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Definition Return to top
Molluscum contagiosum is a viral skin infection that causes raised, pearl-like papules or nodules on the skin.
Causes Return to top
Molluscum contagiosum is caused by a virus that is a member of the poxvirus family. You can get the infection in a number of different ways.
This is a common infection in children and occurs when a child comes into direct contact with a lesion. It is frequently seen on the face, neck, armpit, arms, and hands but may occur anywhere on the body except the palms and soles.
The virus can spread through contact with contaminated objects, such as towels, clothing, or toys.
The virus also spreads by sexual contact. Early lesions on the genitalia may be mistaken for herpes or warts but, unlike herpes, these lesions are painless.
Persons with a weakened immune system (due to conditions such as AIDS) may have a rapidly worse case of molluscum contagiosum.
Symptoms Return to top
Typically, the lesion of molluscum begins as a small, painless papule that may become raised up to a pearly, flesh-colored nodule. The papule often has a dimple in the center. These papules may occur in lines, where the person has scratched. Scratching or other irritation causes the virus to spread in a line or in groups, called crops.
The papules are about 2 - 5 millimeters wide. There is usually no inflammation and subsequently no redness unless you have been digging or scratching at the lesions.
The skin lesion commonly has a central core or plug of white, cheesy or waxy material.
In adults, the lesions are commonly seen on the genitals, abdomen, and inner thigh.
Exams and Tests Return to top
Diagnosis is based on the appearance of the lesion and can be confirmed by a skin biopsy. The health care provider should examine the lesion to rule out other disorders and to determine other underlying disorders.
Treatment Return to top
In people with normal immune systems, the disorder usually goes away on its own over a period of months to years.
Persons with a comprimised immune system (such as AIDS) may have a rapidly worse case of molluscum contagiosum.
Individual lesions may be removed surgically, by scraping, de-coring, freezing, or through needle electrosurgery. Surgical removal of individual lesions may result in scarring. Medications, such as those used to remove warts, may be helpful in removal of lesions, but can cause blistering that leads to temporary skin discoloration.
Outlook (Prognosis) Return to top
Molluscum contagiosum lesions may persist from a few months to a few years. These lesions ultimately disappear without scarring, unless there is excessive scratching, which may leave marks.
Individual lesions usually disappear within about 2 - 3 months. Complete disappearance of all lesions generally occurs within about 6 - 18 months. The disorder may persist in immunosuppressed people.
Possible Complications Return to top
- Persistence, spread, or recurrence of lesions
- Secondary bacterial skin infections
When to Contact a Medical Professional Return to top
Call for an appointment with your health care provider if you have symptoms suggestive of molluscum contagiosum. Also call for an appointment with your health care provider if lesions persist or spread, or if new symptoms appear.
Prevention Return to top
Avoid direct contact with the skin lesions. Do not share towels with other people.
Avoiding sex can also prevent molluscum virus and other STDs. You can also avoid STDs by having a monogamous sexual relationship with a partner known to be disease-free.
Male and female condoms cannot fully protect you, as the virus can be on areas not covered by the condom. Nonetheless, condoms should still be used every time the disease status of a sexual partner is unknown. They reduce your chances of getting or spreading STDs. Use them with spermicide with nonoxynol 9.
1.
Molluscum Contagiosum and Warts
DANIEL L. STULBERG, M.D., Utah Valley Family Practice Residency, Provo, Utah
ANNE GALBRAITH HUTCHINSON, M.D., North Andover, Massachusetts
| Molluscum contagiosum and warts are benign epidermal eruptions resulting from viral infections of the skin. Molluscum contagiosum eruptions are usually self-limited and without sequelae, although they can be more extensive in immunocompromised persons. Spontaneous disappearance of lesions is the norm, but treatment by local destruction (curettage, cryotherapy, or trichloroacetic acid) or immunologic modulation can shorten the disease course, possibly reducing autoinoculation and transmission. Warts result from a hyperkeratotic reaction to human papillomavirus infection; nongenital warts are classified as common, periungual, flat, filiform, or plantar, based on location and shape. Warts are treated by local destruction (acids, cryotherapy, electrodesiccation-curettage), chemotherapy, or immunotherapy. The choice of treatment varies with the age and wishes of the patient, the potential side effects of the treatment, and the location of the lesions. (Am Fam Physician 2003;67:1233-40,1243-4. Copyright© 2003 American Academy of Family Physicians.) |  |
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A PDF version of this document is available. 
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| See page 1226 for definitions of strength-of-evidence levels. | ||
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Molluscum Contagiosum
Papular eruptions that result from infection with the MC virus are usually self-limited and without sequelae in immunocompetent persons, although the lesions can last for months or even years.
MC infection occurs frequently among children and also affects sexually active adults, where it is classified among the sexually transmitted diseases.1 MC has gained additional attention over the past two decades because of its prevalence as an opportunistic infection in persons with human immunodeficiency virus (HIV) infection. In patients with HIV, MC infection often is not self-limited and can be much more extensive and even disfiguring. Recent studies have suggested that MC may serve as a cutaneous marker of severe immunodeficiency and sometimes is the first indication of HIV infection.2
MC is a double-stranded DNA virus in the Poxviridae family. As with other poxviruses, MC is spread through fomite or skin-to-skin contact, and microscopic abrasions in the epidermis are thought to facilitate transmission.3
 FIGURE 1. Molluscum contagiosum with central umbilication. |  FIGURE 2. Child with facial molluscum contagiosum. |  FIGURE 3. Common wart. |
DIAGNOSIS
The typical MC lesion is an asymptomatic, firm, smooth, round papule with central umbilication (Figure 1). Lesions are usually 3 to 5 mm in diameter and number less than 30,4 although these parameters often are exceeded in persons with HIV and other immunocompromised conditions.5,6 In children, the papules typically are found on the extremities, trunk, and face (Figure 2). In sexually transmitted cases, they usually occur on the lower abdomen and in the genital region.
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TREATMENT
Spontaneous disappearance of MC lesions with no residual scarring is common, often after a period of inflammation and minor tenderness.7 Few controlled studies of treatment efficacy have been performed, but many experts recommend local destruction to prevent autoinoculation (spread by scratching) and transmission to others.
Lesion eradication may be mechanical (curettage, laser, or cryotherapy with liquid nitrogen or nitrous oxide cryogun), chemical (trichloroacetic acid, tretinoin [Retin-A]), or immunologic (imiquimod [Aldara]).
Curettage or cryotherapy is commonly performed in the primary care setting. In children, application of topical anesthetic (e.g., lidocaine/prilocaine [EMLA cream]) under occlusion 15 to 30 minutes before curettage has been shown to significantly reduce pain.8
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Anecdotal reports and small studies suggest that imiquimod, an immune enhancer that induces cytokines, may be useful in treating MC, especially when numerous lesions are present or destructive methods are not tolerated.9 [Evidence level C, consensus/expert guidelines] This treatment seems to be migrating into clinical practice. Advantages to imiquimod therapy include minimal side effects and ease of application.
Early studies using varying potencies and application regimens have shown clearance rates of 40 to 82 percent.9 Imiquimod is available as a 5-percent cream and is approved for treating genital and nongenital warts. It is applied three times per week, left on the skin for six to 10 hours, then washed off. A typical course of treatment lasts from four to 16 weeks.
MC in patients with HIV infection and other immunocompromising conditions can be more severe, making treatment more difficult. Researchers have had some initial success with the nucleotide analog cidofovir in HIV-infected patients with advanced MC. Topical and intravenous forms have been tested,10 and controlled trials of cidofovir are likely to be forthcoming.
Warts
Like MC, warts result from infection with a double-stranded DNA virus trophic to human skin. In the case of warts, the agent responsible is human papillomavirus (HPV), of which there are more than 150 serotypes.11 Some are known to cause cervical cancer, but common warts that affect nongenital skin are not thought to have malignant potential. With the exception of cervical lesions, determining the serotype of a wart is not clinically useful. Some physicians use the serotype of cervical lesions to determine how aggressively they evaluate and treat the patient.
The most useful information is gleaned from clinical appearance and the area of the body that is affected. Trained clinicians usually can diagnose warts based solely on their typical appearances in different locations.12 Non-genital warts are subcategorized into common, periungual, flat, filiform, and plantar types.
DIAGNOSIS
Common Warts. Common warts (verrucae vulgaris) are irregularly surfaced, domed lesions that can occur almost anywhere on the body (Figure 3). Multiple warts are common and are spread by skin-to-skin contact or contact with a contaminated surface. After initial infection, warts frequently are spread by autoinoculation from scratching, shaving, or other skin trauma.
 FIGURE 4. Verrucous wart. |  FIGURE 5. Small nodular wart on the hand. |  FIGURE 6. Periungual warts. |
On exposed skin, these warts tend to be hard and, if not affected by mechanical forces, develop the typical carpet-like (verrucous) surface (Figure 4). On areas that receive frequent friction, such as the hands, the firm, nodular aspect predominates (Figure 5). On areas that are moist or occluded, warts tend to be softer and more polypoid.
Periungual Warts. Periungual warts occur at the nail margins (Figure 6). As with other warts on the hands and feet, they often show peeling and roughening of the surface and tend to be somewhat abraded although not as much as palmar warts. They can affect the shape of the nail by undermining its side and pushing the nail up or causing partial detachment, sometimes mimicking the changes that occur with onychomycosis (Figure 7). Occasionally, when the wart affects the nail matrix or when destruction of the wart injures the nail matrix, permanent nail deformity can result.
Flat Warts. Flat warts (verrucae planus) are smooth, flat-topped variants of common warts that are 2 to 4 mm in diameter. They most often occur on the face and extremities of children and on the lower legs of women, where they may be spread by shaving11 (Figure 8).
Filiform Warts. Filiform warts have frond-like projections that often rapidly grow. They are common on the face (Figure 9).
 FIGURE 7. Periungual wart affecting toenail. |  FIGURE 8. Flat warts on the face of a child. |  FIGURE 9. Filiform wart on the face. |
Plantar Warts. Plantar warts occur on the plantar surface of the foot (Figure 10). Because of the forces exerted on the foot, plantar warts tend to become callused and grow into the foot instead of rising above the plantar surface. They often occur in multiples, are firm, and can be very painful. Patients may feel as if they are walking with a pebble in their shoe. Plantar warts can be differentiated from a corn or callus by paring down the surface (Figure 11). A wart has the typical punctate pattern of multiple pinpoint blood vessels (Figure 12). Warts also do not retain the normal fingerprint lines of the hands and feet, as calluses and corns do.
Mosaic plantar warts present with a tile-like pattern (Figure 13) that has been described as a confluence of multiple warts.11 The pattern has been attributed to the natural cylindrical projections (which can be seen in cross section) that wart tissue forms.13
 FIGURE 10. Plantar wart on the heel. |  FIGURE 11. Paring of plantar wart. |  FIGURE 12. Punctate pattern of plantar wart after paring. |
TREATMENT
Treatment options for warts include mechanical destruction and adjustment of the patient's immune system through medications, and observation. The most commonly employed treatments involve destroying the affected tissue by freezing, burning, curetting (usually with electrodesiccation), or applying topical acids. Chemotherapeutics are sometimes used in refractory or severe cases (Table 1). A review of the placebo arms of 17 treatment trials showed an average spontaneous regression rate of 30 percent at an average of 10 weeks.14 Six trials using salicylic acid averaged a 75 percent cure rate, and two trials comparing cryotherapy and salicylic acid found no difference in success rates.14
All treatments are hampered by wart persistence and recurrence. Warts are only an outward symptom of an underlying infection; topical treatments do not eradicate HPV but merely hold it at bay.15 [Evidence level C, consensus/expert guidelines]
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Acids. Many patients treat warts themselves with over-the-counter salicylic acid preparations. Advantages of these acids include convenience, reasonable cost, minimal discomfort, and reasonable effectiveness. Disadvantages include the length of time before results are seen (usually weeks to months) and complex instructions. Patients have to soak the wart in water for five to 10 minutes before each application (daily for liquids, every 48 hours for patches), then debride the dead skin after each application.
Bi- and trichloroacetic acids are applied in the physician's office on a weekly basis, usually after paring down the wart. Although this usually is a painless and effective procedure, these more potent acids have a greater potential to significantly burn surrounding skin.
Acids are well suited for use in children (as long as they don't put the affected area in their mouths) and are appropriate for plantar warts and warts on sensitive body parts where cryotherapy would be more painful.
Freezing. The different methods of freezing warts are presented in Table 1. One advantage of a nitrous oxide cryogun versus a liquid nitrogen gun is its ability to adhere the probe to the skin and elevate the lesion to avoid damage to underlying structures, such as veins, nerves, or tendons (Figure 14). Liquid nitrogen at -196°C (-320.8°F) and nitrous oxide at -89°C (-128.2°F) exceed the temperature required for complete tissue destruction (-50°C [-58°F]), but liquid nitrogen produces a faster freeze.16 A reasonable option for the low-volume practitioner is Verruca-Freeze, a liquid applied from a spray can, at -70°C (-94°F ).
 FIGURE 13. Mosaic plantar wart. |  FIGURE 14. Freezing a wart with nitrous oxide cryogun. |  FIGURE 15. Liquid nitrogen cryospray with 1 to 2-mm margins of freeze. |
The wart is frozen until it and 1 to 2 mm of surrounding skin have turned white (Figure 15). A repeat freeze after thawing causes more effective tissue destruction than a single freeze. The affected tissue turns red or blisters over the next one to two days, then gradually sloughs off over the following weeks. The dead tissue also may generate an immune system reaction to help resolve additional warts. Freezing is time-efficient and works well for most warts. In plantar warts, the discomfort and blistering after freezing can temporarily limit mobility.
Burning. Burning and surgical removal are usually reserved for resistant warts. Appropriate anesthetic measures are necessary because of the associated pain. Treatment can be accomplished in a single visit and is effective, but as with all destructive methods, not guaranteed. A disadvantage is prolonged recovery time from an often large and deep skin defect. Full-thickness excision and suturing are not warranted and can produce additional scarring and complications. Filiform warts are easily shaved or snipped off with an iris scissors (Figure 16). Light electrocautery of the base provides hemostasis and destruction of the residual wart.
Chemotherapy. Chemotherapy with bleomycin (Blenoxane) injection causes acute tissue necrosis. As with cryotherapy, the tissue left behind may stimulate an immune response. Disadvantages are the pain of injection and the expense of the drug. Bleomycin is a sterile powder that is reconstituted with saline. It is stable for only 24 hours after mixing, so it cannot be saved for dosing multiple patients on different days. Chemotherapy may be useful at a designated wart clinic, where several patients can be treated from the same vial of bleomycin in a single day. It is commonly used for plantar warts.
 FIGURE 16. Shaving of filiform wart. |  FIGURE 17. Candida antigen injection of plantar wart. |
Immunotherapy. HPV infection does not disappear once the gross lesions are destroyed. Cell-mediated immunity is required to keep the infection in check, as demonstrated by the high prevalence of warts among immunosuppressed organ-transplant recipients and patients with acquired immunodeficiency syndrome.17,18 Several treatment methods for warts are directed toward enhancing the immune response that suppresses HPV infection (Table 2).
Most people have been exposed to Candida and will mount an immune response. Candida antigen (0.1 mL of 1:1,000 solution, as is used for dermal testing) is mixed with 0.9 mL of 1-percent lidocaine (Xylocaine) and injected into the base of the wart (Figure 17). The wart is then stabbed repeatedly with the needle. Although uncomfortable, this procedure induces an immune response and brings about resolution of the wart in many cases.
In a small study19 using mumps or Candida injection, 74 percent of participants had resolution of the injected wart and, of those with resolution, 78 percent also had resolution of all of their noninjected warts. Candida antigen is available in a multi-dose vial that can be saved with refrigeration, so the cost is not prohibitive. Candida antigen can be used on most verrucae, particularly plantar warts.
Cimetidine (Tagamet) is known to stimulate T-lymphocyte populations, which are important in controlling viral infections. At a dosage of 30 to 40 mg per kg per day, it has been tried with varying success in the treatment of warts. A small trial20 in children found cimetidine to be as effective as the usual topical agents or cryotherapy. Another trial21 combining cimetidine with levamisole (an immunomodulator used in the treatment of colon cancer) reported cure rates of 85.7 percent versus 45.5 percent with cimetidine alone. However, in a more recent double-blind study,22 cimetidine was not found to be significantly more effective than placebo in adults or children, although there was a trend toward efficacy in younger patients. Cimetidine or watchful waiting could be considered for use in children who cannot tolerate destructive treatment methods.
The immunomodulating agents interferon alfa-2b (Intron A), interferon alfa-N3 (Alferon N), and imiquimod are approved for genital HPV. In addition to case reports, one study23 of 50 patients showed a 56 percent clearance rate with imiquimod. Imiquimod is more rapidly being adopted into clinical practice because of its easy application. It may be useful in nongenital HPV, but more study is needed.9
Topical application of sensitizing agents such as diphenylcyclopropenone, dinitrochlorobenzene, and squaric acid causes an allergic contact reaction that has been used for treatment of warts, but these chemicals are not commonly stocked by family physicians.
Efficacy Rates of Various Treatments for Warts | ||||||||||||||||||||
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| *--Extrapolated from Cochrane review1 noting two randomized controlled trials showing equivalence to placebo and two randomized trials showing equivalence to topical salicylic acid. The larger trials of cryotherapy were excluded because of lack of a placebo arm. †--Control arm of cimetidine alone from one trial4 was as effective as topical salicylates or cryotherapy.5 | ||||||||||||||||||||
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IN REPLY: Dr. Chow's comments astutely refer physicians to availing themselves to the best possible evidence in the care of our patients. First, Dr. Chow requests guidance as to which treatments to choose based on good evidence. Dr. Chow has referred to the same Cochrane Review1 that Dr. Hutchinson and I refer to in our article,2 which reviews the most appropriate studies to offer assistance in the treatment approach to warts. In addition to referencing that work, our article presents several small studies that explore other treatment options that are prevalent in clinical practice, with reference to the nature of the study, its size, and its outcome. The accompanying table summarizes the estimated treatment success rates based on the information presented in the Cochrane review,1 in our article,2 and in a recent article about using duct tape to treat warts.3
Two of Dr. Chow's statements, nearly verbatim from the Cochrane review,1 are best interpreted together. (1) "There is only good evidence for the therapeutic efficacy and safety of simple topical salicylic acid," and (2) "no convincing evidence that cryotherapy is any more effective than simple topical treatments." Cryotherapy is not more effective, but, if it is equally effective as two of the allowed studies in the Cochrane review1 indicate, then it should be an acceptable treatment, because many patients prefer a one-time treatment to weeks or months of daily applications.
The Cochrane review1 included only randomized controlled trials and did not include data from most of the large trials involving cryotherapy, because those trials primarily compared various methods of cryotherapy. It is my understanding that many trials are appropriate studies comparing variations of treatments without imposing a placebo arm, just as we would hope in chemotherapy trials testing new versus established therapies or in trials comparing aspirin and coumadin (Warfarin) for clotting disorders. An analysis of the large trials that compare various forms of cryotherapy with the estimated spontaneous resolution rate of 30 percent from the Cochrane analysis1 might yield useful information.
Perfect data are not available but based on the best available evidence, cryotherapy appears to be approximately 60 percent effective in the treatment of warts and topical salicylates are approximately 75 percent effective. Data from population studies and control arms of studies show spontaneous resolution to be approximately 30 percent. Physicians will make the decision with their patients as to which treatment or nontreatment will best suit the individual, based on tolerance of the time and work involved in the treatment, and the side effects and efficacy of the treatment.
DANIEL L. STULBERG, M.D.
Utah Valley Family Practice Residency
1134 N. 500 West
Provo, UT 84604
ANNE GALBRAITH HUTCHINSON, M.D.
203 Turnpike St.
North Andover, MA 01845
The authors indicate that they do not have any conflicts of interest. Sources of funding: none reported.
Figures 1 through 7 and 9 through 17 are used with permission from Utah Valley Family Practice Residency; Figure 8 is used with permission from Richard Usatine, M.D., Florida State University College of Medicine, Tallahassee.
Members of various family practice departments develop articles for "Practical Therapeutics." This article is one in a series coordinated by the Utah Valley Family Practice Residency, Provo, Utah. Guest editor of the series is Steve Ratcliffe, M.D.
The Authors
DANIEL L. STULBERG, M.D., F.A.A.F.P., is a faculty member at the Utah Valley Family Practice Residency, Provo, where he directs the dermatology curriculum and publishes the dermatology e-mail quiz series. He is a graduate of the University of Michigan Medical School, Ann Arbor, where he also completed a residency in family practice.
ANNE GALBRAITH HUTCHINSON, M.D., is in private practice in North Andover, Mass. She received her medical degree from the University of Utah School of Medicine, Salt Lake City, and graduated from the Utah Valley Family Practice Residency.
Warts
How do I know my spot is a wart?
Warts are hard bumps on your skin. They can be as small as a pinhead or as large as a penny. You may have just one wart or many. Warts can develop anywhere on your skin, but they usually appear on the hands or feet.
Warts don't usually hurt or bleed unless they are injured. Warts on the bottom of the feet are called plantar warts. These can be painful to walk on. Warts on the penis or around the vagina or anus are called genital warts.
What causes warts?
Warts are caused by an infection called human papillomavirus (say: "pap-uh-lo-muh-vi-russ"). This virus makes a place on the skin thicken into a wart or many warts.
Are genital warts different?
The same virus causes genital warts. They are treated differently, though, because they are on very sensitive skin. Genital warts can lead to certain kinds of cancer. If you have warts on your genitals, see your doctor for treatment.
Are warts contagious?
Yes. Warts can spread from one place on your body to another place if you touch them or scratch them. You can spread your warts to other people if you share towels, razors, or nail clippers. You can spread genital warts through sexual contact. You can catch plantar warts from walking barefoot in public areas where other people also walk barefoot, such as swimming pools or locker rooms.
What can I do to treat my warts?
Sometimes warts go away on their own after a few months. If you don't want to wait or if your warts don't go away, you can treat them with a mild acid solution or patch that you can buy in drugstores without a prescription.
This medicine works best if you soak the wart in warm water for 10 to 15 minutes before you put on the acid. Cover the wart with a bandage or waterproof tape to help keep the medicine from rubbing off.
Keep putting on the medicine every one or two days, following the package instructions, until the wart is gone. It can take many weeks to get rid of a wart. If dead skin builds up around the wart, it might help to trim it away or rub it down gently with a pumice stone. Be careful not to get the acid on the normal skin around your wart.
When should I see my doctor about my warts?
If you are not sure that your spot is a wart, ask your doctor. If you have a wart on your face or genitals, see your doctor instead of trying to treat it yourself. If your warts are painful or if they do not go away after eight weeks of home treatment, see your doctor.
Your doctor can use stronger acids on your wart. He or she might choose to freeze, burn, or cut off the wart. Your doctor might use a laser or give you a shot to get rid of your wart. Sometimes doctors prescribe a medicated cream or pills to treat difficult warts.
2.A common skin disease, molluscum contagiosum is caused by a poxvirus that infects only the skin. This virus enters the skin through small breaks in the skin barrier. After an incubation period, growths appear. These growths can develop anywhere on the skin. Like warts, which are caused by a different virus, molluscum contagiosum is considered benign. Molluscum contagiosum does not affect any internal organs and rarely causes symptoms. As the name implies, molluscum contagiosum is contagious.
Molluscum contagiosum
with HIV infection
WHAT MOLLUSCUM CONTAGIOSUM LOOKS LIKE
Mollusca are usually small flesh–colored or pink dome-shaped growths that often become red or inflamed. They may appear shiny and have a small central indentation or white core. Because they can spread by skin-to-skin contact, mollusca are usually found in areas of skin that touch each other such as the folds in the arm or groin. They also are found in clusters on the chest, abdomen, and buttocks and can appear on the face and eyelids. Sometimes, the growths appear in a row.
In people who have a disease that weakens the immune system, the mollusca may be very large in size and number, especially on the face.
Molluscum contagiosum
dome-shaped growths
with central indentations
HOW MOLLUSCUM CONTAGIOSUM SPREADS
The virus spreads in three ways. As described above, a person who has molluscum contagiosum can spread the virus to other parts of the body. This may happen by rubbing or scratching a growth and then touching unaffected skin.
Molluscum contagiosum also spreads from person to person through direct skin-to-skin contact. And it is possible to get the disease by coming into contact with an object that has touched infected skin such as a towel, toy, or clothing. There have been reports of people contracting molluscum contagiosum from a swimming pool or gymnastic mat.
THOSE MOST AT RISK
Children tend to get molluscum more often than adults. It is common in young children who have not yet developed immunity to the virus. Children also tend to have more direct skin-to-skin contact with others.
Anyone who is exposed to the virus through skin-to-skin contact has an increased risk of developing molluscum contagiosum. This may happen by participating in a close contact sport such as wrestling or having sexual contact with an infected person. Living in a tropical area also increases the risk. The virus thrives in areas that are warm and humid. Certain medical conditions also make a person more susceptible. People who have atopic dermatitis or a disease that weakens the immune system are more likely to develop molluscum contagiosum.
TREATMENT
While molluscum contagiosum will eventually go away on its own without leaving a scar, many dermatologists advise treating. Treatment can prevent the growths from spreading to other areas of a patient's body and to other people.
Before treatment begins, a dermatologist may confirm that the growths are mollusca by scraping an area of infected skin and looking at the cells under a microscope. If molluscum contagiosum is present, there are a number of treatment options.
Treatment for mollusca is similar to that for warts. Growths can be frozen with liquid nitrogen, destroyed with various acids or blistering solutions, or treated with an electric needle (electrocautery) and scraped off with a sharp instrument (curette). Laser therapy also has been effective in treating mollusca. All of these treatments can be performed in a dermatologist's office. If there are many growths, treatment sessions may be needed every 3 to 6 weeks until the growths disappear. Some discomfort is associated with these treatments.
Molluscum contagiosum
Sometimes an at-home treatment is prescribed. These treatments include applying a topical retinoid, topical immune modifier, or other topical antiviral medication.
During treatment, some growths may appear as others are fading. This is normal.
An option, especially with young children, is not to treat molluscum and wait for the growths to disappear. This avoids exposure to possible side effects from treatment; however, if rapid growth of new lesions is noted, a dermatologist should be consulted. It is always possible for a person's skin to get infected with the virus again. The condition may be easier to control if treatment is started early — when there are only a few growths.Molluscum contagiosum
From Wikipedia, the free encyclopedia
| 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 |
| MeSH | D008976 |
| Molluscum contagiousm virus | ||||||||
|---|---|---|---|---|---|---|---|---|
 EM of Molluscum contagiosum virus | ||||||||
| 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 four types of MCV, MCV-1 to -4; MCV-1 is the most prevalent and MCV-2 is seen usually in adults and often sexually transmitted. About one in six young people are infected at some time with MC.[citation needed] The infection is most common in children aged one to ten years old.[1] MC can affect any area of the skin but is most common on the body, arms, and legs. It is spread through direct contact or shared items such as clothing or towels.
In adults, molluscum infections are often sexually transmitted and usually affect the genitals, lower abdomen, buttocks, and inner thighs. In rare cases, infections are also found on the lips, mouth, and eyelids.
The time from infection to the appearance of lesions ranges from 2 week[citation needed] to 6 months, with an average incubation period of 6 weeks. Diagnosis is made on the clinical appearance; the virus cannot routinely be cultured.
Contents[hide] |
[edit] 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. In some cases the dimpled section may bleed once or twice.[citation needed]
The viral infection is limited to a localized area on the topmost layer of the epidermis.[2] Once the virus containing head of the lesion has been destroyed, the infection is gone. 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.
[edit] Treatments
Individual molluscum lesions may go away on their own and are reported as lasting generally from 6 to 8 weeks,[3] to 2 or 3 months.[4] However via autoinoculation, the disease may propagate and so an outbreak generally lasts longer with mean durations variously reported as 8 months,[3] to about 18 months,[5][6] and with a range of durations from 6 months to 5 years.[4][6]
Treatment is often unnecessary[7] depending on the location and number of lesions, and no single approach has been convincingly shown to be effective.[8] 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.[6] The virus lives only in the skin and once the growths are gone, the virus is gone and cannot be spread to others. Molluscum contagiosum is not like herpes viruses, which can remain dormant in the body for long periods and then reappear. Thus, when treatment has resulted in elimination of all bumps, the infection has been effectively cured and will not reappear unless the patient is reinfected. [9] In practice, it may not be easy to see all of the molluscum contagiosum bumps. Even though they appear to be gone, there may be some that were overlooked. If this is the case, one may develop new bumps by autoinoculation, despite their apparent absence.
[edit] Cryotherapy
Cryotherapy involves killing infected cells by "freezing" them with a pressurized liquid spray, usually liquid nitrogen or nitrous oxide. The procedure is relatively painless and can be performed by any health professional, including nurse practitioner or physician assistant. The infected cells may fall off immediately or fade over several days.
[edit] Betadine
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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).[citation needed] 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.
[edit] 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.[10]
[edit] 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).[11] However the oil may irritate normal skin at concentrations of 1%.[12][13]
[edit] Cantharidin
Cantharidin is a chemical found naturally in many members of the beetle family Meloidae which causes dermal blistering. Not FDA approved but available through Canada or select US compounding pharmacy. It is a great method for treatment of small children, as it is not painful on application. Usually can not be used near the eyes or in uncooperative children, as the chemical is caustic if scratched and rubbed on the eyes. Usually applied with a wooden applicator like the sharp end of a wooden Qtip. Some advocate leaving it on unoccluded. Some advocate covering it with tape for 1 to 8 hours.[14]
[edit] Tea tree oil
Another essential oil, tea tree oil is reported to at least reduce growth and spread of lesions when used in dilute form.[15] Tea tree oil may cause contact dermatitis to those with sensitive skin, although less often in dilute form.
[edit] 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.[16][17] These treatments require several months for the infection to clear, and are often associated with intense inflammation and possibly discomfort.
[edit] Imiquimod
Doctors occasionally prescribe Imiquimod, the optimum schedule for its use has yet to be established.[18] Imiquimod is 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. Another dose regimen: apply imiquimod three times daily for 5 consecutive days each week [19]. This is not FDA-approved treatment for molluscum contagiosum.
[edit] Systemic treatments
Cimetidine (however, double blind placebo studies seem to refute this[20]), Griseofulvin (single case, anecdotal evidence) and Methisazone have seen some use.[21]
[edit] 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 its use is banned by the FDA in the United States in its pure, undiluted form, the topical blistering agent cantharidin can be effective.[nb 1] It should be noted that cryosurgery and curette scraping are not painless procedures. They may also leave scars and/or permanent white (depigmented) marks.
[edit] 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.[22][23] 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.
[edit] Duct Tape
Application of duct tape over lesions until they begin to crust over and heal is well tolerated, has been effective,[24] and can be implemented at home with readily available materials. Tape is cut to the size of lesions and applied after washing or when previously applied tape falls off. This treatment for molluscum was motivated by success with treating warts similarly. The conclusions of a controlled study were that duct tape occlusion therapy was significantly more effective than cryotherapy for treatment of the common wart.[25]
[edit] Prognosis
Most cases of molluscum will clear up naturally within two years (usually within nine months). So long as the skin growths are present, there is a possibility of transmitting the infection to another person. When the growths are gone, the possibility for spreading the infection is ended.[9]
Unlike herpes viruses, which can remain inactive in the body for months or years before reappearing, molluscum contagiosum does not remain in the body when the growths are gone from the skin and will not reappear on their own.[9] However, like the common cold, there is no permanent immunity to the virus, and it is possible to become infected again in the future upon exposure to an infected person.
[edit] See also
- Acrochordons (also called skin tags — similar in appearance and grow in similar areas)
