Molluscum contagiosum differential diagnosis

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Molluscum contagiosum Microchapters

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Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Molluscum contagiosum from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic criteria

History and Symptoms

Physical Examination

Laboratory Findings

X ray

Ultrasound

CT Scan

MRI

Other Imaging Studies

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2], João André Alves Silva, M.D. [3]

Overview

Molluscum contagiosum must be differentiated from other diseases that cause infection of the skin and of the mucous membranes, including chickenpox, herpes zoster, erythema multiforme, among others.

Differential Diagnosis

  • Skin lesions due to cryptococcosis, histoplasmosis, or Penicillium marneffei infection may resemble molluscum lesions.
  • Other lesions that may be mistaken for molluscum contagiosum include flat warts, condyloma acuminatum, pyogenic granuloma , adnexal tumors, Langerhans cell histiocytosis , basal cell carcinoma , and amelanotic melanoma. Skin biopsy is useful for distinguishing molluscum contagiosum from other disorders.

Lesions that may be mistaken for molluscum contagiosum

Disease Features Images
Cryptococcosis 
  • An infection acquired by inhalation of soil contaminated with the encapsulated yeast (fungus) Cryptococcus neoformans
  • May be completely asymptomatic, or may have latent infection or symptomatic disease.
  • Pneumonia-like illness with fever, cough, sputum production and chest pain.
  • May cause meningoencephalitis presenting with headache, nausea, vomiting, altered sensorium and focal neurological deficits.

Histoplasmosis
  • Acquired via inhalation of airborne microconidia.
  • Can present with:
    • Acute pulmonary histoplasmosis presenting with fever, cough and dyspnea
    • Skin rash
    • Symmetrical joint pain
    • Disseminated histoplasmosis presents with features of sepsis, acute respiratory distress syndrome and disseminated intravascular coagulation

Penicillium marneffei
Condyloma acuminatum
  • Spread through direct skin-to-skin contact during oral, genital, or anal sex with an infected partner.
  • Often occur in clusters and can be very tiny or can spread into large masses in the genital or penis area.

Pyogenic granuloma

Langerhans cell histiocytosis

Basal cell carcinoma
  • Develop in the basal cell layer of the skin.
  • Cumulative DNA damage leads to mutations, after sunlight exposure.
  • Skin growths on sun-exposed skin

Amelanotic melanoma
  • Amelanotic or hypomelanotic lesions or maybe nodular and desmoplastic subtypes
  • Lesions may present as pink or red macules, plaques, or nodules, often with well-defined borders
  • Often clinically confused with benign lesions

Disease Features
Impetigo 
  • It commonly presents with pimple-like lesions surrounded by erythematous skin. Lesions are pustules, filled with pus, which then break down over 4-6 days and form a thick crust. It's often associated with insect bites, cuts, and other forms of trauma to the skin.
Insect bites
  • The insect injects formic acid, which can cause an immediate skin reaction often resulting in a rash and swelling in the injured area, often with formation of vesicles.
Kawasaki disease
Measles
Monkeypox
  • The presentation is similar to smallpox, although it is often a milder form, with fever, headache, myalgia, back pain, swollen lymph nodes, a general feeling of discomfort, and exhaustion. Within 1 to 3 days (sometimes longer) after the appearance of fever, the patient develops a papular rash, often first on the face. The lesions usually develop through several stages before crusting and falling off.
Rubella
Atypical measles
Coxsackievirus
  • The most commonly caused disease is the Coxsackie A disease, presenting as hand, foot and mouth disease. It may be asymptomatic or cause mild symptoms, or it may produce fever and painful blisters in the mouth (herpangina), on the palms and fingers of the hand, or on the soles of the feet. There can also be blisters in the throat or above the tonsils. Adults can also be affected. The rash, which can appear several days after high temperature and painful sore throat, can be itchy and painful, especially on the hands/fingers and bottom of feet.
Acne
Syphilis It commonly presents with gneralized systemic symptoms such as malaise, fatigue, headache and fever. Skin eruptions may be subtle and asymptomatic It is classically described as:
Molluscum contagiosum
  • The lesions are commonly flesh-colored, dome-shaped, and pearly in appearance. They are often 1-5 millimeters in diameter, with a dimpled center. Generally not painful, but they may itch or become irritated. Picking or scratching the lesions may lead to further infection or scarring. In about 10% of the cases, eczema develops around the lesions. They may occasionally be complicated by secondary bacterial infections.
Mononucleosis
Toxic erythema
  • It is a common rash in infants, with clustered and vesicular appearance.
Rat-bite fever
  • It commonly presents with fever, chills, open sore at the site of the bite and rash, which may show red or purple plaques.
Parvovirus B19
  • The rash of fifth disease is typically described as "slapped cheeks," with erythema across the cheeks and sparing the nasolabial folds, forehead, and mouth.
Cytomegalovirus
Scarlet fever
Rocky Mountain spotted fever
Stevens-Johnson syndrome
  • The symptoms may include fever, sore throat and fatigue. Commonly presents ulcers and other lesions in the mucous membranes, almost always in the mouth and lips but also in the genital and anal regions. Those in the mouth are usually extremely painful and reduce the patient's ability to eat or drink. Conjunctivitis of the eyes occurs in about 30% of children. A rash of round lesions about an inch across, may arise on the face, trunk, arms and legs, and soles of the feet, but usually not on the scalp.
Varicella-zoster virus
  • It commonly starts as a painful rash on one side of the face or body. The rash forms blisters that typically scab over in 7-10 days and clears up within 2-4 weeks.
Chickenpox
  • It commonly starts with conjunctival and catarrhal symptoms and then characteristic spots appearing in two or three waves, mainly on the body and head, rather than the hands, becoming itchy raw pox (small open sores which heal mostly without scarring). Touching the fluid from a chickenpox blister can also spread the disease.
Meningococcemia
Rickettsial pox
Meningitis

References

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  3. Nthumba PM (2008). "Giant pyogenic granuloma of the thigh: a case report". J Med Case Reports. 2 (1): 95. doi:10.1186/1752-1947-2-95. PMC 2329656. PMID 18377654.
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  8. Langerhans cell histiocytosis. Radiopeadia (2015) http://radiopaedia.org/articles/langerhans-cell-histiocytosis Accessed on February, 3 2016
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