Molluscum contagiosum


Warts caused by poxvirus.

Lesions are small, waxy bumps and measure 1-6 mm in size.

Larger lesions may have a pit in the center of the lesion.

Lesions may become swollen, red and inflamed and suggests the lesions are resolving.

Leads to chronic, localized infection of the skin that can occur anywhere in the body.

Young patients often have lesions on their chest, under the arms, legs, and groin.

Typical flesh-colored, dome-shaped and pearly lesions

A viral infection of the skin but occasionally may involve the mucous membranes.

Sometimes referred to as water warts.

Approximately 1.8% of the population affected.

Caused by a DNA poxvirus called the molluscum contagiosum virus (MCV).

Has no nonhuman-animal reservoir as it infects only humans.

There are four types: MCV-1 to -4.

MCV-1 is the most prevalent and MCV-2 is seen usually in adults.

The virus is spread from person to person by touching the affected skin.

The virus may also be spread by fomites, and can spread to other parts of their body by touching or scratching a lesion and then touching another part of the body.

Can be spread from one person to another by sexual contact.

MC has a higher incidence in children, sexually active adults, and those who are immunodeficient.

The infection is most common in children aged one to ten years of age.

Can affect any area of the skin but is most common on the trunk of the body, arms, groin, and legs.

Molluscum infections have globally been on the rise.

Inkfections are seldom serious and routinely disappear without treatment.

Molluscum contagiosum is contagious until the lesions resolve.

Differential diagnosis includes coccidiomycosis, histoplasmosis, basal cell carcinoma, and warts.

Process may remain for up to 4 years if not treated.

Lesions are flesh-colored, dome-shaped, and pearly in appearance, often dimpled and 1-5 millimeters.

Lesions are generally not painful.

Lesions may itch or become irritated and infected by scratching.

So long as the skin growths are present, there is a possibility of transmitting the infection to another person.

The infection is localized in the epidermal layers, where it induces a complex hyperproliferative lesion with an abundance of virus particles but a absence of immune effectors.

Approximately 10% of the cases have associated eczema.

Can cause disfigurement and suffering in children.

Less common in adults and often sexually transmitted.

Extensive and persistent skin infection with the virus can indicate underlying immunodeficiency.

As the viral infection is limited to a localized area on the topmost layer of the epidermis, once has been destroyed, the infection is gone.

The central waxy core contains the virus, and it can spread to neighboring skin areas.

Children are particularly susceptible to autoinoculation.

Lesions may go away on their own and are reported as lasting generally from 6 weeks to 3 months.

If autoinoculation occurs outbreak generally lasts longer.

Mean durations for an outbreak are reported from 8 months to about 18 months.

Durations are reported as widely as 6 months to 5 years, lasting longer in immunosuppressed individuals.

Virus is a Group I (dsDNA) of the Poxviridae Virus, Genus: Molluscipoxvirus and Species: Molluscum contagiosum virus

Clinical diagnosis.

Virus cannot routinely be cultured.

The diagnosis can be confirmed by excisional biopsy.

Histologically characterized by molluscume bodies in the epidermis above the stratum basale.

Molluscume bodies consist of large cells with abundant granular eosinophilic cytoplasm with accumulated virons and a small peripheral nucleus.

Treatment initial recommendations are often expectant management.

Treatment options are invasive, requiring tissue destruction that may spread the infection further.

When treatment results in elimination of lesions, the infection has been cured and will not reappear unless reinfected.

Astringent chemicals applied to the surface of lesions destroys layers of the skin include potassium hydrochloride, and cantharidin.

Randomized, placebo controlled clinical trials in children treated with a combination of essential oils have demonstrated the effectiveness.

A study showed a 90% or greater reduction in the number of visible lesions in 16 of 19 children using a combination of essential oil of Melaleuca alternifolia (tea tree oil) and organically bound iodine .

Tea tree oil alone works in about 18% of children.

Wart medicines, such as salicylic acid may or may not shorten infection duration.

Daily topical application of tretinoin cream may help.

Above treatments require several months of therapy for the infection to clear, and are often associated with inflammation and discomfort.

Imiquimod immunotherapy may be used to trigger the immune system to fight the virus causing the skin growth.

Surgical treatments include cryosurgery with liquid nitrogen to destroy lesions, as well as scraping them off with a curette.

Potassium hydroxide (KOH) solution compared with cryotherapy showed no statistically significant difference in clearance between the two modalities, each demonstrating > 85% complete clearance at 4 weeks.

KOH is less expensive than cryotherapy and can be applied at home.

Pulsed dye laser therapy may be used for cases that are persistent and do not resolve following other measures.

Does not remain in the body when the growths are gone from the skin and will not reappear on their own.

There is no permanent immunity to the virus, and it is possible to become infected again upon exposure to an infected person.

Extensive lesions can occur in patients with DOCK8 deficiency-a genetic disorder affecting migration of dendritic and specialised T cells in skin.

Disappearance of lesions is the consequence of a vigorous immune response in healthy people.

Advantage of treatment is to hasten the resolution of the virus and limits the size of the scar.

Prognosis for minimal scarring is best if treatment is initiated when lesions are small.

Adults commonly have their lesions in the groin.

Large single lesions can appear in unusual places.

Children may have eczematous patches around the lesions.

Diagnosis usually made on a clinical basis.

Treatment with liquid nitrogen, topical acid therapy, silver nitrate, phenol or cantharidin.

Can be removed with topical surgery.

With time, months to 1-2 years, all lesions disappear.

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