Molluscum contagiosum
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| ICD-10 | B08.1 |
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| ICD-9 | 078.0 |
| eMedicine | derm/270 |
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Molluscum contagiosum (MC) is a viral infection of the skin or occasionally of the mucous membranes. MC infects humans, other primates and kangaroos. The infecting 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, saliva, or shared articles of clothing (including towels).
In adults, molluscum infections are often sexually transmitted and usually affects the genitals, lower abdomen, buttocks, and inner thighs. In rare cases, molluscum infections are also found on the lips and mouth.
The time from infection to the appearance of lesions ranges from 1 week to 6 months.
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[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.
In most patients, the lesions are asymptomatic. They may be complicated by secondary bacterial infections. They may cause itching and consequent eczema around the tumors.
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
Molluscum lesions may go away on their own in six to nine months, but can persist, via autoinoculation, for up to four years. Treatment is often unnecessary[1] depending on the location and number of lesions, nonetheless, treatment may be sought after for the following reasons:
- Medical Issues including:
- Bleeding
- Secondary infections
- Itching & Discomfort
- Potential Scarring
- Chronic keratoconjunctivitis
- Social Reasons
- Cosmetic
- Embarrassment
- Fear of transmission to others
- Social exclusion
Health professionals usually recommend treating bumps located in the genital area to prevent them from spreading. The virus can spread from one part of the body to another or to other people. Molluscum contagiosum is contagious until the bumps are gone—which, if untreated, may be up to 6 months or longer.
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). 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. These treatments require several weeks for the infection to clear. Repeated application of adhesive or duct tape after bathing for 16 weeks led to cure in 90% of patients in one study. Also treating with apple cider vinegar (soak cotton ball in vinegar, place on molluscum, then cover with band-aid for 24 hours. Wart will be gone with only scab remaining)
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 is 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 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.
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. [2] [3] 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.
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 towels.
- If bumps are on the face, avoid shaving.
- If bumps are on the genital area, avoid sexual activity.
[edit] Footnotes
- ^ Prodigy knowledgebase (July 2003). Molluscum Contageosum. National Health Service. Retrieved on 2006-07-06. - UK NHS guidelines on Molluscum Contagiosum
- ^ Hammes S, Greve B, Raulin C (Jan 2001). "[Molluscum contagiosum: treatment with pulsed dye laser]". Hautarzt 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.
[edit] External links
- 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
