Molluscum contagiosum

Molluscum contagiosum (MC) is viral infection of the skin or occasionally of the mucous membranes. MC infects humans, other primates and kangaroos. The infecting virus is a DNA poxvirus called the molluscum contagiosum virus (MCV). There are 4 types of MCV, MCV-1 to -4, with MCV-1 being the most prevalent and MCV-2 seen usually in adults and often sexually transmitted. The incidence of MC infections in young children is around 17% and peaks between 2-12 years of age. MC affects any area of the skin but is most common on the body, arms, and legs. It is spread through direct contact, saliva, or shared articles of clothing (including towels).

In adults, molluscum infections are often sexually transmitted and usually affects the genitals, lower abdomen, buttocks, and inner thighs. In rare cases, molluscum infections are also found on the lips and mouth.

The time from infection to the appearance of lesions ranges from 1 week to 6 months.

Symptoms

Molluscum contagiosum lesions are flesh-colored, dome-shaped, and pearly in appearance. They are often 1-5 millimeters in diameter, with a dimpled center. They are generally not painful, but they may itch or become irritated. Picking or scratching the bumps may lead to further infection or scarring. In about 10% of the cases, eczema develops around the lesions.

In most patients, the lesions are asymptomatic. They may be complicated by secondary bacterial infections. They may cause itching and consequent eczema around the tumors.

The central waxy core contains the virus. In a process called auto-inoculation, the virus may spread to neighboring skin areas. Children are particularly susceptible to auto-inoculation, and may have widespread clusters of lesions.

Treatments

Molluscum lesions may go away on their own in six to nine months, but can persist, via autoinnoculation, for up to four years. Treatment is often unnecessary - UK NHS guidelines on Molluscum Contagiosum depending on the location and number of lesions, nonetheless, treatment may be sought after for the following reasons:

Medical Issues including:
- Bleeding
- Secondary infections
- Itching & Discomfort
- Potential Scarring
- Chronic keratoconjunctivitis
Social Reasons
- Cosmetic
- Embarrassment
- Fear of transmission to others
- Social exclusion

There are a few treatment options that can be done at home. Betadine surgical scrub can be gently scrubbed on the infected area for 5 minutes daily until the lesions resolve (this is not recommended for those allergic to iodine or betadine). For mild cases, over-the-counter wart medicines, such as salicylic acid may shorten infection duration. Daily topical application of tretinoin cream ("Retin-A 0.025%") may also trigger resolution. These treatments require several weeks for the infection to clear. Repeated application of adhesive or duct tape after bathing for 16 weeks led to cure in 90% of patients in one study.

The infection can also be cleared without medicine if there are only a few lesions. First, the affected skin area should be cleaned with an alcohol swab. Next, a sterile needle is used to cut across the head of the lesion, through the central dimple. The contents of the papule is removed with another alcohol swab. This procedure is repeated for each lesion (and is therefore unreasonable for a large infection). With this method, the lesions will heal in two to three days.

Surgical treatments include cryosurgery, in which liquid nitrogen is used to freeze and destroy lesions, as well as scraping them off with a curette. Application of liquid nitrogen may cause burning or stinging at the treated site, which may persist for a few minutes after the treatment. Scarring or loss of color can complicate both these treatments. With liquid nitrogen, a blister may form at the treatment site, but it will slough off in two to four weeks. Although no longer available in the United States, the topical blistering agent cantharadin can be effective.

Pulsed dye laser therapy for molluscum contagiosum may be the treatment of choice for multiple lesions in a cooperative patient (Dermatologic Surgery, 1998). Unfortunately, not all dermatology offices have this 585nm laser.

Footnotes

External links

Poxviruses | Sexually-transmitted diseases

Molluscum contagiosum | Molusco contagioso | Molluscum contagiosum | Waterwrat | Molusco contagioso

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Symptoms

Treatments

Footnotes

External links