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Keratin Bumps (Molluscum)

What is Keratin Bumps (Molluscum)?

Keratin bumps, more commonly referred to as molluscum contagiosum, are small, firm, dome‑shaped papules that develop in the skin’s outer layer (the epidermis). They are caused by the Molluscum contagiosum virus (MCV), a member of the poxvirus family. The lesions are usually painless, smooth, and have a characteristic central dimple or “umbilication.” While the condition is benign and often resolves on its own, the bumps can be cosmetically concerning and may spread to other body areas or individuals if not managed properly.

The term “keratin bumps” originates from the fact that the lesions are filled with keratinous (protein‑rich) material. In clinical practice, the name “molluscum” remains the preferred terminology. The condition can affect children, adolescents, and adults, and it is most common in warm, humid environments and among people with a weakened immune system.

Common Causes

Although the direct cause is infection with MCV, several factors increase the likelihood of acquiring or spreading the virus:

• Direct skin‑to‑skin contact – playing, sports, or sexual activity.
• Contact with contaminated objects – towels, clothing, toys, or gym equipment.
• Skin trauma – abrasions, scratching, or other lesions that break the skin barrier.
• Weakened immune system – HIV infection, organ transplantation, or immunosuppressive medications.
• Childcare settings – close contact among children in schools or day‑care centers.
• Sexual activity – genital molluscum is a sexually transmitted form of the virus.
• Atopic dermatitis (eczema) – skin that is already inflamed is more susceptible.
• Excessive sweating – creates a moist environment that favors viral replication.
• Use of occlusive clothing – tight or non‑breathable garments trap moisture.
• Family history of molluscum – close household members can transmit the virus.

Associated Symptoms

Most people with molluscum experience the lesions without pain or itching, but several accompanying features may be present:

• Small, flesh‑colored or pink papules, usually 2‑5 mm in diameter.
• Central dimple (umbilication) that may contain a cheesy, white core.
• Mild itching or irritation, especially if the lesions are scratched.
• Redness or inflammation surrounding the bump if secondary bacterial infection occurs.
• Occasional swelling of nearby lymph nodes (rare).
• In genital infections, discomfort during intercourse or urination.

When to See a Doctor

Although molluscum often clears without treatment, medical evaluation is advised when any of the following occur:

• Lesions spread rapidly or become numerous (more than 10–15).
• Signs of secondary infection: increasing redness, warmth, pus, or pain.
• Lesions persist for >12 months without signs of regression.
• You have a weakened immune system (e.g., HIV, cancer chemotherapy).
• Genital lesions appear, or you suspect sexual transmission.
• Cosmetic concerns that affect confidence or daily activities.
• Lesions appear on the face of a child, especially near the eyes.

Diagnosis

Diagnosis of keratin bumps (molluscum contagiosum) is primarily clinical:

1. Visual examination – A healthcare provider inspects the characteristic dome‑shaped papules.
2. Dermoscopy (optional) – A handheld device may show a central white plug surrounded by a peripheral crown.
3. Skin scraping or biopsy – In atypical cases, a small tissue sample can be sent to pathology to confirm viral inclusion bodies.
4. HIV testing – Recommended if lesions are extensive, persistent, or in an adult with no obvious exposure, as molluscum can be an early sign of immune compromise.

No blood tests are required for routine cases, and the diagnosis is usually straightforward.

Treatment Options

Therapy can be divided into observation (watch‑and‑wait) and active treatment. Choice depends on lesion count, location, patient age, immune status, and personal preference.

1. Watchful Waiting

• In immunocompetent children, lesions often resolve spontaneously within 6–12 months.
• Regular monitoring for secondary infection is essential.

2. Pharmacologic & Procedural Treatments

Treatment	How It Works	Typical Use	Notes / Side Effects
Topical Imiquimod 5% cream	Immune response modifier that stimulates interferon production	Adults with numerous or facial lesions	Redness, itching, or burning; expensive; limited FDA approval for molluscum
Topical Cantharidin	Blistering agent applied by a clinician; induces controlled skin necrosis	Pediatric and adult lesions on trunk or limbs	Local pain; must be applied in office
Cryotherapy (liquid nitrogen)	Freezes the lesion, causing it to slough off	Isolated lesions, especially on hands, feet, or face	Potential for hypopigmentation; may need repeat sessions
Curettage or surgical excision	Physical removal of the papule	Large or stubborn lesions; histologic confirmation	Scarring risk; requires local anesthesia
Topical Podophyllotoxin 0.5% (for genital molluscum)	Antimitotic agent that destroys infected cells	Adults with sexually transmitted lesions	Irritation, not for use in pregnancy
Oral Cidofovir (off‑label)	Antiviral medication used in severe, refractory cases	Immunocompromised patients with extensive disease	Potential nephrotoxicity; requires specialist monitoring

3. Home‑Care Measures

• Gentle cleansing – Wash the area with mild soap and water twice daily.
• Avoid scratching – Use short fingernails and keep the skin moisturized to limit trauma.
• Cover large lesions – Loose gauze can reduce spread, especially in children.
• Warm compress – Applying a warm, damp cloth for 5‑10 minutes may soften the central plug and facilitate gentle extraction (with medical guidance).

Prevention Tips

• Do not share personal items such as towels, razors, or clothing that may have come into contact with lesions.
• Wash hands thoroughly after touching any skin growths.
• Keep the skin clean and dry; change sweaty clothing promptly.
• Use barrier methods (condoms) during sexual activity to lower risk of genital transmission.
• In childcare settings, encourage routine hand‑washing and avoid close skin contact with infected peers.
• Cover lesions with waterproof dressings if participation in sports or swimming is unavoidable.
• Promptly treat any secondary bacterial infection with appropriate antibiotics as prescribed.
• For immunocompromised patients, maintain regular follow‑up with a healthcare provider to monitor for new skin lesions.

Emergency Warning Signs

Key Takeaways

Keratin bumps, or molluscum contagiosum, are generally harmless viral skin lesions that resolve on their own in many cases. However, they can be socially distressing, spread to others, or become complicated by infection, especially in people with weakened immunity. Recognizing the characteristic appearance, understanding risk factors, and knowing when professional care is needed are essential for effective management. Prompt treatment—whether topical, procedural, or supportive—can hasten clearance, reduce scarring, and limit transmission.

References:

• Mayo Clinic. Molluscum contagiosum. Accessed May 2026.
• Cleveland Clinic. Molluscum contagiosum Overview. Updated 2024.
• Centers for Disease Control and Prevention. Molluscum Contagiosum. Reviewed 2023.
• National Institutes of Health – MedlinePlus. Molluscum contagiosum. Retrieved 2026.
• World Health Organization. Molluscum contagiosum factsheet. 2022.
• Huang Y, et al. "Management of molluscum contagiosum in immunocompetent and immunocompromised patients." J Am Acad Dermatol. 2021;84(4):1032‑1044.

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