Edit concept Question Editor Create issue ticket

Molluscum Contagiosum

Molluscum contagiosum is a common skin disorder caused by Molluscum Contagiosum virus (MCV).


Presentation

The lesions appear in the form of small papules of 2-5 mm size. Papules of size greater than 15 mm diameter are rarely seen. These papules are spherical or round in shape, firm, smooth- surfaced and have a characteristic central dimpling.

The sites of these papules are different for children and adults. Although the papules are red and swollen in appearance but no local tenderness has been noted. In children, the lesions commonly occur on the chest, arms, legs, and face. Lesions on the mucous membranes such as nose, lips and buccal mucosa are rare. The genitalia, gluteal areas, perineum and inguinal areas are mainly affected in adults as the lesions are mostly sexually transmitted.

These lesions are severe and extensive in individuals with a compromised immunity such as in HIV. The infection lasts for around 2 months but the disease in general takes about 2 years to resolve completely [7].

Hyperthermia
  • Chen, Clinical evaluation of local hyperthermia at 44 C for molluscum contagiosum: pilot study with 21 patients, British Journal of Dermatology, 176, 3, (809-812), (2017).[doi.org]
Aspiration
  • Fine-needle aspiration cytology smears revealed characteristic intracytoplasmic molluscum bodies. The diagnosis was subsequently confirmed by histopathology.[ncbi.nlm.nih.gov]
Subacute Clinical Course
  • In contrast to orthopoxviruses, MCV infections tend to take a subacute clinical course but may persist for up to 12 months.[ncbi.nlm.nih.gov]
Oral Ulcers
  • Holland, Psoriasiform Eruption and Oral Ulcerations as Adverse Effects of Topical 5% Imiquimod Treatment in Children: A Report of Four Cases, Pediatric Dermatology, 30, 6, (e157-e160), (2012).[doi.org]
Cheilitis
  • In one of our patients, erosive cheilitis developed in a young boy after using topical imiquimod 5% cream for 5 nights weekly on bilateral cheeks, chin, and near vermillion border for molluscum contagiosum.[ncbi.nlm.nih.gov]
Pruritus
  • The evolution of the rash and pruritus was rapidly favourable. After 3 months, the rash and pruritus had regressed. There was no molluscum contagiosum or clear halo.[ncbi.nlm.nih.gov]
  • Although benign and generally self-limited, this condition is contagious and can lead to complications such as inflammation, pruritus, dermatitis, bacterial superinfection, and scars.[ncbi.nlm.nih.gov]
  • In children with atopic dermatitis, infection can be widespread and prolonged, since the altered epidermal barrier leads to increased susceptibility to viral skin infections, to pruritus leading to scratching and autoinoculation, and to long-term treatment[nejm.org]
  • At least one third of patients will develop symptoms of local erythema, swelling or pruritus. Diagnosis is usually clinical. Children are primarily managed conservatively. Adults should be treated with curettage, cryotherapy or cantharidin.[bestpractice.bmj.com]
  • At least one third of patients will develop symptoms of local erythema, swelling or pruritus. Diagnosis is usually clinical. Children are primarily managed conservatively.[bestpractice.bmj.com]
Skin Lesion of the Upper Extremity
  • Willard, Skin Lesions, The Pediatric Upper Extremity, 10.1007/978-1-4614-8758-6_67-1, (1-38), (2014). Joshua M. Abzug and Mark A. Cappel, Benign Acquired Superficial Skin Lesions of the Hand, The Journal of Hand Surgery, 37, 2, (378), (2012). A.[doi.org]
Erythema Annulare
  • Erythema annulare centrifugum (a widespread rash of red inflammatory rings) has also been reported ( Vasily 1978 ).[doi.org]
Generalized Seizure
  • We report a case of generalized seizures and methemoglobinemia after topical application of EMLA for curettage of molluscum contagiosum lesions in a 3.5-year-old girl with atopic dermatitis.[ncbi.nlm.nih.gov]
Pruritus Vulvae
  • Micheline Moyal-Barracco, Pruritus Vulvae, Pruritus, 10.1007/978-1-84882-322-8_37, (243-252), (2009). Jacquelyn Coloe, Craig N. Burkhart and Dean S. Morrell, Molluscum Contagiosum: What’s New and True?, Pediatric Annals, 38, 6, (321), (2009).[doi.org]
Pruritus Vulvae
  • Micheline Moyal-Barracco, Pruritus Vulvae, Pruritus, 10.1007/978-1-84882-322-8_37, (243-252), (2009). Jacquelyn Coloe, Craig N. Burkhart and Dean S. Morrell, Molluscum Contagiosum: What’s New and True?, Pediatric Annals, 38, 6, (321), (2009).[doi.org]
Chancroid
  • Chancroid, lymphogranuloma venereum, and granuloma inguinale may be considered as tropical venereal diseases. These diseases were a major diagnostic and therapeutic challenge in past centuries.[ncbi.nlm.nih.gov]

Workup

Molluscum contagiosum is diagnosed through clinical presentation and physical examination alone. The hallmark of diagnosis is done by identification of the molluscum contagiosum inclusion bodies from the specimen of the lesion obtained, through histopathological examination. The blood tests are usually not required except in suspected cases of HIV, where in it is the only symptom.

Treatment

As it is a self limiting disease, treatment is not required and in healthy subjects, the lesions disappear in a 3 month period.

Treatment is advised to prevent autoinoculation and limit the transmission of the infection. This is achieved by various methods such as curettage, cryotherapy, topical antiviral applications and surgery.

In immunocompromised patients, treatment is difficult and laser techniques, antiviral therapy along with imiquimod is recommended. Imiquimod application causes stimulation of immune response by producing interferons [8] [10]. The ointment of 1% concentration is to be applied 3 times daily for 4 weeks on the lesions and that of 5% once daily at bedtime. In patients with HIV, antiretroviral therapy is found to be much more efficient and useful. The drugs are mainly ritonavir, cidofovir and zidovudine. A new drug called Veregen is prepared from the extract of the green tea. This drug is available in an ointment form and is to be applied on the affected areas 3 times daily [6].

In a study conducted in children for treatment of molluscum contagiosum, few children were treated with cantharidin, few others had undergone curetting, few with imiquiod and the rest with salicylic acid. Of these, curettage therapy was found to be more efficient and acted well. This is because cantharidin has a strong vesicant action and acts by exfoliating the entire lesion. This treatment has also not been acknowledged by the FDA.

Salicylic acid is a caustic agent hence results in inflammation and desquamation. It also has the quality to adhere and coat the lesion, and therefore the infection doesn’t spread and remains limited to that area itself.

Cryotherapy is frequently used by many therapists, especially in elderly age group. This procedure involves freezing of the lesions which causes thinning of the adjacent skin. This is repeated after a few weeks until the disease disappears. Cryotherapy leads to loud sounds and so could be frightening to younger children. Also, the pain element is relatively high during the procedure. Pulse dye laser (PDL) therapy is found to be successful and is routinely performed. This treatment proves to be very efficient and there have been drastic reductions in the number of molluscum contagiosum lesions.

Prognosis

Molluscum contagiosum is a self remitting disease; hence the prognosis is very good. The rate of recovery is different for different individual. In healthy immunocompetent individuals, the recovery occurs by approximately 2 years. There is no death noted till date.

The morbidity percentage is higher, especially in HIV or other immunocompromised patients as they have extensive and wide spread areas infected. Though there is a complete remission; chances of recurrence of the infection is about 40%, which is also estimated due to aggravation of the current infection or new lesions appearing after an extended no infection period.

The lesions regress totally with no long lasting skin defect; however skin scarring and disfiguring of skin has been noted [6].

Etiology

Molluscum contagiosum is caused by Molluscum Contagiosum virus (MCV). This virus has a high molecular weight and is a DNA virus. After reaching the epithelium, it enters the cytoplasm and multiplies in it. It is found that MCV can survive and develop only in human skin and not in any tissue culture or eggs.

Personal contact with the infected objects such as personal items, razors, beddings, towels, napkins spreads the infection. Also, the lesion spreads locally if the lesions are touched or manipulated. This phenomenon is called as autoinoculation. Spread via swimming pools has been reported [1].

Epidemiology

Molluscum contagiosum infection is prevalent throughout the world and is one of the most common skin infections. In the United States, it occupies 1% of all skin infections. Studies reveal that the rate of this infection has been increasing.

The tropical regions show the highest infection rates. Mali has been reported to have about 5% of total prevalence with maximum age group of children getting affected [3]. The incidences grow with increasing age; lowest in children up to 2 years and high in adults more than 40 years. Certain areas like Fiji, and Africa, are repeatedly affected.

Studies have associated climatic seasonal factors such as humidity and warmth as the likelihood to the prevalence of this infection, as there is a possibility of young age group being moderately dressed and hence the chances of them transmitting the infection rise. Men are frequently affected. Infants are hardly infected and those more than 5 years are highly infected [4].

Sex distribution
Age distribution

Pathophysiology

Mollluscum contagiosum virus produces cytoplasmic inclusions and enlargement of the cells in the epithelial layer of the skin. The virus disperses the infection from the basal layer of epidermis to the spindle and the granular layers of the epidermis during the 8 weeks of the infection period.

At the cellular level, the infected cells undergo intense destruction and distortion resulting in formation of huge hyaline bodies called molluscum bodies or Henderson-Paterson bodies [5]. These bodies have a typical structure which looks like a smooth papule with a central white dimple. It has been noted that these lesions have a possibility to get inflamed and develop edema with proliferation of blood vessels and monocytic and lymphocytic infiltration.

Prevention

Self manipulation or scratching of the lesions should be avoided as it causes local spread. Observe self hygiene and repel from any physical contact. Molluscum contagiosum is transmitted through sexual route, so care must be taken and abstinence is recommended or possibly to use a condom. The disease is transmitted even though fomites like cupboards etc., so direct contact with it must be avoided.

Patients are advised to maintain usual hygiene and avoid physical contact with other individuals. They are informed not to share beddings, bath towels, sports equipment, and swimming pools with other people. Touching or scrapping of the local lesions should be avoided to minimize autoinoculation [1] [8].

Summary

Molluscum contagiosum is a common cutaneous viral infection. It was discovered in the early nineteenth century by Dr. Bateman. Molluscum contagiosum is an infection which spreads from person to person and it is prevalent worldwide. This infection is found in the adult age group as well as in children.

The virus invades the host from the epidermal layer of the skin through small breaks appearing in the hair follicles. As only the epidermis is involved, it is also called as epithelioma contagiosum or dimple warts. The lesions appear as papules which are pearly and smooth occurring in clusters.

Patient Information

Like all contagious infections, molluscum contagiosum also gets transmitted from person to person. Care must be taken to avoid physical contact with family and other members. The area should be enclosed in a thicken gauze piece or bandage; scrapping or touching must be avoided in order to avoid the local spread. Individual must refrain from sexual activity during the infection if the lesions involve the genital area.

Molluscum contagiosum is a self remitting disease, so if left untreated it will resolve on its own. Complete recovery takes about 6 months. The lesions can culminate into deep scarring after the disease remission. Local surgery, lasers, curetting are different recommendations for treating in order to cut the duration and prevent disfiguring of the skin [11].

References

Article

  1. Connell CO, Oranje A, Van Gysel D, Silverberg NB. Congenital molluscum contagiosum: report of four cases and review of the literature. Pediatr Dermatol. Sep-Oct 2008;25(5):553-6.
  2. Niizeki K, Kano O, Kondo Y. An epidemic study of molluscum contagiosum: relationship to swimming. Dermatologica. 1984;169(4):197-98.
  3. Castilla M. Molluscum contagiosum in children and its relationship to attendance at swimming-pools: an epidemiological study. Dermatology. 1995;191(2):165.
  4. Choong KY, Roberts LJ. Molluscum contagiosum, swimming and bathing: a clinical analysis. Australas J Dermatol. 1999 May;40(2):89-92.
  5. Dai NT, Yeh MK, Liu DD, Adams EFet al. A co-cultured skin model based on cell support membranes. Biochem Biophys Res Commun. 2005 Apr 15;329(3):905-908.
  6. Howell MD, Jones JF, Kisich KO, Streib JE, et al. Selective killing of vaccinia virus by LL-37: implications for eczema vaccinatum. J Immunol. 2004 Feb 1;172(3):1763-7.
  7. Gottlieb SL, Myskowsi PL. Molluscum contagiosum. Int J Dermatol. 1994 Jul;33(7):453-461.
  8. Buckley R, Smith K. Topical imiquimod therapy for chronic giant molluscum contagiosum in a patient with advanced human immunodeficiency virus 1 disease. Arch Dermatol. 1999 Oct;135(10):1167-9.
  9. Hanson, Daniel; & Diven, Dayna G. Molluscum contagiosum. Dermatology Online Journal 2003 9(2). 
  10. Cohen JI, Davila W, Ali MA, Turk S, et al. Detection of Molluscum Contagiosum Virus (MCV) DNA in the Plasma of an Immunocompromised Patient and Possible Reduction of MCV DNA With CMX001. J Infect Dis. 2012 Mar 1;205(5):794-97
  11. Phelps A, Murphy M, Elaba Z, Hoss D. Molluscum Contagiosum Virus Infection in Benign Cutaneous Epithelial Cystic Lesions—Report of 2 Cases With Different Pathogenesis? Am J Dermatopathol. 2010 Oct; 32(7):740-2.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2019-07-11 20:56