Molluscum Contagiosum

Molluscum contagiosum in adults, a sexually transmitted disease (STD), is described as asymptomatic pimples over the genitalia by most of the patients. It is basically caused by Molluscum contagiosum virus, a DNA virus of the poxvirus family. It spreads by close contact commonly with the children, the immunocompromised and increasingly younger adults, in the latter as a sexually transmitted disease. The incidence peaks at 5-10 years of age.

Presentation in Sufferer

• After a variable incubation period (14 days to 6 months), typical lesions start as small whitish papules and gradually enlarge to become typical shiny, pearly white, hemispherical, dome-shaped, 5-10 mm umbilicated papules with central depression.

• Lesions are mostly multiple, sometimes single or a few lesions may localize anywhere on the body depending on their mode of transmission. For example, on the face and limbs of children and the genitals of adults in case of sexual transmission.

• Atypical presentation can occur over scalp, lips, palms and soles and mistaken for verruca vulgaris.

• In HIV infection or AIDS patients, this infection is common. It is often a marker of advanced disease and may exhibit multiple and extensive lesions. The morphology of which may not remain as distinctive as in the immunocompetent.

• Giant lesions or grapelike clusters of multiple small lesions may occur, especially in the beard area.

Course of Action

The disease is chronic, whereas autoinoculation and shaving spread it. The inflammation, trauma and secondary infection, promote its spontaneous cure. In atopic individuals, eczema may develop around the healed lesions.

Diagnosis

1. In immunocompetent patients, the diagnosis is easily done clinically. Extrusion of the cheesy white molluscum body or pearl from the lesion is corroborative.
2. In cases of HIV infected or AIDS patients, disseminated histoplasmosis or cryptococcosis may mimic this infection necessitating histological examination for confirmation.

Treatment

Despite the eventual spontaneous resolution, particularly in the children, treatment does help to minimize autoinoculation and prevent transmission to others. Young adults should be evaluated for concomitant sexually transmitted disease and their partners have to get treated in order to prevent reinfection.

• Antibiotics are required if there is secondary infection.

• Cryotherapy is the treatment of choice.

• Physical expression of the molluscum body in total by squeezing a papule with blunt forceps or superficial curettage or shaving with a sharpened wooden spatula.

• Chemicals like phenol, carbolic acid, trichloroacetic acid (TCA), silver nitrate or iodine solution should be applied very carefully, after piercing the papules with a sharpened stick and taking out the molluscum body, avoiding spillage and necrosis of the surrounding skin.

• KOH (Potassium hydroxide) applied over lesions for 30 days leads to clearance by digesting proteins.

• Topical 5% Imiquimod cream is helpful in treating giant molluscum.

Recurrent or recalcitrant lesions in the HIV or immunocompromised have been treated with the following:

1. Topical Tretinion or 5% Fluorouracil has been used in the treatment of recurrences in the immune compromised host.
2. IV Cidofovir resolved recalcitrant lesions in the HIV infected. A topical gel is also being tried.
3. Antiretroviral therapy in HIV infected also causes regression of the lesions.
4. Electron beam therapy and pulsed dye laser have been found useful in recalcitrant molluscum contagiosum in immunocompromised hosts.

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