Papule Differentiation

Common Warts, Flat Warts, and Molluscum Contagiosum: Differences in Small Raised Lesions

Name: Warts, flat warts, and molluscum contagiosum: differences in small raised lesions
Published: 2026-08-23

When distinguishing between common warts, flat warts, and molluscum contagiosum, you must compare not only the size but also the surface roughness, central indentation, skin lines, and location where symptoms occurredthe order in which they spread. Especially for lesions on children and the face LesionHere are the differences to check before arbitrarily picking or squeezing them.

Last modified August 23, 2026Doctor of Korean Medicine Yeon-seung Choi

Click on unfamiliar terms to see their meanings immediately.

Rough and hard protrusions, flat skin-colored papulesor pearly papules with a central indentation must be distinguished, even if they look similar. The location, such as the hands, feet, face, or a child's torso, is also an important clue.

Points to check in the photos first

Even if they look similar, the dead skin, blisters, and borders may differ

We have provided both typical appearances and examples that look slightly different. Do not decide based on a single similar photo; compare how long symptoms like dead skin, wheals, comedones, or oozing have persisted in the same area.

Educational close-up example showing common warts with a rough and firm raised surface on an adult's finger — **Rough and hard common warts on the fingers**
Common warts often cause the skin texture to break and the surface to rise roughly. Unlike calluses, we examine the direction of pain when pressed, the presence of black dots, and whether they are spreading to surrounding areas.

Educational close-up example of flat warts showing multiple small, flat, skin-colored papules on an adult's temple and edge of the forehead — **Flat warts on the temples and edges of the forehead**
Flat warts may appear as clusters of flat papules that are skin-colored or light brown. Compare the surface height and direction of spreading with acne comedones or milia.

Educational close-up example of molluscum contagiosum showing a cluster of round papules with slight central depressions near the fold of a child's arm — **Molluscum contagiosum near the elbow crease**
A smooth dome shape with a slight central indentation is a clue for molluscum contagiosum. If surrounding eczema and scratch marks are present, the speed of spread is also evaluated.

Educational close-up example showing a wart with black dots mixed in the keratin on a pressure area of the sole of the foot — **Warts on pressure areas of the sole**
Warts on the sole can grow inward rather than outward due to body weight and may look like calluses. We compare whether the skin lines continue through the lesion and if there is pain when pinched from the side.

Points to check	Common wart	Flat wart	Molluscum contagiosum
Surface	Rough, hard, and keratotic	Small, flat, and generally smooth	Round, smooth, and glossy
Center	May contain black dots	No distinct central indentation	The center may be indented like a navel
Common locations	Fingers, around nails, soles of the feet	Face, back of hands	Children's elbow creases, torso
Things to check together	Skin lines and pressure pain	Increase along the direction of shaving or scratching	Surrounding eczema and scratching

If the surface is rough and skin lines are interrupted, consider a common wart

Common warts have thick surface keratin and may show small black dots. On the soles of the feet, they become flat like calluses due to body weight, so we check for pain when pressed from above, pain when pinched from the side, and whether the skin lines continue.

Compare small papules on the face with comedones and milia

Flat warts may appear as multiple small, flat papules that are skin-colored or light brown. Clues include whether they are centered in the pores like acne comedones, whether they are white and hard like milia, and whether new lesions have increased along the direction of shaving or scratching.

Educational example of flat warts showing scattered small flesh-colored and light brown papules with flat surfaces on an adult's hand skin — **Flat warts scattered on the back of the hand**
Flat warts on the back of the hand may increase along the direction of scratching. We check the date they suddenly increased along with any areas that were picked or shaved.

Check for round papules with a central indentation along with surrounding eczema

Molluscum contagiosum is common in children and may show a central depression. If the surrounding skin is itchy and becomes red like eczema, it can easily spread through scratching; therefore, we record not only the number of lesions but also the itchiness and the state of the skin barrier.

Please take photos of the first bump that appeared and the order in which they spread

Please take photos that clearly show whether the surface is rough, if the center is indented, and if the skin lines continue. Please also let us know which bump appeared first and the order in which new ones increased.

Educational example of molluscum contagiosum showing multiple small pearly papules with central depression on a child's torso skin — **Molluscum contagiosum clustered on the torso**
Even within the same group of papules, observing the central depression and surface gloss helps distinguish them from flat warts or folliculitis. An actual diagnosis is confirmed through a medical examination.

Do not group them under the single term 'wart'; check the surface roughness, central indentation, skin lines, and the order of appearance.

Next reading

Content to follow

Are rough, hard, raised skin changes warts?
How do I distinguish them from corns, flat warts, or molluscum contagiosum?
When new warts appear even after treatment, what does Korean medicine focus on?

Medical Evaluation GuidePrepare for your visit with skin photos, symptoms, and medications usedRather than a single photo, please prepare a chronological record of the date the symptoms first appeared, the timing of when they disappear and reappear, itching and pain, and the medications used and your reactions to them. It is helpful for the medical evaluation to take photos of the same area from the same distance during both normal states and when symptoms are most severe.Medical Evaluation GuideDistinguishing between rashes that disappear within hours and dermatitis that lasts for daysFirst, observe whether swelling in the same area generally fades without leaving a mark within a day, or whether it stays for several days, leaving dead skin, oozing, or scabs. Wheals that disappear and reappear in different locations suggest urticaria (hives), while long-lasting surface changes suggest other types of dermatitis; however, a diagnosis requires looking at the overall progression.

You can check the simple meaning first before proceeding to the detailed explanation

Skin terms used in this differential guide

PapuleA papule refers to a small, raised skin lesion. Unlike pustules containing pus or vesicles containing clear fluid, papules often feel firm beneath the surface.Lesion DistributionWhen describing the distribution, please explain not only "where it appeared," but also whether it is symmetrical on both sides, if it is in skin-fold areas, or if it follows areas exposed to sunlight, cosmetics, or clothing.RecurrenceA recurrence may be the same condition reappearing, but it could also be a new condition that looks similar. It is necessary to check if the location, appearance, and triggering situations are the same.Skin lesionA skin lesion is not a specific disease name, but a term referring to observable changes such as redness, blisters, keratinization, or swelling.Secondary InfectionA secondary infection occurs when an additional infection develops on top of eczema or a scratch. Pain, heat, pus, yellow crusts, or rapid spreading can be indicators.

When herbal medicine treatment is the primary focus

We set the goals for herbal medicine treatment based on your previous treatments and when symptoms recurred

For viral papules, infectivity and the need for standard treatment must be confirmed first. In cases where they spread repeatedly or new skin changes appear after treatment, Korean herbal medicine treatment focusing on overall systemic recovery may be considered while continuing the current treatment for skin changes.

Before the consultation

We ask where it appeared and when it worsened again

We check the surface and number of skin changes, the pattern of spreading, the possibility of immune deficiency, sleep, fatigue, and the progress of previous treatments.

During treatment

We check if not only the itching, but also sleep and daily life are improving

We compare the speed and range of new skin changes, whether they spread due to scratching, and the recovery of the treated areas.

Treatment sequence

We set the goals for herbal medicine treatment by identifying the problems that need to be resolved first

If there are causes that require immediate priority, such as infection or rapid worsening, those treatments come first. Subsequently, for herbal medicine treatment, we determine the primary goal of recovery by examining current discomfort, recurring patterns, sleep, digestion, and fatigue, and coordinate the sequence with necessary dermatological treatments.

While reducing aggravating factors through lifestyle management, herbal medicine treatment determines the initial target by analyzing the pattern of lesions, sleep, digestion, and fatigue through pattern identification (Byeonjeung). Necessary skin treatments are continued in accordance with the progress.

Consult about treatment

Evidence and Update Information

This content was organized by Korean medicine doctor Choi Yeon-seung and updated on 2026-08-23.

American Academy of Dermatology, Warts
Centers for Disease Control and Prevention, Molluscum contagiosum
American Academy of Dermatology, Warts: Signs and symptomsEvidence of wart shape, color, black vascular dots, and types (common, plantar, flat, filiform, genital), as well as symptoms of pain, itching, and bleeding