Molluscum Contagiosum Differential Diagnoses

Updated: Aug 10, 2017
  • Author: Ashish C Bhatia, MD, FAAD; Chief Editor: Dirk M Elston, MD  more...
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DDx

Diagnostic Considerations

The cutaneous manifestations of other opportunistic infections, such as cutaneous cryptococcosis, histoplasmosis, and aspergillosis, may mimic molluscum contagiosum and must be ruled out in immunocompromised hosts. (See the images below.)

This lesion of cutaneous coccidioidomycosis could This lesion of cutaneous coccidioidomycosis could be included among the differential diagnoses of molluscum contagiosum.
This keratoacanthoma could be included among the d This keratoacanthoma could be included among the differential diagnoses of molluscum contagiosum.

Molluscum contagiosum may be randomly associated with other lesions, such as epidermal cysts, nevocellular nevi, sebaceous hyperplasias, and Kaposi sarcoma. Pseudocystic molluscum contagiosum, giant molluscum contagiosum, and molluscum contagiosum associated with other lesions are responsible for frequent clinical misdiagnoses.

Infection of children through sexual abuse is possible; however, to a greater extent than warts, molluscum contagiosum virus is quite common on the genital, perineal, and surrounding skin of children. [21, 22] Regard abuse as unlikely, unless other suspicious features are present.

Histologic or microscopic confirmation of molluscum contagiosum is indicated in patients who are immunocompromised because several life-threatening opportunistic infections may clinically mimic molluscum contagiosum.

Conditions to consider in the differential diagnosis of molluscum contagiosum include the following:

  • Keratoacanthoma
  • Verruca vulgaris (warts)
  • Eccrine poroma
  • Epidermal cyst
  • Foreign body granuloma
  • Lichen planus
  • Flat warts (verruca plana)
  • Pyoderma

Perforating disorders (all very rare in children) to consider in the differential diagnosis of molluscum contagiosum include the following:

  • Acquired reactive perforating dermatosis of renal failure
  • Kyrle disease
  • Perforating serpiginous elastoma
  • Perforating folliculitis
  • Verrucous perforating collagenoma
  • Perforating granuloma annulare

Differential diagnoses to consider in patients with AIDS include the following:

  • Cutaneous cryptococcus [23] : Cutaneous cryptococcus presents as molluscumlike eruptions (on the face, it often has a very dramatic appearance); the patient may have few or no other symptoms associated with cryptococcal meningitis.
  • Cutaneous coccidioidomycosis
  • Cutaneous histoplasmosis
  • Cutaneous aspergillosis

Differential Diagnoses