eMedicine Specialties > Infectious Diseases > Skin and Soft-Tissue Infections

Molluscum Contagiosum: Differential Diagnoses & Workup

Author: Ashish C Bhatia, MD, FAAD, Assistant Professor of Clinical Dermatology, Department of Dermatology, Northwestern University, Feinberg School of Medicine; Director of Clinical Research, Department of Dermatology and Dermatologic Surgery, River North Dermatology and Dermatologic Surgery, DuPage Medical Group
Coauthor(s): Tracy Campbell, MD, Staff Physician, Department of Dermatology, Rush Medical Center; Seth Forman, MD, Private Practice, Tampa, Florida; David Rowe, MD, Pathologist, Laboratory Medicine, Martha Jefferson Hospital; Robert Orenstein, DO, Associate Professor, Department of Medicine, Medical College of Virginia, Virginia Commonwealth University; Medical Director, Infectious Disease Clinic, Medical College of Virginia Hospitals; Julia R Nunley, MD, Professor, Program Director, Dermatology Residency, Department of Dermatology, Virginia Commonwealth University Medical Center
Contributor Information and Disclosures

Updated: Apr 1, 2008

Differential Diagnoses

Aspergillosis
Cryptococcosis
Basal Cell Carcinoma
Epitheliomas, Basal Cell
Coccidioidomycosis (Infectious Diseases)
Histoplasmosis
Condyloma Acuminatum
Varicella-Zoster Virus

Other Problems to Be Considered

Lichen planus
Flat warts (verruca plana)
Pyoderma

Workup

Laboratory Studies

  • Consider testing for HIV infection in patients with facial lesions.

Procedures

  • Skin biopsy: A biopsy of a lesion may be obtained to confirm the diagnosis of molluscum contagiosum histologically.
  • Squash preparation (microscopic examination of cellular exudate)  
    • The cellular material contained within the central umbilication may be extracted manually, flattened between 2 microscope slides, and stained.
    • Microscopic examination of this preparation reveals the intracytoplasmic molluscum inclusion bodies (Henderson-Paterson bodies).

Histologic Findings

The prototypical hematoxylin and eosin (H&E)–stained histological section of molluscum contagiosum reveals a cup-shaped indentation of the epidermis into the dermis (see Image 4). Within the region of the indentation, the epidermis appears thickened (acanthosis) compared to the surrounding uninvolved skin, and the cornified layer typically is disintegrated. The striking feature is the presence of intracytoplasmic, eosinophilic, granular inclusions within the keratinocytes of the basal, spinous, and granular layers of the epidermis (see Image 5). These inclusions, termed molluscum bodies or Henderson-Paterson bodies, can measure 35 µm in diameter and tend to displace the nucleus to the periphery of the cell. Ultrastructural studies have shown that the molluscum bodies are membrane-bound sacs that contain numerous molluscum contagiosum virions. The surrounding dermis is relatively unremarkable.

In nonprototypical cases, in which intradermal rupture of molluscum bodies occurs, an intense dermal inflammatory infiltrate consisting of lymphocytes, histiocytes, and occasional foreign body–type multinucleated giant cells may be observed. Rarely, metaplastic ossification may occur. Exceptionally, the dermal inflammatory infiltrate may be intense enough to simulate a cutaneous lymphoma (pseudolymphoma).

More on Molluscum Contagiosum

Overview: Molluscum Contagiosum
Differential Diagnoses & Workup: Molluscum Contagiosum
Treatment & Medication: Molluscum Contagiosum
Follow-up: Molluscum Contagiosum
Multimedia: Molluscum Contagiosum
References
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Further Reading

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Keywords

molluscum contagiosum, MC, molluscum contagiosum virus disease, MCV disease, opportunistic infection, sexually transmitted disease, STD, Henderson-Paterson body, Orthopoxvirus genus, renal transplantation, tacrolimus, topical immune suppressants, molluscum body

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Contributor Information and Disclosures

Author

Ashish C Bhatia, MD, FAAD, Assistant Professor of Clinical Dermatology, Department of Dermatology, Northwestern University, Feinberg School of Medicine; Director of Clinical Research, Department of Dermatology and Dermatologic Surgery, River North Dermatology and Dermatologic Surgery, DuPage Medical Group
Ashish C Bhatia, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American Medical Association, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, and Connective Tissue Oncology Society
Disclosure: Nothing to disclose.

Coauthor(s)

Tracy Campbell, MD, Staff Physician, Department of Dermatology, Rush Medical Center
Tracy Campbell, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Chicago Dermatological Society, and Women's Dermatologic Society
Disclosure: Nothing to disclose.

Seth Forman, MD, Private Practice, Tampa, Florida
Seth Forman, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Abbott Laboratories Honoraria Speaking and teaching

David Rowe, MD, Pathologist, Laboratory Medicine, Martha Jefferson Hospital
David Rowe, MD is a member of the following medical societies: United States and Canadian Academy of Pathology
Disclosure: Nothing to disclose.

Robert Orenstein, DO, Associate Professor, Department of Medicine, Medical College of Virginia, Virginia Commonwealth University; Medical Director, Infectious Disease Clinic, Medical College of Virginia Hospitals
Robert Orenstein, DO is a member of the following medical societies: Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Julia R Nunley, MD, Professor, Program Director, Dermatology Residency, Department of Dermatology, Virginia Commonwealth University Medical Center
Julia R Nunley, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Society of Nephrology, International Society of Nephrology, Medical Dermatology Society, Medical Society of Virginia, National Kidney Foundation, Phi Beta Kappa, and Women's Dermatologic Society
Disclosure: Johnson and Johnson stock holder dividends; Amgen stock holder dividends; Forest Lab, Inc stock holder dividends; Galaxo Smith Klein stock holder dividends; Covidien stock holder dividends; Novartis Grant/research funds Consulting; Biolex  sub-investigator

Medical Editor

Daniel R Lucey, MD, MPH, Chief, Fellowship Program Director, Department of Internal Medicine, Division of Infectious Diseases, Washington Hospital Center; Professor, Department of Internal Medicine, Uniformed Services University of the Health Sciences
Daniel R Lucey, MD, MPH is a member of the following medical societies: Alpha Omega Alpha and American College of Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

John W King, MD, Professor of Medicine, Chief, Section of Infectious Diseases, Director, Viral Therapeutics Clinics for Hepatitis, Louisiana State University Health Sciences Center; Consultant in Infectious Diseases, Overton Brooks Veterans Affairs Medical Center
John W King, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Association of Subspecialty Professors, Infectious Diseases Society of America, and Sigma Xi
Disclosure: emedicine $50.00 author of chapter

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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