Molluscum BOTE Sign: A Predictor of Imminent Resolution

Abstract

Molluscum contagiosum is a common self-limited viral skin infection. The course of the infection often includes tender, crusted, erythematous lesions that prompt suspicion for bacterial infection. However, these signs of inflammation represent a host response that often precedes resolution of the viral disease, rather than bacterial superinfection, and do not require additional antibacterial treatment. We present a case report and retrospective review of 7 additional cases to characterize the clinical presentation of inflamed molluscum, assess the utilization of medical resources, and consider the psychosocial burden associated with mistaken diagnoses of bacterial infection. We propose the acronym “BOTE”* sign (for beginning of the end) to help underscore the significance of inflammation as an expected variant in the evolution of molluscum immunity.