Dermatology: Practical and Conceptual


Image Letter | Dermatol Pract Concept. 2023;13(2):e2023106 1

Cryotherapy Unmasks Umbilication 
in Molluscum Contagiosum

Camilo Arias-Rodriguez1, Julia Nowowiejska2, Giuseppe Argenziano3, Vincenzo Piccolo3

1 Department of Dermatology, Universidad Pontificia Bolivariana, Medellín, Colombia

2 Department of Dermatology and Venereology, Medical University of Bialystok, Bialystok, Poland

3 Dermatology Unit, University of Campania, Naples, Italy

Citation: Arias-Rodriguez C, Nowowiejska J, Argenziano G, Piccolo V. Cryotherapy Unmasks Umbilication in Molluscum Contagiosum. 
Dermatol Pract Concept. 2023;13(2):e2023106. DOI: https://doi.org/10.5826/dpc.1302a106

Accepted: September 17, 2022; Published: April 2023

Copyright: ©2023 Arias-Rodriguez et al. This is an open-access article distributed under the terms of the Creative Commons  
Attribution-NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted 
noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited.

Funding: None.

Competing Interests: None.

Authorship: All authors have contributed significantly to this publication.

Corresponding Author: Julia Nowowiejska, MD, PhD, Department of Dermatology and Venereology, Medical University of Bialystok, 
Poland. Tel: +48857409572 E-mail: julia.nowowiejska@umb.edu.pl

Case Presentation

Molluscum contagiosum (MC) is a viral skin disease 

caused by the Molluscum contagiosum virus [1]. The virus 

is characterized by high infectious potential and may be 

transmitted via direct contact, using fomites, or due to auto-

inoculation [1]. Clinically, MC usually manifests as multiple 

pearl-whitish shiny papules with the umbilicated center, al-

though solitary lesions may be observed [1]. On dermoscopy, 

typical features can be seen, mainly a central white-yellowish 

amorphous areas, surrounded by blurry crowned vessels 

on the periphery [2]. Solitary lesions represent a clinical 

challenge, especially in cases where umbilication is not ev-

ident (Figure 1A), and in cases with confusing dermoscopic 

findings. What else can aid diagnosis in these cases, apart 

from histopathological examination?

Teaching Point

Cryotherapy is a practical and cost-effective solution to this 

problem. After administration of a short cycle of liquid nitrogen 

to a lesion with an inconspicuous umbilicated center, the con-

cavity appears instantly, confirming the diagnosis of molluscum 

contagiosum (Figure 1B). Cryotherapy is widely available in 

every dermatology department, moreover, it is a non-invasive 

technique and it does not require much time to perform or to 

recover after the procedure. Hence, in doubtful monolesional 

non-umbilicated cases, it improves the diagnostic efficacy.



2 Image Letter | Dermatol Pract Concept. 2023;13(2):e2023106

References

1. 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;12:373–381. DOI: 10.2147/CCID.S187224. 

PMID: 31239742. PMCID: PMC6553952.

2. Piccolo V. Update on Dermoscopy and Infectious Skin Diseases. 

Dermatol Pract Concept. 2019;10:e2020003. DOI: 10.5826 

/dpc.1001a03. PMID: 31921490 PMCID: PMC6936624.

Figure 1. Molluscum contagiosum. (A) A solitary, non-umbilicated lesion before administration of treatment. (B) On the right: 

umbilicated center appears after administration of cryotherapy.