Warts are most often confused with molluscum contagiosum. Molluscum is a common viral infection of the skin, more common in children. It is caused by a DNA virus of the poxvirus group. The lesions are discrete, pearly, skin-colored, dome-shaped papules varying in size from 1 to 5 mm. Typically they have central umbilication from which a plug of cheesy material can be expressed. These papules may occur anywhere, but the face, eyelids, neck, underarms, and thighs are the most common sites of infection. Lesions may also occur in clusters on the genitalia or in the groin of adolescents. Mucosal lesions are rare.
Molluscum contagiosum is a self-limited disease, but lesions can persist for months to years and can spread to distant sites, and may be transmitted to others. Molluscum contagiosum has responded to some of the same treatments as genital warts, but it may be best to leave it untreated.
J Cutan Med Surg 2000 Apr;4(2):76-82:
Imiquimod Therapy for Molluscum Contagiosum.
Liota E E, Smith KJ, Buckley R, Menon P, Skelton H Department of Dermatology, National Naval Medical Center, Bethesda, Maryland.
"Background: Molluscum contagiosum virus (MCV) is a large double-stranded DNA virus that is a member of the family Poxviridae, and which has a worldwide distribution. As with other poxviruses, MCV does not appear to develop latency but evades the immune system through the production of viral specific proteins. Objective: To evaluate the therapeutic efficacy of imiquimod 5% cream for MCV. Methods: Thirteen children >5 and <10 years old, 19 immune-competent adults and four adults with advanced, but stable HIV-1 disease with >10 MCV lesions were treated with topical 5% imiquimod cream three times weekly for up to 16 weeks.
Results: Fourteen of 19 immune-competent adults, four of four adults with HIV-1 disease, and six of 13 children had resolution of their MCV lesions in <16 weeks of imiquimod therapy. Children tended to have more pruritus and inflammatory reactions with imiquimod, although most treated lesions appeared to respond. The development of new MCV lesions resulted in a lower overall resolution of the lesions in children. Imiquimod appeared to be the most efficacious in patients with HIV-1 disease and in the genital area in immune-competent adults.
Conclusion: Although topical imiquimod appears to have some efficacy in the therapy of MCV, in children the pruritus correlated relatively well with the development of new lesions. In adults, areas that would be expected to have better penetration appeared to respond more consistently. Although the HIV-1-positive patients had the largest clinical lesions at the onset of therapy, as a group they had the best overall response to therapy."