Genital-Only Molluscum Contagiosum in an Adolescent with Fitzpatrick Skin Type VI: Clinical and Dermoscopic Features

Abstract

Aims: This case report aims to describe the clinical and dermoscopic features of genital-only molluscum contagiosum in an adolescent with Fitzpatrick skin type VI. Genital lesions in adolescents may be mistaken for condylomata acuminata, while their appearance on deeply pigmented skin may be less familiar. Presentation of Case: We report a 16-year-old adolescent male with Fitzpatrick skin type VI who presented with a one-month history of pruritic papules confined to the genital and adjacent pubic region, with progressive extension and no systemic symptoms. Examination showed multiple discrete, smooth, pearly papules, several with central umbilication. Dermoscopy revealed a central orifice, white polylobular amorphous structures, peripheral crown vessels, and focal dotted vessels, supporting the diagnosis of molluscum contagiosum without biopsy. Because the lesions were numerous, symptomatic, and progressive, and a non-destructive home-based approach was preferred for this sensitive site, imiquimod 5% cream was selected off-label after discussion of the self-limited course of the disease and available options. It was applied in a thin layer on three nonconsecutive nights per week, left in place for 6–10 hours, and then washed off; a copper-zinc repair cream was used between applications. Marked clinical improvement was observed after six weeks without reported local or systemic adverse effects. Discussion: Dermoscopy was particularly valuable in Fitzpatrick skin type VI, enabling recognition of characteristic features and differentiation from condylomata acuminata. Although improvement was temporally associated with off-label imiquimod, spontaneous resolution cannot be excluded. Conclusion: This case highlights the diagnostic value of dermoscopy for genital molluscum contagiosum in deeply pigmented skin.