Warts
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Warts vs Molluscum
A wart is a rough skin growth caused by a human papillomavirus, or HPV. The surface feels like fine sandpaper, and most warts have tiny dark dots inside. Molluscum is a different virus that makes small round bumps. They are smooth, pearly and dome-shaped, and most have a tiny dimple in the middle. Run a fingertip over it: rough points to a wart, smooth points to molluscum.
At a glance
| The difference | Warts | Molluscum Contagiosum |
|---|---|---|
| What it is | An HPV infection in the outer skin | A poxvirus infection in the outer skin |
| What it looks like | Rough, grey-brown, cauliflower top | Smooth, pearly, with a centre dimple |
| Does it hurt | Usually not | Usually not |
| What it does over time | Clears, often after months or years | Clears on its own in 6 to 18 months |
| Treatment | Salicylic acid, then freezing | Often nothing at all |
Molluscum Contagiosum
Side by side
The differences that matter
What it is
Warts
An HPV infection in the outer skin
A human papillomavirus gets into the top layer of skin through a small break. It makes the skin cells there grow faster. That extra growth is the lump you can see.
Molluscum Contagiosum
A poxvirus infection in the outer skin
A virus from the pox family infects the same top layer. Instead of thickening the skin, it fills each bump with a soft white core.
How it works, illustrated
Warts
The outer layer sheds and replaces itself steadily. Small nicks and scrapes close over before anything can get in.
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HPV needs a way through - a cut, a hangnail, a shaving nick, or skin softened by water. It reaches the dividing cells at the bottom of the outer layer and settles there.
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The virus makes those cells divide faster than they should. They pile up into the rough, raised bump, with tiny clotted vessels showing as black dots.
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HPV hides in the outer layer, where there is little blood supply and few immune cells patrolling. That is why warts last months or years, and why they eventually clear on their own once the immune system finds them.
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Molluscum Contagiosum
The barrier is intact and nothing is getting through it.
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A poxvirus, spread by skin-to-skin contact and by shared towels, mats and baths. Damp or eczema-prone skin lets it in more easily.
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The virus makes skin cells multiply into small firm domes with a dimple in the middle, each one full of virus.
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Scratching or shaving over a bump carries the virus along the line of the scratch, which is why new ones appear in rows.
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Eventually it recognizes the infection and clears it, often with a red, sore-looking flare first. That flare is the sign it is ending, not worsening.
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What it looks like
Warts
Rough, grey-brown, cauliflower top
The surface is dry and grainy, with a thickened rim around it. Most warts have tiny black or dark red dots inside. Those are small blood vessels that have clotted.
Molluscum Contagiosum
Smooth, pearly, with a centre dimple
Skin-coloured or slightly pink, shiny and firm. The small pit in the middle is the most useful sign. It is hard to see on a bump under two millimetres.
Across skin tones
Warts
Warts on light skin
On light skin a wart usually shows a pink or reddish tinge and a thin red ring around the base, and the tiny black dots inside it stand out clearly against pale, thickened skin. That contrast is why warts are often recognized early here. Freezing leaves a pale mark less often than on deeper tones, though it still blisters and stings.
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Warts on medium skin
On medium skin a wart is usually the same color as the skin around it or slightly gray, and the ring of redness is fainter. The reliable clue is texture rather than color: a firm, rough, thickened bump with the fine skin lines stopping at its edge instead of running across it. Freezing here can leave a mark, so a small test spot first is reasonable.
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Warts on brown skin
On brown skin a wart often reads as gray or brown rather than pink, so it is more often taken for a callus, a corn or a mole and treatment tends to start later than it should. Run a finger over it: a wart is firm and rough, and the fine skin lines stop at its edge. Because injured skin here commonly heals a different color, slower options like daily salicylic acid, filing and paring in clinic are usually the better first move.
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Warts on deep skin tones
On deep skin tones the redness dermatologists look for is effectively invisible, so warts are recognized late and are the most likely to be dismissed as hard skin. The trade-off around treatment also shifts: freezing and anything that blisters can leave a pale ring or a dark mark that outlasts the wart by a year. Test one small wart before treating a group, keep freezing shorter, and add a daily sunscreen on any treated area of the face, hands or arms.
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Molluscum Contagiosum
Molluscum on light skin
This is the textbook picture: firm, dome-shaped bumps two to five millimetres across, pink to pearly white, each with a small dip in the center. They are commonly mistaken for warts, for whiteheads, or for a few stray bug bites, and children are often treated for acne or eczema first. The dip in the middle is the giveaway. Scratching them is what spreads them, so a line of bumps along a scratch mark is a normal part of the picture.
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Molluscum on medium skin
The pearly shine textbooks describe already starts to fade here, and the bumps read as pale pink to skin-colored. The shape is the more dependable sign: firm, domed, with a central dip, and often in a small group in one warm fold of skin. One bump going red and sore usually means the immune system has finally found it and that bump is on its way out. That flare looks like an infection and is often treated as one, when the better answer is usually to leave it alone.
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Molluscum on brown skin
On brown skin the bumps usually look skin-colored or slightly gray rather than pink or pearly, and the shine is much less obvious. The dip in the center and the firm dome shape are the reliable signs, and running a finger over the area often finds them faster than looking does. Because the color cue is weak, molluscum here is regularly read as small warts, as a rash, or as nothing at all, and a child can be treated for the wrong thing for months.
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Molluscum on deep skin
What molluscum leaves behind matters more here than the bumps do. Bumps that have been scratched, picked or treated with something that blisters the skin heal into flat dark marks, and on deeper skin tones those routinely take six to twelve months to fade — far longer than the bump lasted. Pale spots can be left as well, and they show up more. Since molluscum clears on its own, watchful waiting and the gentler treatments are often the better trade, and treating a few bumps first to see how the skin answers is sensible.
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Size
Warts
A pinhead to a pea
One wart starts small and thickens over weeks. Several can join into a single larger patch.
Molluscum Contagiosum
Two to five millimetres
Each bump stays about the size of a pinhead or a small bead. What grows is the number of bumps, not the size of them.
Does it hurt
Warts
Usually not
Warts on the hands are painless. A wart on the sole of the foot takes your body weight and can feel like standing on a stone.
Molluscum Contagiosum
Usually not
Molluscum can itch, and a scratched bump turns red and sore. That red ring often means the bump is finally clearing.
Where it shows up
Warts
Hands, fingers and feet
Backs of the hands, around the fingernails, knees, and the soles of the feet.
Molluscum Contagiosum
Trunk, armpits and skin folds
Chest, tummy, sides, armpits, the crooks of the elbows and the backs of the knees. Face and neck in small children.
Where it appears
Warts
Fingers, hands, knees and feet
Warts land where skin gets knocked, wet or broken: the fingers, the backs of the hands, around and under the nails, the knees, and the soles and edges of the feet. Biting nails or picking skin spreads them along the finger.
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The face, in a shaving path
Flat warts turn up in groups on the face, often spread in a line along a shaving path. The long, thread-like kind grow around the eyes, the nose and the mouth. They are the same virus, spread by the razor.
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Molluscum Contagiosum
Children: trunk, armpits, neck and face
In children the usual places are the trunk, the armpits, the inner arms, the neck and the face — skin that is warm, folded and rubbing. Wherever they are, they cluster in creases and run in lines where a child has scratched and carried the virus along.
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Adults: lower abdomen, groin and inner thighs
In adults, bumps on the lower abdomen, the groin, the inner thighs and the genitals usually mean the virus was passed on through sexual contact, and testing for other infections is normally offered at the same time.
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What it does over time
Warts
Clears, often after months or years
The immune system does get there in the end. Children often clear warts within two years. Adults usually take longer.
Molluscum Contagiosum
Clears on its own in 6 to 18 months
New bumps keep appearing while old ones fade, so the crop looks endless for a while. Then it stops.
Treatment
Warts
Salicylic acid, then freezing
Daily salicylic acid with gentle filing between applications is the usual first step. Freezing with liquid nitrogen in a clinic is the common next step, over several visits.
Molluscum Contagiosum
Often nothing at all
Most children are left to clear on their own, because the bumps go anyway and the treatments sting. A clinician can scrape or freeze single bumps that are bothersome.
Warts
Salicylic Acid
The first treatment for almost every ordinary hand or foot wart, and the one with the best evidence outside the clinic. It dissolves the infected thickened skin a layer at a time, so it only works if it goes on every single day. Soak the wart for five minutes, file the dead surface off, apply, and cover it. Twelve weeks is a fair trial; ten days is not.
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Soaking and filing
Not a treatment on its own, but the thing that makes salicylic acid work. Filing the dead crust off between doses lets the next dose reach live infected skin instead of sitting on top of it. Use a file or pumice kept only for that wart and thrown away afterwards, because one file used on several warts spreads them between your own sites.
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Home freeze kits
The pharmacy sprays get nowhere near as cold as clinic liquid nitrogen, so they work best on small, new, thin warts on the hands and poorly on thick foot warts. They sting and can blister. On deeper skin tones they carry the same risk of leaving a pale or dark mark as clinic freezing does.
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Duct tape
Covering a wart with tape for a few days at a time, then filing it, is cheap and harmless, and the trials are genuinely mixed on whether the tape itself adds anything. Any benefit is probably from the covering and the filing. It is reasonable alongside salicylic acid and a poor substitute for it.
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Cryotherapy (Liquid Nitrogen)
Liquid nitrogen freezes the infected skin and the injury also draws immune attention to the spot. It needs repeating every two to four weeks, usually three or four times, and a wart regrowing from the edge between sessions is normal rather than failure. Over several months its results are broadly similar to salicylic acid used properly. It stings, it blisters, and on deeper skin tones it can leave a lasting pale or dark mark.
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Cantharidin
A blistering liquid painted on in clinic and washed off a few hours later. It is painless going on, which is why it is a common first choice for children and for warts on the face. The blister that follows lifts the infected skin away over the next few days and can be sore. It usually takes more than one visit.
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Electrodesiccation and Curettage
The wart is numbed, burned with an electric current and scraped away in one visit. It is kept for a single stubborn wart that has failed everything gentler, because it leaves a scar, and a scar on the sole of a foot can hurt more than the wart did. Warts can still regrow at the edge of the scar.
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Pulsed Dye Laser (V-Beam)
The laser targets the small blood vessels feeding the wart rather than the virus itself. It is an option for stubborn warts on the hands and around the nails when freezing has not worked, and it spares the skin around it, which matters on the face. Several sessions are needed, results are inconsistent, and it is not usually covered by insurance.
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Cimetidine
An old stomach-acid tablet that people ask about for multiple stubborn warts, on the idea that it nudges the immune system. The better-controlled trials found it no more effective than a dummy tablet in adults. It is safe and cheap, so it is occasionally still tried in children, but it should not replace treatment that is known to work.
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Imiquimod cream
A cream that works on the last step of the problem: it makes the local immune system pay attention to the virus. It is used mainly for flat warts on the face and for warts that keep coming back, applied a few nights a week for weeks. It reddens and irritates the skin while it works, and it does poorly on thick foot warts.
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Tretinoin
A retinoid cream used for the flat warts that appear in groups of dozens on the face and the backs of the hands, where acid and freezing would be too harsh over so wide an area. It speeds up the turnover of the infected surface cells. It takes months, and it makes the skin dry and sun-sensitive while it runs.
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5-fluorouracil cream
A chemotherapy cream at a low strength, applied to the wart itself, often under tape. It is used for flat warts and for warts that have not shifted with acid, and it is a common choice in children because it does not hurt going on. It reddens and can crust the treated skin, and it is not used in pregnancy.
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Molluscum Contagiosum
Watchful waiting
Doing nothing is a real plan, and for a lot of children it is the best one. The infection ends on its own, usually within six to eighteen months, and it leaves nothing behind if the bumps are left alone. No treatment has been shown to change the long-run outcome dramatically. The cost of waiting is time; the cost of treating is discomfort and, sometimes, marks that outlast the bumps.
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Cover bumps, keep nails short
Most molluscum spread is self-spread, carried from one patch of skin to another on fingernails, razors and towels. Trimmed nails do less damage during sleep scratching, clothing or a plaster over the bumps stops them being caught and stops them reaching other children, and everyone having their own towel keeps it out of the rest of the household. In adults, simply stopping shaving over the area often halts the spread on its own.
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Hydrocortisone 1%
For the dry itchy eczema-like patch that develops around the bumps in about a third of children — not for the bumps themselves. Treating it properly matters, because the itch drives the scratching and the scratching is what spreads the infection. Use it on the skin between and around the bumps, thinly and for a short course. Strong steroid creams applied over the bumps calm the redness and can help the virus stay longer.
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Salicylic Acid
The wart products in the pharmacy are the wrong tool here. Molluscum is a poxvirus, not the wart virus, and the bumps are soft domes rather than thickened skin for an acid to dissolve. On thin skin, on a child, and on thirty bumps at once, it mostly buys irritation and dark marks. If a bump is going to be treated, the clinic options are more reliable and better controlled.
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Tea Tree Oil
A common suggestion, usually combined with iodine, and the evidence behind it is a small number of low-quality studies. Against an infection that clears by itself, that is very hard to read. The real drawback is that it stings and it commonly causes an allergic rash on children's skin, which then itches, which then gets scratched.
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Cantharidin
A blistering liquid painted onto each bump in the clinic and washed off a few hours later at home. A small blister forms over the next day and the bump lifts off with it. It is painless to apply, which is why it suits children, and it usually takes two or three visits. It is not used on the face or the genitals, and it can leave a dark or pale mark, so a few bumps are treated first to see how the skin reacts.
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Cryotherapy (Liquid Nitrogen)
Each bump is frozen for a few seconds, and it usually takes several visits a few weeks apart. It works, and it is quick. It also stings sharply at the time, which most young children will not sit through twice, and it leaves dark or pale marks more readily than the other options — a real consideration on deeper skin tones, where those marks can last longer than the infection would have.
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Cimetidine
An old stomach-acid tablet, taken by mouth for several weeks in the hope of nudging the immune system into recognizing the virus. It appeals because it is painless and needs no procedure, which matters for a frightened child with many bumps. The trials do not support it, and it interacts with a number of other medicines, so it is a long shot rather than a plan.
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Potassium hydroxide solution
A dilute alkaline solution dabbed on individual bumps at home, usually once or twice a day until each bump becomes inflamed and then clears. It is cheap and it can be done without appointments. It stings, it works by irritating the skin, and it can leave dark or pale marks if it is overdone — so it goes on the bumps only, and starting with a few is sensible.
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Berdazimer gel
A newer prescription gel mixed and applied at home once a day, designed specifically for molluscum. In its trials about a third of children had all their bumps clear at twelve weeks, against roughly one in five given the placebo gel — a real effect, but a modest one. Redness and irritation where it is applied are common, and cost and availability are the practical limits.
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Tretinoin
A retinoid dabbed onto individual bumps to irritate them into clearing. It is sometimes chosen for bumps on the face, where blistering or scraping is less appealing. The evidence for it in molluscum is thin, it is slow, and it makes the skin around the bumps red and flaky, which is its own reason to scratch.
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Imiquimod
This one was studied properly in children, in two large trials, and it did not work any better than the placebo cream — while causing more skin reactions, and in some children pain and swelling. It is still prescribed for molluscum out of habit. On the evidence there is, it should not be.
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When it needs a doctor
Warts
A wart that bleeds or changes
Worth a visit if a growth bleeds without being knocked, changes colour or shape, spreads despite months of drugstore treatment, or sits on the face.
Molluscum Contagiosum
A bump near the eye, or one that turns hot
Worth a visit if bumps are on the eyelid, if one becomes hot and swollen with spreading redness, or if you are not sure what you are looking at.
Texture is the fastest test
Molluscum Contagiosum
Molluscum is smooth. It feels like a small firm bead with normal skin over the top. Stretch the skin around one and the central dimple usually shows. That pit is where the soft core sits.
Both spread, and both spread the same way
Warts
Warts move on contact and on damp shared surfaces. Pool decks, changing room floors and shared files carry the virus. They also travel on your own body, so picking or shaving over a wart can move it to new skin.
Molluscum Contagiosum
Molluscum moves on contact too, plus shared towels and bath water. Brothers and sisters often catch it from each other. Scratching one bump and then scratching normal skin is how a child ends up with a line of them.
Why molluscum is usually left alone
Warts
Warts are treated more often, because they last longer. A hand wart can sit for years, and treating it shortens that. Salicylic acid used daily, with filing between applications, is the part most people give up on too early.
Molluscum Contagiosum
Molluscum ends by itself, so the goal is to avoid a scar. Freezing, scraping and acid all work, but each one can leave a small mark, and there may be thirty bumps. Most clinicians treat only the few that are irritated or in the way.
Neither one is a sign of anything wrong
Related topic illustrations
Warts
Warts around and under the nails
Warts that set up in the nail folds are the most stubborn of the group, because the nail shields the virus from creams and from freezing. Left long enough, a wart growing under the nail can lift it or leave a permanent ridge or split in the nail plate. Nail biting and picking at hangnails are how most of them start, and they are the ones most worth taking to a dermatologist early.
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Squamous Cell Carcinoma
The reason a single stubborn growth in an adult should be looked at rather than treated blindly. This skin cancer can be rough and raised enough to pass for a wart. The differences are that it is usually one growth rather than several, it keeps growing rather than sitting still, it often bleeds or crusts and does not heal, and it turns up on sun-exposed skin in older adults. Warts are commoner in children and tend to come in groups.
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Molluscum Contagiosum
Warts
The mix-up that matters most, because the treatments are different. Both are small firm bumps a child picks up from contact, but a wart has a rough, grainy surface, often with tiny dark dots in it, and no dip in the middle. Molluscum bumps are smooth, dome-shaped and pearly with a central dip. They are caused by completely different viruses, and wart removers bought for one are not the answer for the other.
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Keratosis Pilaris
Both cover a child's arms in small bumps, and both are harmless. Keratosis pilaris bumps are much smaller, rough like sandpaper, and there are dozens of them evenly spread over the backs of the upper arms and the fronts of the thighs, one at each hair. Molluscum bumps are bigger, smooth, dome-shaped with a dip on top, and they come in scattered clusters and lines rather than covering an area evenly.
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Common questions
Questions Patients Ask
Can molluscum turn into a wart?
No. They are two different viruses, and one does not become the other. A child can have both at the same time, which is common and is just bad luck.
Which one is more contagious?
Both spread easily by skin contact. Molluscum spreads faster between children in the same house, because it travels on shared towels and bath water as well as on hands.
Do the bumps have a hole in the middle?
Molluscum usually does. Stretching the skin around the bump makes the small central dimple easier to see. Warts do not have one.
Should my child stay home from school?
No. Molluscum and warts are both common and mild, and children are not kept out of school for either. Covering a bump with clothing or a plaster during swimming and contact sport is enough.
How long until they go away?
Molluscum clears on its own in about 6 to 18 months. Warts are slower, often taking one to two years in children and longer in adults.
Is it worth treating either one?
Treating a wart shortens it, and salicylic acid used daily is the standard starting point. Molluscum is usually left alone, because it ends anyway and the treatments can leave small marks.