, such as towels, bath sponges, clothing, toys and swimming floats.
Spreading to other places on your own body (autoinoculation) by scratching, picking, squeezing or shaving. This is the main reason a few bumps become 20–30.
Swimming pools Several studies find that children who swim regularly get molluscum more often, but this is thought to be due to shared towels and equipment rather than the pool water.
Incubation period The time from catching the virus to the first bump is generally about 2–7 weeks, but can be up to 6 months. This is why some people have all the visible bumps treated and new ones still appear over the following weeks.
Factors that make it more widespread or longer lasting
Children aged about 1–10 years
Children with atopic dermatitis (eczema), dry, itchy skin and frequent scratching, as the bumps spread faster and last longer
People with a weakened immune system, for example untreated HIV infection, immunosuppressive medicines or chemotherapy
Adults who shave or wax the pubic area while they have bumps
What does molluscum contagiosum look like, and can you identify it yourself?
These features identify molluscum quite reliably:
Size: Mostly 2–5 mm. Very small bumps can be pinhead-sized. In people with a weakened immune system they can reach 1 cm or more (giant molluscum).
Colour: Skin-coloured, light pink or pearly white, with a shiny surface.
Shape: Dome-shaped, round, with smooth edges and a dimple in the centre, which becomes clearer as the bump grows or under a magnifying glass.
Pattern: Often in clusters, or in lines along scratch marks (Koebner phenomenon).
Symptoms: Usually painless. Some people have mild itching, especially if there is a red rash around the bumps.
If the bumps meet all of the criteria above, molluscum is very likely, but several other conditions look similar. In adults, especially a single bump on the face, a dermatologist should confirm the diagnosis, because early basal cell carcinoma can also be a shiny bump. Dermatologists can usually diagnose it by looking and with a skin microscope (dermoscopy). A biopsy is used only when the diagnosis is unclear.
Molluscum contagiosum in children
Appearance: Skin-coloured raised bumps with a central dimple, from a few to several dozen. Common on the trunk, armpits, inner elbows, behind the knees, inner thighs and buttocks. Sometimes found around a child's genitals, which in most children is from scratching and spreading and does not always mean sexual abuse, but doctors will always assess it together with other context.
Cause: Caught from classmates or siblings through close contact, towels and toys, then spread across the body by scratching.
Severity/urgency: Low. It is harmless and clears on its own in healthy children. The main problems are how long it lasts, the nuisance, and parents' worry.
When to see a doctor: See a doctor if any of the following apply
Bumps on the eyelid or the edge of the eye
Bumps multiply very fast within a few weeks, or there are more than 50
A red, itchy rash around the bumps, with the child scratching until they cannot sleep
Red, painful, pus-filled bumps, or the child has a fever
You are not sure whether it is molluscum or another condition
Molluscum contagiosum in adults
Appearance: In adults with a normal immune system there are usually few bumps, 1–20, in the lower abdomen, pubic area, inner thighs and genitals. Bumps on the face or trunk in adults usually come from close contact with a child who has it, or from contact sports.
Cause: In adults it is mostly caught through sexual contact or close skin-to-skin contact, and spread on the body by shaving or waxing.
Severity/urgency: The condition itself is not dangerous, but when an adult has molluscum in the genital area, doctors usually recommend screening for other sexually transmitted infections such as HIV and syphilis, because the route of spread is the same.
When to see a doctor: See a doctor if any of the following apply
You are an adult with bumps in the genital area. Every case should be checked
Many bumps on the face, or bumps larger than 1 cm
Bumps keep increasing for longer than 3–6 months
A single bump on the face in an older adult, which must be told apart from skin cancer
Molluscum contagiosum in the genital area, in women and men
Searches for "molluscum in women" and "molluscum female genitals" are many times more common than searches about molluscum in children, because people are embarrassed to ask. This section is therefore set out clearly.
Appearance: Round, shiny bumps with a dimple, on the pubic area, outer labia, groin, inner thighs, base of the penis or scrotum. They usually do not appear on inner mucous membranes such as inside the vagina, unlike genital warts, which can grow on mucous membranes.
Cause: Caught through skin contact during sex. Condoms reduce the risk to some extent but cannot prevent it completely, because the bumps are on the surrounding skin that a condom does not cover. Shaving or waxing clearly increases the spread of bumps in lines.
Severity/urgency: It is not dangerous for pregnancy or fertility and does not cause cervical cancer, but you should see a doctor to tell it apart from genital warts and herpes, which are treated differently and call for different care of sexual partners.
When to see a doctor: See a doctor every time a new bump appears in the genital area, especially if there are sores, pain, clear blisters or abnormal vaginal discharge.
What to do while you have it
Stop shaving or waxing the area. Trim hair with scissors instead
Avoid sex until all the bumps have cleared, or use a condom and avoid touching the areas with bumps
Tell your partner to watch for signs, and be tested for other sexually transmitted infections as your doctor advises
If you are not sure whether it is molluscum, genital warts or milia, read more on telling them apart at What causes genital warts, and how to tell them from molluscum. If it is clear blisters that break into painful sores, see Genital herpes: what it looks like and how many days it takes to clear
Molluscum contagiosum in people with a weakened immune system
Appearance: Very many bumps, from dozens to hundreds, which can be larger than 1 cm, on the face, eyelids and neck, and which come back quickly after treatment.
Cause: The body cannot clear the virus. Seen in people with HIV with very low immunity (especially CD4 below 100–200 cells/mm³), organ transplant recipients, and people on long-term immunosuppressive medicines or high-dose oral steroids.
Severity/urgency: Moderate to high. The warts themselves are not dangerous, but they signal an immune problem, and bumps in this group can look like more serious fungal infections such as cryptococcosis or talaromycosis, which need urgent treatment.
When to see a doctor: Immediately, if you are an adult with bumps spread across the face or unusually large bumps, especially with weight loss, long-lasting fever or long-lasting diarrhoea. The doctor may recommend a blood test for HIV and a biopsy to confirm. The most effective treatment in this group is restoring immunity, for example starting HIV antiviral treatment, which can make the bumps shrink on their own.
Molluscum contagiosum on the face and eyelids
Appearance: Small shiny bumps on the eyelid margin, inner corner of the eye or cheek. If they are on the edge of the eye there may be a red eye, irritation and long-lasting discharge on the same side.
Cause: Virus from the bumps keeps falling into the conjunctiva, causing follicular conjunctivitis that does not clear with ordinary eye drops.
Severity/urgency: Moderate. The bumps are not dangerous, but if the eye stays inflamed for a long time the cornea can be affected.
When to see a doctor: See a dermatologist together with an eye doctor. Do not use strongly irritating medicines such as potassium hydroxide or cantharidin near the eyes yourself. Bumps on the eyelid margin usually need to be carefully curetted by a doctor.
What does the red rash around molluscum bumps, and the BOTE sign, mean?
Many parents are alarmed when bumps that had been quiet suddenly turn red and swollen, some with white pus, and they assume a bacterial infection. In fact it usually is not.
Appearance: There are two common patterns. The first is one or several bumps that turn red, swollen and raised like a boil (called the BOTE sign, short for beginning of the end). The second is a red, dry, itchy rash around a group of bumps (molluscum dermatitis), seen in about 1 in 3 children with molluscum.
Cause: The immune system starts to recognise and attack the virus. Bumps that become inflamed like this usually settle within 2–4 weeks, and it is often a sign that the other bumps will begin to clear too.
Severity/urgency: Mostly low. Antibiotics are not needed.
When to see a doctor: If the redness spreads wider than 1–2 cm around a bump, or there is severe pain, fever, discharging pus, or honey-yellow crusts, which may be a true bacterial infection.
Caring for the red rash around bumps: Apply moisturiser twice a day. If it is very itchy, the doctor may prescribe a mild steroid cream such as hydrocortisone 1%, applied only to the red rash around the bumps once or twice a day for no more than 1–2 weeks, to reduce scratching, which is what spreads the bumps. If it is a true bacterial infection, the doctor may use an antibiotic ointment such as mupirocin 2% three times a day for 5–7 days.
Is molluscum contagiosum dangerous or serious?
The short answer: in people with a normal immune system, molluscum is not serious. It does not spread to internal organs, does not become cancer and clears on its own. The only problems that can really occur are
It lasts a long time, from several months to more than a year
Small pitted scars can occur in some people, especially from bumps that were picked, squeezed or badly inflamed
Temporary white or dark marks after the bumps clear or after cryotherapy
Secondary bacterial infection from picking and scratching
Conjunctivitis if bumps are on the edge of the eye
Worry and effects on daily life, such as a child being teased or an adult worrying about sex
What to watch for is unusually widespread molluscum in an adult, which can signal an impaired immune system, as described above.
Does molluscum contagiosum clear on its own, and how many months does it take?
It clears on its own because the immune system eventually clears the virus. The figures used when talking with patients in the clinic are
Each individual bump lasts about 2–3 months and then shrinks on its own
The whole course of the disease in children averages about 13 months. A UK follow-up study of children found that about half cleared within 12 months and about 2 in 3 within 18 months. A minority still have it after 2 years.
Children with atopic dermatitis usually have it for longer and have more bumps
After the bumps clear the skin mostly returns to normal. Bumps that were not picked usually leave no marks
The reason it is still worth knowing the treatment options even though it clears on its own: some families cannot wait 12–18 months, the bumps are in places that rub often, a child scratches and keeps spreading it, or an adult wants to reduce the chance of passing it to a partner.
How is molluscum contagiosum treated, and when to wait or treat
Dermatology and paediatric guidelines in many countries agree that in a healthy child, waiting for it to clear on its own (watchful waiting) is a reasonable choice, and that treatment does not make it clear much faster overall, because new bumps can still appear from virus that is incubating.
Treatment is usually recommended when
The patient is an adult, especially with genital bumps, to reduce spread
There are bumps on the edge of the eye, or there is conjunctivitis
There are many bumps that are increasing quickly, with an itchy rash and constant scratching
Bumps are in a place that rubs, hurts or breaks open often
The patient or parents are very worried, or there is a clear emotional effect
Weakened immune system
The choice of method depends on age, number of bumps, location, how much pain the child can tolerate and the family's wishes. Choosing medicines and procedures is the doctor's decision after examination. The information below is to help you understand how each method works.
Clinic treatments for molluscum: curettage, cryotherapy and cantharidin
Curettage (scraping the bumps out)
The doctor uses a small curette to scrape the white material out of each bump, one at a time. It is the fastest method, and a bump that has been scraped usually does not come back in the same spot.
Preparation: In children, the doctor may apply a numbing cream containing lidocaine 2.5% and prilocaine 2.5% (lidocaine/prilocaine) under a cover for about 60 minutes beforehand. The amount must be limited by the child's weight, and it must not be applied over a wider area than allowed.
Suitable for: A small number of bumps, adults, genital bumps, and bumps on the eyelid margin when done by an experienced doctor.
Limitations: Mild pain and pinpoint bleeding, and in some people it may leave small pitted marks. A young child with dozens of bumps may not be able to tolerate it.
Cryotherapy with liquid nitrogen
The doctor sprays liquid nitrogen on each bump for about 5–10 seconds, freezing it with a narrow white ring around the bump.
Frequency: Repeated every 2–4 weeks until the bumps are gone, usually 1–3 sessions.
Suitable for: Adults and older children who can tolerate cold and stinging.
Limitations: Stinging, and clear blisters can form within 24–48 hours. It may leave white or dark marks, especially in people with darker skin. Not suitable for bumps on the face of young children.
Cantharidin
Cantharidin is a substance that makes the top layer of skin blister. When the blister dries and comes off, the wart bump comes off with it. In many countries there is a standard 0.7% formulation approved for children aged 2 years and over.
How it is done: The doctor dabs a small amount only onto the bumps (patients must not apply it themselves) and it is washed off with soap and water after 2–6 hours as the doctor specifies. The first time usually starts with a short duration to see how the skin responds.
What happens: Blisters form within 24–48 hours and dry into scabs within about 1 week.
Frequency: Repeated every 2–4 weeks until the bumps are gone.
Advantages: Painless when applied, suitable for children who are afraid of needles or cold.
Precautions: Must not be used on the face, around the eyes, on the genitals or on thin skin. Blisters can become large or painful. Not used in pregnant women.
What creams treat molluscum, and how well do they work?
The question "what cream to use for molluscum" is asked very often. The straight answer is that every topical medicine works gradually, takes several weeks, and the evidence is still weaker than for curettage or cantharidin. The medicines dermatologists actually use are as follows.
Potassium hydroxide (KOH) 5–10% solution: Dab only on the bumps once or twice a day with a small cotton bud, and stop dabbing a bump once it becomes red and inflamed. Most people use it for 2–4 weeks, and some for up to 8–12 weeks. Comparison studies found it works better than placebo. Side effects are stinging, irritation and temporary dark or pale marks. Do not use near the eyes or mucous membranes.
Tretinoin 0.025–0.05% cream: Apply a thin layer on the bumps at bedtime. It causes mild inflammation to help the body clear the virus. The evidence is limited, so it is used as a supporting option. Do not use in pregnancy.
Podophyllotoxin 0.5%: Used in some adults with genital bumps. Apply twice a day for 3 days in a row, then stop for 4 days, in cycles of no more than 4. Do not use in pregnant women or children.
Cidofovir antiviral cream 1–3%: Reserved for patients with a weakened immune system who have severe bumps that resist other methods. It must be under the care of a specialist.
Medicine not recommended in children: Imiquimod 5% cream, an immune-stimulating medicine used for genital warts. A large randomised study in children found it was no better than placebo but caused more redness and stinging, so it is not recommended for molluscum in children.
Signs the cream is working: The bumps start to turn red and inflamed, then dry and shrink within 2–6 weeks, with no new bumps. Signs you should go back to the doctor: The bumps are unchanged after 4–6 full weeks of use, the skin around the bumps stings and blisters over a wide area, or the bumps keep increasing.
Treating molluscum yourself: what you can and should not do
Searches for "how to treat molluscum yourself" are frequent. What you can safely do at home is stop it spreading and keep the skin healthy, not remove the bumps yourself.
What you can do
Keep the child's nails short to reduce scratching
Moisturise the whole body twice a day, especially for children with dry skin or eczema
Cover bumps in places that are often scratched or rubbed with a plaster or clothing
Use separate towels, sponges and personal items
Bathe the affected child separately from siblings, or bathe the affected person last
What you should not do
Squeeze, pick or dig at the bumps yourself. This spreads the virus, increases the bumps, causes bacterial infection and scarring
Use high-strength salicylic acid wart remedies from a pharmacy without asking a doctor, especially on the face and genitals
Apply tea tree oil, apple cider vinegar, garlic or herbal remedies yourself. There is not enough good evidence, and they can burn and irritate the skin
Use leftover imiquimod cream from someone else
Can a child with molluscum go to school or swim?
They can go to school or nursery. Paediatric guidelines in many countries do not recommend keeping children home because of molluscum. Just cover bumps in visible or easily touched areas with clothing or a plaster.
They can swim if the bumps are covered with a waterproof plaster or the child wears a long-sleeved swimsuit, and does not share towels, floats or goggles with others.
Close-contact sports such as wrestling or judo: cover all bumps completely. If they cannot be covered, stay out temporarily.
At home Keep towels and sleepwear separate, and wash them in warm water with ordinary detergent. There is no need to disinfect the whole house.
Molluscum contagiosum and look-alike conditions: how to tell them apart
Genital warts: Rough, cauliflower-like growths that can grow on mucous membranes — no central dimple, caused by HPV.
Common warts: Rough, hard skin with tiny black dots — not shiny, no dimple.
Acne or heat rash: Has a head, changes quickly within 3–7 days — no smooth dimple, arises at hair follicles.
Milia: Small hard white bumps 1–2 mm under the skin — no dimple, not contagious.
Sebaceous hyperplasia: Yellow bumps on the face of adults that can have a dimple — yellow, with blood vessels around them, not contagious.
Chickenpox: Clear blisters on a red base, with fever, appearing in several stages at once — blisters, not firm fleshy bumps, clears in 1–2 weeks.
Basal cell carcinoma: A single shiny bump on the face of an older adult, with fine blood vessels — keeps growing slowly, can break into a sore, does not clear on its own.
Skin tags: Soft hanging growths on a stalk, on the neck and armpits — no dimple, do not form spreading clusters.
Read more about skin tags at What causes skin tags, and how to tell them from warts and moles, and an overview of other skin conditions at the skin conditions article hub
Molluscum contagiosum in pregnancy
Pregnant women can get molluscum like anyone else, and the immune changes of pregnancy may make the bumps multiply somewhat. Things to know:
The virus does not cross the placenta and does not cause birth defects
Medicines that must not be used in pregnancy are podophyllotoxin, tretinoin and cantharidin
The methods that can be used are curettage or cryotherapy by a doctor, or waiting for it to clear after delivery
If there are genital bumps close to the due date, tell your obstetrician, but in general it is not a reason for a caesarean section
Can molluscum contagiosum come back, and how can you prevent it?
It can come back for two reasons. First, new bumps that appear after treatment mostly come from virus that was already incubating 2–7 weeks earlier, and are not a treatment failure. Second, immunity to the virus is not permanent, so you can catch it again on further exposure.
Ways to reduce the chance of catching it and getting it again
Do not share towels, razors, sponges or clothing
Keep dry skin and eczema calm, because inflamed skin is the way in for the virus
Adults: use condoms and do not shave the pubic area while bumps remain
Check household members or partners. If they have similar bumps, care for them at the same time
When to see a dermatologist
You are not sure whether it is molluscum or another condition
An adult with bumps in the genital area
Bumps on the eyelid, or a red eye that lasts on one side
Bumps larger than 1 cm, or spread across the face in an adult
Bumps multiplying fast, or lasting longer than 12–18 months
A red itchy rash around the bumps that stops sleep, or fever, pain and spreading pus
People with a weakened immune system, or pregnant women
What to prepare before seeing the doctor: Note when the first bump appeared and roughly how many there are, take photos over time for comparison, and list any medicines already tried and any history of eczema or other medical conditions.
In brief
Molluscum contagiosum is caused by a poxvirus, not HPV. The bumps are shiny, 2–5 mm, with a central dimple.
In healthy children it is not dangerous and clears on its own, about 2–3 months per bump and about 13 months on average for the whole course.
Adults with genital bumps should see a doctor and be tested for other sexually transmitted infections.
Red, inflamed bumps (BOTE sign) are mostly a sign it is about to clear, not an infection.
Doctors' methods are curettage, cryotherapy, cantharidin or KOH 5–10% cream. Imiquimod is not recommended in children.
Do not squeeze or pick. Cut nails, moisturise and use separate towels.
Frequently asked questions about molluscum contagiosum
What is molluscum contagiosum?
Molluscum contagiosum is a viral skin infection caused by a poxvirus, causing skin-coloured or pearly-white, smooth, shiny bumps 2–5 mm across with a central dimple, containing white material like cooked rice. It is common in children aged 1–10 and in adults who catch it through sex. It spreads through skin contact and shared items. In people with a normal immune system it is not dangerous and clears on its own within 6–18 months, but see a doctor if the bumps are on the eye or genitals, or are unusually numerous.
Is molluscum contagiosum the same as HPV?
No. Molluscum is caused by the molluscum contagiosum virus, which belongs to the poxvirus group. HPV is the virus that causes common warts and genital warts. The key difference is that molluscum does not raise the risk of cervical or other cancers, the HPV vaccine does not prevent it, and they look different. Molluscum is smooth and shiny with a central dimple, while genital warts are rough and cauliflower-like. If you have bumps in the genital area and are unsure which it is, have a doctor examine them, because treatment and care of sexual partners differ.
What cream do you use for molluscum contagiosum?
The topical medicine dermatologists use most often is potassium hydroxide (KOH) 5–10%, dabbed only on the bumps once or twice a day and stopped when the bumps start to turn red and inflamed, usually for 2–4 weeks. Other options are tretinoin 0.025–0.05% at bedtime and, in adults with genital bumps, podophyllotoxin 0.5%. Cantharidin must be applied by a doctor at the clinic only. Imiquimod is not recommended in children because studies found it no different from placebo. Every medicine can cause stinging and irritation, none should be used near the eyes, and the choice of medicine should be set by a doctor.
Does molluscum contagiosum go away on its own?
Yes. Each bump usually lasts about 2–3 months and then shrinks, but the whole course in children averages about 13 months because new bumps keep appearing from scratching and virus that is still incubating. About half clear within 12 months and about 2 in 3 within 18 months. If you see bumps turn red and swollen like inflammation, it is usually a sign that the immune system has started to clear the virus, and they settle within 2–4 weeks. If an adult's bumps do not shrink at all for several months or keep increasing, see a doctor.
Is molluscum contagiosum dangerous?
In people with a normal immune system, molluscum is not dangerous, does not spread to internal organs and does not become cancer. The harms that can occur are lasting for several months, small pitted scars if picked or squeezed, marks after treatment, secondary bacterial infection from scratching, and conjunctivitis if the bumps are on the edge of the eye. What to watch for is an adult with many bumps, bumps larger than 1 cm or bumps across the face, which may be a sign of an impaired immune system such as untreated HIV infection. In that case see a doctor promptly.
What causes molluscum contagiosum on the female genitals, and what should you do?
In adult women, molluscum on the pubic area, labia or groin is mostly caught through skin contact during sex, and often spreads further through shaving or waxing. The bumps are not dangerous to fertility and are not related to cervical cancer. What to do: see a doctor to confirm it is not genital warts or herpes, stop shaving the area, avoid sex or use a condom until the bumps clear, and be tested for other sexually transmitted infections as your doctor advises. A commonly used treatment is curettage or cryotherapy by a doctor, which reduces spread to a partner faster than waiting for it to clear on its own.
Written by Dr. Patara Voravutinon, Dermatologist · Last reviewed September 28, 2026
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