molluscum or folliculitis?

[sharpeye58]

I am an otherwise healthy 22 year old. 7 months ago (May), I noticed a singular red bump on my penis. I immediately went to my school's health clinic, and dealt with the bumbling idiots of doctors who misdiagnosed my condition for a full month. I went through the full gamut of STD tests, all of which were negative. I then saw my quack dermatologist from home during the early summer, he also diagnosed me as having a bacterial infection. During this time, I also had trimmed both my pubic hair and chest hair with the same buzzer, as I was unaware of the infectious nature of the mollusucm. 2 weeks later, I saw another dermatologist that was recommended to me, as the bumps had spread to my inner thighs and pubic region. This derm immediately recognized it as molluscum, and upon my insistence he biopsied them as well. He prescribed Aldara cream (this is late July). I was also a pool lifeguard, so every day I would sit in a wet bathing suit for 2 months, and during this time, the bumps basically spread all over my legs, front and back, and I also started noticing bumps on my chest and arms. I used the Aldara as prescribed, and individual bumps would go away in 1-2 weeks, but the overall infection was relentless. I returned to the derm about a month later, and he said some of the other red bumps were folliculitis, and that the bumps on my chest and arms were not molluscum (but I was not totally convinced) and prescribed a steroid cream, which I'm not sure if it helped or not, but the overall redness/itchiness of some of the infection eventually did go away. Then in September, I moved to a new location in the world, where it is very hot and humid every day, and I sweat a lot during the day. I have not been sexually active in 9 months or so. When I first moved there, I only had 2-3 noticeable red bumps on my legs, but over the course of a month or two, I started to notice the frequency of the bumps increasing all over my legs, and there were still occasional red bumps on my chest, arms, and even back/neck that were unique to my body/skin. I have since returned home and seen another derm (not the one responsible for the original diagnosis, he was unavailable unfortunately), who looked at the remaining bumps on my legs, chest, and arms very closely, and assured me that they were all folliculitis. They are all located on hair follicles, and are like a pinkish/red bump with a white core, that I'm sure I could pop very easily like a white head (but I do not pop them). I, however, am not completely convinced that they are not folliculitis, because in my mind, they do not look very different from the original bumps that were diagnosed as molluscum. And, there is currently one on my inner groin, in a spot that was originally infected with molluscum, but had been completely free from any kind of mark/lesion in about 3 months. Also, I am psychotically paranoid about this infection now, and have resorted to airdrying after a shower (no towel), stopped working out in any way (to avoid sweating), stopped surfing/swimming, and washing my clothes after only wearing them once. So I do not understand how there can be a new bump on my inner thigh.  Basically, these are my questions:

- Has anyone had a similar experience with molluscum spreading to different parts of your body from shaving/buzzing?
- How easily can it realistically spread around your body from autoinoculation?
- Can the molluscum trigger my skin/immune system (I have atopic skin) into breaking out in folliculitis?
- Can the hot/humid environment where I live contribute to autoinoculation?
- Should I believe the derm in saying that it is folliculitis? I feel like the only derm I can trust is the original one who made the diagnosis, but he is unavailable during the time I am home.

[Bhupinder Kaur, MD]

Hello,
From the appearance it looked like folliculitis. Molluscum contagiosum is a common, benign, self limiting viral infection of the skin. The characteristic description of the rashes is the central depression or plug. You can get a skin biopsy as well as culture sensitivity of the discharge from the molluscum done.

I sincerely hope that helps. Take care and please do keep me posted on how you are doing.

[sharpeye58]

Thank you for your reply. What I'm concerned about primarily, is how this could be folliculitis and not molluscum (although I would clearly prefer for it to be folliculitis). My previous infection was confirmed as molluscum, and there were at least 10-15 bumps that were confirmed as such. When I started lifeguarding, and the bumps started spreading, I thought it was the molluscum that was spreading, due to all of the information I had taken in from my doctor and from the internet on ease of autoinoculation. However, in order for this to all be folliculitis, it would seem to be that the molluscum infection ended about 3-4 months ago, when I noticed that my thighs/penis were clear of lesions (but the rest of my legs/chest still had bumps). Is it then possible that the molluscum had resolved already (in 3 months), even while being a very active lifeguard in a wet bathing suit, and toweling off after being wet, and unaware of its infectious nature for the first 1.5 months? For the second 1.5 months, I was on Aldara treatment.

Thank you.

[Bhupinder Kaur, MD]

Hello,
From the symptoms it looks like recurrent folliculitis. It can be eosinophilic folliculitis also as a result of an autoimmune process directed against the sebocytes or some component of the sebum. Diagnosis can be confirmed after culture sensitivity of the discharge from the bumps or biopsy skin. Molluscum presents as multiple, small, dome-shaped papules, often with a central depression or plug and from your description of the red bumps being clustered around a hair follicle, the possibility of folliculitis is important.

After culture sensitivity, topical and oral antifungals may be prescribed.  Hope it helps. Take care and do keep me posted on how you are doing or if you have any additional queries. Warm regards.