Molluscum vs Warts vs Acne — How to Tell Them Apart

If you have noticed small bumps on your skin and your first response is "is this normal?" you are not alone. Several common skin conditions look similar at first glance, especially to someone who has not seen them before. Molluscum, warts, acne, and even herpes can all produce small bumps. They are caused by completely different things and need completely different management.

Here is an honest, side-by-side comparison of how to tell them apart — plus when self-diagnosis is reasonable versus when to see a doctor.

A note before we start

Self-diagnosis works for the obvious cases. It fails for the subtle ones. If you are not confident, see a dermatologist. This guide is for orientation, not a substitute for clinical examination.

Molluscum contagiosum

What it is: A viral skin infection caused by the molluscum contagiosum virus (a pox virus).

What it looks like:

• Small (1-5 mm), dome-shaped, flesh-colored or pearly-white bumps
• Smooth and shiny surface — like a small pearl
• Often has a tiny central dimple ("umbilication") — this is the most distinctive feature
• Usually painless
• Can appear in clusters or singly
• Common locations: arms, legs, abdomen, genital area, face (especially in children)

Key identifier: That central dimple. Squeeze gently (don't actually do this — but if you did), white cheesy material would come out. The dimple is essentially diagnostic.

Course: Develops over weeks. Spreads through skin contact. Self-resolves over 6-18 months without treatment. Often becomes inflamed and red right before resolving.

Treatment: Watchful waiting, ZymaDerm, cryotherapy, cantharidin (in clinic), tea tree + iodine. See our molluscum natural treatments guide.

Genital warts (HPV)

What it is: Warts caused by certain strains of human papillomavirus (HPV-6, HPV-11, and others).

What it looks like:

• Soft, fleshy, often pinkish or skin-colored growths
• Rough or cauliflower-like surface — bumpy, not smooth
• No central dimple
• Vary widely in size — from a millimeter to several centimeters
• Can be solitary, clustered, or merge into larger plaques
• Common locations: genitals, anus, mouth (rare)
• Usually painless, but can itch or bleed if irritated

Key identifier: The rough, cauliflower-like surface. Genital warts feel different from any other genital lesion you have probably encountered.

Course: Develop over weeks to months after HPV exposure. Can persist for months to years if untreated. Often clear with immune response or treatment.

Treatment: Cryotherapy, podofilox, imiquimod, sinecatechins, electrocautery, surgical excision. See our HPV warts removal guide.

Common warts (non-genital)

What it is: Warts caused by other HPV strains, primarily HPV-2 and HPV-4.

What it looks like:

• Firm, rough, raised growths — typically tan or grey
• Cauliflower-like surface, sometimes with tiny black dots (clotted capillaries)
• Common locations: hands, fingers, knees, soles of feet (plantar warts), face
• Generally painless except plantar warts which can hurt on weight-bearing

Key identifier: The black-dot capillary pattern and the rough surface.

Treatment: Salicylic acid (Compound W), cryotherapy, duct tape (yes — actually has some evidence), in-office cryo or cantharidin.

Acne

What it is: Inflammatory follicle disease caused by clogged pores, bacteria (Cutibacterium acnes), and inflammation.

What it looks like:

• Several distinct lesion types:
  • Whiteheads (closed comedones)
  • Blackheads (open comedones)
  • Red papules (no head)
  • Pustules (with white pus head)
  • Cysts (deep, painful, nodular)
• Often has a visible pore or central pustule
• Frequently inflamed, tender, or painful
• Common locations: face, chest, shoulders, back
• Can appear on the genital area too (especially folliculitis in pubic area)

Key identifier: A mix of lesion types, oily skin, inflammation, possible pus.

Treatment: Topical retinoids, benzoyl peroxide, salicylic acid, antibiotics, isotretinoin for severe cases.

Genital herpes (HSV)

What it is: Recurrent infection caused by herpes simplex virus.

What it looks like:

• Cluster of small, fluid-filled blisters (vesicles) — not solid bumps
• Often preceded by tingling, burning, or itching at the site (prodrome)
• Painful — this is the key differentiator from most other genital lesions
• Blisters break, ulcerate, then crust over
• Heals in 7-14 days for first outbreak, 4-7 days for recurrences
• Common locations: genitals, buttocks, thighs, mouth (cold sores)
• Often accompanied by swollen lymph nodes (first outbreak especially) and flu-like symptoms

Key identifier: Fluid-filled blisters that hurt, not solid bumps. The prodromal tingling. The fact that they ulcerate.

Treatment: Antivirals (valacyclovir, acyclovir, famciclovir). See our herpes pillar guide.

Pubic lice (crabs)

What it is: Small parasitic insects living in coarse body hair.

What it looks like:

• Tiny crab-shaped insects (just visible to naked eye) in pubic hair
• Eggs (nits) attached to hair shafts
• Intense itching
• Red bumps from bites
• Common locations: pubic hair, sometimes armpits, eyelashes, eyebrows

Key identifier: The actual lice visible on close inspection. Persistent itching.

Treatment: Permethrin cream, pyrethrin lotion.

Skin tags

What they are: Benign overgrowths of skin, often in friction areas.

What they look like:

• Flesh-colored, soft, fleshy, sometimes pedunculated (stem-like)
• Smooth surface
• Usually painless
• Common locations: neck, armpits, groin, eyelids
• Don't change much over time

Key identifier: They hang from skin on a small stalk, are soft, and don't grow rapidly.

Treatment: Cosmetic only; if removal desired, simple in-office snip or cautery.

Folliculitis

What it is: Inflammation of hair follicles.

What it looks like:

• Small red bumps centered on hair follicles
• Sometimes pus-headed (looks like a pimple at the base of a hair)
• Itchy or mildly painful
• Common locations: any hair-bearing skin — often pubic area after shaving

Key identifier: Each bump centered on a hair follicle.

Treatment: Usually self-resolves; warm compresses help; topical antibiotics if widespread.

Side-by-side decision table

When to see a doctor

Skip self-diagnosis and see a dermatologist (or urgent care for acute) when:

• The lesion is on your face, especially near the eyes or mouth — treatment requires precision
• You are immunocompromised (HIV with low CD4, on immunosuppressants)
• The lesion is rapidly growing, bleeding, or changing color
• You have severe pain
• You have a fever or systemic symptoms
• You're pregnant
• You're unsure — uncertainty is itself a reason to ask
• It is not responding to over-the-counter treatment after 4 weeks
• You have a partner who has been diagnosed with a specific STI and you're trying to determine whether you have it

What NOT to do

• Don't pick or pop molluscum — spreads the virus and causes scarring
• Don't try to "scrape off" a wart — bleeds, scars, spreads HPV
• Don't apply OTC wart removers to genital skin unless the label specifically allows it — chemical burns
• Don't burst herpes blisters intentionally — increases pain, slows healing, spreads virus
• Don't share towels, washcloths, razors, or clothing that contacts affected skin — most of these spread

The bottom line

If a bump is:

• Smooth, dome-shaped, with a central dimple → likely molluscum
• Rough and cauliflower-textured → likely a wart
• Painful and a fluid-filled blister → likely herpes
• With a visible pore, comes and goes → likely acne
• With visible parasites in hair → pubic lice

When in doubt, see a dermatologist. The cost of a single dermatology visit is much less than the cost of mistreating something.

For more on molluscum specifically, see our molluscum pillar guide. For HPV warts, our HPV pillar guide. For herpes, our herpes pillar guide.