Molluscum contagiosum and herpes are two viral skin infections with some similarities but distinct differences. Both skin conditions are very contagious, so it’s important to identify and treat them accordingly.
What is it?
Molluscum contagiosum: Molluscum contagiosum is a contagious viral skin infection characterized by small dome-shaped bumps or lesions. These bumps often have a central dimple and can range in number from just a few to several dozen.
Herpes: Herpes is a contagious viral infection characterized by painful fluid-filled bumps. It is caused by the herpes simplex virus (HSV), which has two main types: HSV-1 and HSV-2. HSV-1 is commonly associated with oral herpes (cold sores), while HSV-2 is typically associated with genital herpes. However, both types can cause sores on the skin in either location.
Who gets it?
Molluscum contagiosum
Molluscum contagiosum is most common in children, especially those aged 2-5 years, although it can also affect teens and adults (especially those who are sexually active). It is commonly seen in settings where close skin-to-skin contact is frequent, such as schools and daycare centers.
Individuals with weakened immune systems, such as those with HIV/AIDS, transplant patients, or people taking certain medications, are also at higher risk. Additionally, people or children with atopic dermatitis/eczema are at an increased risk due to the disruption of the skin barrier.
Herpes
Herpes can affect anyone who comes into contact with the virus. One can get HSV-1 infection during childhood by coming into direct contact with lesions or fluid.
HSV-2 infection is often acquired through sexual contact. The chances of HSV-2 infections are higher in females, those with multiple sexual partners, individuals who have sex at a young age, those with a suppressed immune system, or those with another sexually transmitted disease.
Cause and transmission
Molluscum contagiosum
Molluscum contagiosum is caused by the molluscum contagiosum virus, a poxvirus. It is spread through direct contact with an infected person or contaminated objects. Bumps in the genital area are often due to sexual contact with an individual who has infected lesions.
Herpes
As discussed earlier, herpes is caused by the herpes simplex virus types 1 and 2. It is primarily spread through direct contact with the active lesions or its fluid. The virus can be transmitted through saliva, genital secretions, skin-to-skin contact, and by sharing personal items such as toothbrushes, utensils, etc.
Areas affected
Molluscum contagiosum
Molluscum contagiosum lesions can occur anywhere on the body but are most commonly found on the face, neck, arms, and hands in children. In adults, they are more frequently found in the genital area, abdomen, and inner thighs.
Herpes
The location of herpes sores depends on the type of herpes virus (HSV-1 or HSV-2) and the mode of transmission. HSV-1, which causes cold sores, leads to lesions on the lips, around the lips, and other areas of the face. HSV-2 primarily causes genital herpes and leads to sores on the genitals and surrounding areas.
Symptoms
Molluscum contagiosum
The main symptom of molluscum contagiosum is the appearance of small, raised, flesh-colored, white, or pink bumps on the skin. These bumps have a waxy or shiny surface and a central dimple or whitish core. These can be single lesions or a cluster of them.
These bumps are usually painless but may become itchy. The lesions usually persist for a long time, from 6 months to 18 months or even longer in some cases. The bumps may undergo an inflammatory reaction, leading to red, swollen, or crusted bumps, after which they usually heal.
Herpes
The symptoms of herpes depend on whether it is the first or recurrent infection. The first outbreak is often more severe and accompanied by other symptoms such as fever, body aches, and swollen lymph nodes.
Before the appearance of bumps, one may feel burning, itching, or a tingling sensation. This is followed by the appearance of red bumps that form fluid-filled blisters. These blisters are often seen in clusters and can be painful or itchy. The blisters may break open and form ulcers before crusting over and healing. (Related: Cold sore stages)
Unlike molluscum contagiosum, which lasts several months, herpes bumps usually heal in a few weeks (the first outbreak may last 2-4 weeks while the recurrent herpes outbreak usually lasts 1-2 weeks).
When molluscum contagiosum bumps heal, they may also appear red, swollen, and crusty, which can sometimes be confused with herpes but the longer duration of the molluscum bumps and their lack of pain can help differentiate them from herpes.
Contagiousness
Both molluscum contagiosum and herpes are contagious as long as the bumps are present.
Long-term effects
Once the molluscum contagiosum virus is treated or clears, the infecting virus is no longer in the skin and causes no long-term effects or symptoms.
Herpes simplex virus, on the other hand, once it infects a person, remains dormant in the body and can lead to an outbreak in certain situations such as menstruation, a suppressed immune system, sun exposure, skin injury, fever, stress, or surgery.
Pictures
The picture below shows the classic appearance of molluscum contagiosum: waxy bumps with a central dimple.
The picture below shows the inflammatory reaction of molluscum contagiosum bumps, after which the bumps usually clear.
The picture below shows fluid-filled bumps of herpes.
The picture below shows scab formation on herpes sores.
Diagnosis
Molluscum contagiosum: Molluscum contagiosum is usually diagnosed based on the appearance of the lesions. Your doctor may perform a physical examination, and in some cases, a skin biopsy may be performed to confirm the diagnosis.
Herpes: Herpes is diagnosed based on the appearance of the sores. If needed, the diagnosis may be confirmed through laboratory tests, such as viral culture or polymerase chain reaction (PCR) tests.
Treatment
Molluscum contagiosum
In many cases, molluscum contagiosum does not require treatment and will resolve on its own over time. However, if treatment is desired or if the bumps are bothersome, in the genital area, one has eczema, or has a suppressed immune system, these bumps can be treated by several options, including:
- Procedures done in a doctor’s office such as cryotherapy (freezing), curettage, or laser therapy.
- Topical medication (Cantharidin) applied by a doctor in the office.
- Topical medications applied at home (e.g., imiquimod, podophyllotoxin, tretinoin, salicylic acid, sinecatechin and Berdazimer).
- Additionally, oral medications such as cimetidine may be prescribed.
Read more details about molluscum contagiosum treatments.
Herpes
There is no cure for herpes, but antiviral medications (e.g., acyclovir, valacyclovir, famciclovir) can help reduce the severity and duration of outbreaks. These medications can also help reduce the risk of transmitting the virus to others.
Prevention
Molluscum contagiosum
To prevent molluscum contagiosum:
- Avoid direct skin-to-skin contact with infected individuals.
- Refrain from sharing personal items, such as towels or razors.
- Practice good hand hygiene.
Herpes
To prevent herpes:
- Practice safe sex by using condoms and avoiding sexual contact during outbreaks.
- Avoid skin-to-skin contact with others during outbreaks.
- Avoid sharing personal items that may come into contact with sores, such as towels or utensils.
- Practice good hand hygiene.
Takeaway: Main differences
- Molluscum contagiosum is caused by the molluscum contagiosum virus, while herpes is caused by herpes simplex virus types 1 and 2.
- Molluscum contagiosum leads to skin-colored, pink, or white bumps with a central dimple, while herpes primarily leads to bumps filled with fluid, called blisters.
- The bumps of molluscum contagiosum are usually not painful, although they can be itchy, while the bumps of herpes are often painful and itchy.
- Molluscum contagiosum bumps are not preceded by any burning or tingling, while herpes sores are often preceded by tingling, itching, or burning.
- In addition, if it is the first herpes infection, a person may also have fever, swollen lymph nodes, body aches, headache, or other flu-like symptoms.
- Molluscum contagiosum bumps can last for a long time, usually 6 to 18 months, while herpes sores usually last for 10 to 14 days (the first herpes outbreak can last longer).
- Molluscum contagiosum bumps can be treated by procedures or topical medications applied in a doctor’s office or certain medications applied or taken at home. Herpes bumps are treated by medications (antivirals) that can be applied topically or taken orally.
- Molluscum contagiosum bumps once cleared or treated, are completely gone. On the other hand, herpes, once it infects a person, remains in the body dormant and can reactivate under certain conditions, leading to an outbreak.
References
- Keam SJ. Berdazimer Topical Gel, 10.3%: First Approval. Drugs. 2024 Mar;84(3):363-368. doi: 10.1007/s40265-024-02012-9. PMID: 38409574. Link: https://pubmed.ncbi.nlm.nih.gov/38409574/
- Meza-Romero R, Navarrete-Dechent C, Downey C. Molluscum contagiosum: an update and review of new perspectives in etiology, diagnosis, and treatment. Clin Cosmet Investig Dermatol. 2019 May 30;12:373-381. PMID: 31239742; PMCID: PMC6553952. Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6553952/
Disclaimer: This blog post is for information purposes only and does not replace medical advice.