Molluscum contagiosum
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| Molluscum contagiosum Classification and external resources | |
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| Typical flesh-colored, dome-shaped and pearly lesions | |
| ICD-10 | B08.1 |
| ICD-9 | 078.0 |
| DiseasesDB | 8337 |
| MedlinePlus | 000826 |
| eMedicine | derm/270 |
| Vaccinia virus | ||||||||
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 EM of Molluscum contagiosum virus
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| Virus classification | ||||||||
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Molluscum contagiosum (MC) is a viral infection of the skin or occasionally of the mucous membranes. MC has no animal reservoir, infecting only humans, as did smallpox. However, there are different pox viruses that infect many other mammals. The infecting human MC 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 or shared articles of clothing (including towels).
In adults, molluscum infections are often sexually transmitted and usually affect the genitals, lower abdomen, buttocks, and inner thighs. In rare cases, molluscum infections are also found on the lips, mouth, and eyelids.
The time from infection to the appearance of lesions ranges from 1 week to 6 months, with an average incubation period of 6 weeks. Diagnosis is made on the clinical appearance; the virus cannot routinely be cultured.
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. They may occasionally be complicated by secondary bacterial infections.
The central waxy core contains the virus. In a process called autoinoculation, the virus may spread to neighboring skin areas. Children are particularly susceptible to auto-inoculation, and may have widespread clusters of lesions.
Physical Examination
Skin
 Molluscum Contagiosum (Rx: Curettage, Cryotherapy, etc)[1] |
 Molluscum lesions on an arm. |
Treatments
Individual molluscum lesions may go away on their own and are reported as lasting generally from 6 to 8 weeks,[2] to 2 or 3 months.[3] However via autoinoculation, the disease may propagate and so an outbreak generally lasts longer with mean durations variously reported as 8 months,[2] to about 18 months,[4][5] and with a range of durations from 6 months to 5 years.[3][5]
Treatment is often unnecessary[6] depending on the location and number of lesions, with no single approach shown to be convincingly effective.[7] Nonetheless, treatment may be sought after for the following reasons:
- Medical issues including:
- Bleeding
- Secondary infections
- Itching and discomfort
- Potential scarring
- Chronic keratoconjunctivitis
- Social reasons
- Cosmetic
- Embarrassment
- Fear of transmission to others
- Social exclusion
Many health professionals recommend treating bumps located in the genital area to prevent them from spreading.[5] It is important to realize that treating the bumps does not cure the disease. The virus is in the skin and new bumps will often appear even after all the visible ones are surgically treated. Any surgical option of treatment may therefore have to be repeated each time new bumps occur. The body eventually mounts an effective immune response and rids itself of the virus, but until then, new bumps may occur over the course of a year or more.
Betadine
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). However, the ability of iodine to penetrate intact skin is poor, and without a pin prick or needle stick into each molluscum lesion this method does not work well. Do not use on broken skin.
Astringents
Astringent chemicals applied to the surface of molluscum lesions to destroy successive layers of the skin include trichloroacetic acid, podophyllin resin, potassium hydroxide, and cantharidin.[8]
Australian lemon myrtle
A 2004 study demonstrated over 90% reduction in the number of lesions in 9 out of 16 children treated with 10% strength solution of essential oil of Australian lemon myrtle (Backhousia citriodora).[9] However the oil may irritate normal skin at concentrations of 1%.[10][11]
Over-the-counter substances
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.[12][13] These treatments require several months for the infection to clear, and are often associated with intense inflammation and possibly discomfort.
Imiquimod
Doctors occasionally prescribe Imiquimod, the optimum schedule for its use has yet to be established.[14] Imiquimod, a form of immunotherapy. Immunotherapy triggers your immune system to fight the virus causing the skin growth. Imiquimod is applied 3 times per week, left on the skin for 6 to 10 hours, and washed off. A course may last from 4 to 16 weeks. Small studies have indicated that it is successful about 80% of the time
Non-medicine treatment
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 are 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 treatment
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 cantharidin can be effective. It should be noted that cryosurgery and curette scraping are not painless procedures. They may also leave scars and/or permanent white (depigmented) marks.
Laser
Pulsed dye laser therapy for molluscum contagiosum may be the treatment of choice for multiple lesions in a cooperative patient (Dermatologic Surgery, 1998). The use of pulsed dye laser for the treatment of MC has been documented with excellent results. The therapy was well tolerated, without scars or pigment anomalies. The lesions resolved without scarring at 2 weeks. Studies show 96%–99% of the lesions resolved with one treatment.[15][16] The pulsed dye laser is quick and efficient, but its expense makes it less cost effective than other options. Also, not all dermatology offices have this 585nm laser. It is important to remember that removal of the visible bumps does not cure the disease. The virus is in the skin and new bumps often appear over the course of a year until the body mounts an effective immune response to the virus. Thus any surgical treatment may require it to be repeated each time new crops of lesions appear.
Prevent spreading
To prevent molluscum contagiosum from spreading:
- Try not to scratch. Put a piece of tape or a bandage over any bumps.
- Avoid contact sports, swimming pools, and shared baths and articles of clothing (towels.)
- If bumps are on the face, avoid shaving.
- If bumps are on the genital area, avoid sexual activity.
See also
- Acrochordons (also called skin tags — similar in appearance and grow in similar areas)
References
- ↑ http://picasaweb.google.com/mcmumbi/USMLEIIImages/photo#5089143298860559810
- ↑ 2.0 2.1 Weller R, O'Callaghan CJ, MacSween RM, White MI (1999). "Scarring in Molluscum contagiosum: comparison of physical expression and phenol ablation". BMJ 319 (7224): 1540. PMID 10591712.
- ↑ 3.0 3.1 derm/270 at eMedicine
- ↑ MedlinePlus Encyclopedia 000826
- ↑ 5.0 5.1 5.2 Tyring SK (2003). "Molluscum contagiosum: the importance of early diagnosis and treatment". Am. J. Obstet. Gynecol. 189 (3 Suppl): S12–6. PMID 14532898.
- ↑ Prodigy knowledgebase (July 2003). Molluscum Contagiosum. National Health Service. Retrieved on 2006-07-06. - UK NHS guidelines on Molluscum Contagiosum
- ↑ van der Wouden JC, Menke J, Gajadin S, et al (2006). "Interventions for cutaneous molluscum contagiosum". Cochrane Database Syst Rev (2): CD004767. doi:10.1002/14651858.CD004767.pub2. PMID 16625612.
- ↑ Molluscum Contagiosum - Treatment Overview. WebMD (January 12, 2007). Retrieved on 2007-10-21.
- ↑ Burke BE, Baillie JE, Olson RD (2004). "Essential oil of Australian lemon myrtle (Backhousia citriodora) in the treatment of molluscum contagiosum in children". Biomed. Pharmacother. 58 (4): 245–7. doi:10.1016/j.biopha.2003.11.006. PMID 15183850.
- ↑ Hayes AJ, Markovic B (2002). "Toxicity of Australian essential oil Backhousia citriodora (Lemon myrtle). Part 1. Antimicrobial activity and in vitro cytotoxicity". Food Chem. Toxicol. 40 (4): 535–43. PMID 11893412.
- ↑ Hayes AJ, Markovic B (2003). "Toxicity of Australian essential oil Backhousia citriodora (lemon myrtle). Part 2. Absorption and histopathology following application to human skin". Food Chem. Toxicol. 41 (10): 1409–16. PMID 12909275.
- ↑ Papa C, Berger R (1976). "Venereal herpes-like molluscum contagiosum: treatment with tretinoin". Cutis 18 (4): 537-40. PMID 1037097.
- ↑ (1996) "Molluscum Contagiosum". Adolesc Med 7 (1): 57-62. PMID 10359957.
- ↑ Hanna D, Hatami A, Powell J, et al (2006). "A prospective randomized trial comparing the efficacy and adverse effects of four recognized treatments of molluscum contagiosum in children". Pediatric dermatology 23 (6): 574-9. doi:10.1111/j.1525-1470.2006.00313.x. PMID 17156002.
- ↑ Hammes S, Greve B, Raulin C (2001). "[Molluscum contagiosum: treatment with pulsed dye laser]" (in German). Der Hautarzt; Zeitschrift für Dermatologie, Venerologie, und verwandte Gebiete 52 (1): 38-42. PMID 11220237.
- ↑ Hughes P (Feb 1998). "Treatment of molluscum contagiosum with the 585-nm pulsed dye laser.". Dermatol Surg 24 (2): 229-30. PMID 9491117.
External links
- Center of Disease Control - Molluscum
- WebMD - Molluscum contagiosum
- Daniel Hanson and Dayna G. Diven (2003). "Molluscum Contagiosum". Dermatology Online Journal 9 (2): 2.
- Health In Plain English - Molluscum contagiosum
- VisualDxHealth - medical photos and treatment overview
- Dermatlas: A photo/case gallery
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Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
