Molluscum contagiosum

• Molluscum contagiosum is a viral infection that causes white bumps on the skin; usually clears up in a few months.
• Molluscum contagiosum is an infection caused by a poxvirus (molluscum contagiosum virus).
• The result of the infection is usually a benign, mild skin disease characterized by lesions (growths) that may appear anywhere on the body.
• Within 6-12 months, Molluscum contagiosum typically resolves without scarring but may take as long as 4 years.

Molluscum contagiosum

Molluscum contagiosum is characterized by specific skin lesions known as Mollusca. These lesions have several distinguishing features:

• Typically, the lesions, or Mollusca, are raised and exhibit colors ranging from white, pink, or flesh-toned. They are often accompanied by a central dimple or pit.
• These lesions are recognized by their pearly sheen.
• Their texture is usually smooth and firm to the touch.
• The size of these lesions varies but typically ranges from the diminutive size of a pinhead to as large as a pencil eraser (2 to 5 millimeters in diameter).
• Some individuals may experience itchiness, soreness, redness, or swelling associated with the lesions.
• Mollusca can appear anywhere on the body, such as the face, neck, arms, legs, abdomen, and genital area, presenting either singly or in clusters.
• Notably, these lesions are infrequently found on hand palms or foot soles.

Transmission

The spread of molluscum contagiosum is primarily due to the molluscum contagiosum virus. Modes of transmission include:

• Direct person-to-person contact, facilitating the spread of the virus.
• Interaction with contaminated fomites - non-living objects like towels, toys, pool equipment, etc.
• Although suspected, there's no proven correlation between sharing wet environments like swimming pools, baths, or saunas and the transmission of the virus.

Molluscum contagiosum

Autoinoculation

The virus exhibits the potential for self-transfer in various ways:

• Direct contact with a lesion and subsequently touching another body part can transfer the virus, termed autoinoculation.
• Procedures like shaving or electrolysis can unintentionally propagate the spread of mollusca.
• The virus is also communicable through sexual contact, making molluscum contagiosum a potential sexually transmitted disease.
• There's ambiguity over whether intact lesions can spread the disease or if lesion rupture is necessary.
• Importantly, the molluscum contagiosum virus is confined to the skin's top layer (epidermis) and doesn't spread systemically or via respiratory routes like coughing or sneezing.
• Once the lesions have resolved, the person becomes non-contagious.

Molluscum contagiosum

Risk Factors

While molluscum contagiosum can affect anyone, certain populations exhibit increased susceptibility:

• Immune-compromised individuals, especially those with conditions like HIV or undergoing cancer treatment.
• Persons with atopic dermatitis due to the associated skin breaks.
• Individuals residing in humid, warm climates or crowded living conditions.
• An upward trend in molluscum contagiosum infections has been observed in the U.S. since 1966.

Molluscum bumps

Etiology

The causal agent behind molluscum contagiosum is a specific poxvirus. Its characteristics include:

• The lesions, predominantly painless, can occasionally become inflamed.
• Typically, these lesions self-resolve within 6 to 12 months, though some cases can extend to 4 years.

Clinical Features

Molluscum contagiosum's global distribution is skewed more towards developing nations, and it's traditionally been considered a pediatric disease. Notable clinical aspects include:

• Previous vaccination against smallpox doesn't confer protection against molluscum contagiosum.
• The incubation period remains somewhat elusive but is believed to span between 2 weeks and 6 months.
• Children with atopic dermatitis are at an elevated risk due to the skin's compromised barrier and immune dysfunction.

Skin disease "molluscum contagiosum"

Immunocompromised

Immune-compromised patients present unique challenges in the context of molluscum contagiosum:

• Patients with conditions like HIV/AIDS can exhibit unusually large lesions and face challenges with standard treatments.
• Differential diagnosis for molluscum contagiosum should consider conditions like cryptococcosis, basal cell carcinoma, and histoplasmosis, among others.
• The nature and presentation of the disease can differ based on the patient's immune status.

Poxvirus of molluscum contagiosum

Treatment Options

• Because molluscum contagiosum is self-limited in healthy individuals, treatment may be unnecessary.
• Nonetheless, issues such as lesion visibility, underlying atopic disease, and the desire to prevent transmission may prompt therapy.
• Treatment for molluscum is usually recommended if lesions are in the genital area (on or near the penis, vulva, vagina, or anus). If lesions are found in this area it is a good idea to visit your healthcare provider as there is a possibility that you may have another disease spread by sexual contact.
• Be aware that some treatments available through the internet may not be effective and may even be harmful.

Physical removal

• Physical removal of lesions may include cryotherapy (freezing the lesion with liquid nitrogen), curettage (the piercing of the core and scraping of caseous or cheesy material), and laser therapy.
• These options are rapid and require a trained health care provider, may require local anesthesia, and can result in post-procedural pain, irritation, and scarring.
• It is not a good idea to try and remove lesions or the fluid inside of lesions yourself.
• By removing lesions or lesion fluid by yourself you may unintentionally autoinoculate other parts of the body or risk spreading it to others.
• By scratching or scraping the skin you could cause a bacterial infection.

Oral therapy

• Gradual removal of lesions may be achieved by oral therapy.
• This technique is often desirable for pediatric patients because it is generally less painful and may be performed by parents at home in a less threatening environment.
• Oral cimetidine has been used as an alternative treatment for small children who are either afraid of the pain associated with cryotherapy, curettage, and laser therapy or because the possibility of scarring is to be avoided.
• While cimetidine is safe, painless, and well tolerated, facial mollusca do not respond as well as lesions elsewhere on the body.

Topical therapy

• Podophyllotoxin cream (0.5%) is reliable as a home therapy for men but is not recommended for pregnant women because of presumed toxicity to the fetus. Each lesion must be treated individually as the therapeutic effect is localized.
• Other options for topical therapy include iodine and salicylic acid, potassium hydroxide, tretinoin, cantharidin (a blistering agent usually applied in an office setting), and imiquimod (T cell modifier).
• Imiquimod has not been proven effective for the treatment of molluscum contagiosum in children and is not recommended for children due to possible adverse events.
• These treatments must be prescribed by a health care professional.

Confluent molluscum contagiosum on the head of an infant

Therapy for immunocompromised persons

• Most therapies are effective in immunocompetent patients; however, patients with HIV/AIDS or other immunosuppressing conditions often do not respond to traditional treatments.
• In addition, these treatments are largely ineffective in achieving long-term control in HIV patients.
• Low CD4 cell counts have been linked to widespread facial mollusca and therefore have become a marker for severe HIV disease.
• Thus far, therapies targeted at boosting the immune system have proven the most effective therapy for molluscum contagiosum in immunocompromised persons.
• In extreme cases, intralesional interferon has been used to treat facial lesions in these patients.
• However, the severe and unpleasant side effects of interferon, such as influenza-like symptoms, site tenderness, depression, and lethargy, make it a less-than-desirable treatment.
• Furthermore, interferon therapy proved most effective in otherwise healthy persons. Radiation therapy is also of little benefit.

Prevention

• The best way to avoid getting molluscum is by following good hygiene habits.
• Remember that the virus lives only in the skin and once the lesions are gone, the virus is gone and you cannot spread the virus to others.
• Wash your hands
• Don’t scratch or pick at molluscum lesions
• Keep molluscum lesions covered
• Be careful during sports activities
• Swimming should also be avoided

Molscum contagiosum

Other ways to avoid sharing your infection

• Do not shave or have electrolysis on areas with lesions.
• Don’t share personal items such as unwashed clothes, hair brushes, wrist watches, and bar soap with others.
• If you have lesions on or near the penis, vulva, vagina, or anus, avoid sexual activities until you see a health care provider.

Long Term Effects

• Recovery from one molluscum infection does not prevent future infections.
• Molluscum contagiosum is not like herpes viruses which can remain dormant (“sleeping”) in your body for long periods of time and then reappear.
• If you get new molluscum contagiosum lesions after you are cured, it means you have come in contact with an infected person or object again.

Complications

• The lesions caused by molluscum are usually benign and resolve without scarring.
• However scratching at the lesion, or using scraping and scooping to remove the lesion, can cause scarring. For this reason, physically removing the lesion is not often recommended in otherwise healthy individuals.
• The most common complication is a secondary infection caused by bacteria.
• Secondary infections may be a significant problem in immunocompromised patients, such as those with HIV/AIDS or those taking immunosuppressing drug therapies.
• In these cases, treatment to prevent further spread of the infection is recommended.

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