Molluscum Contagiosum

What Is Molluscum Contagiosum?

Most patients describe molluscum contagiosum in adults, a sexually transmitted disease (STD), as asymptomatic pimples over the genitalia. It is basically caused by the 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.

How Is Molluscum Contagiosum Transmitted?

Molluscum contagiosum is primarily transmitted through direct contact. Touching the infected area transmits the virus from one person to another. In the case of children, transmission through direct contact is seen, whereas, in HIV-infected young adults, transmission is by sexual contact. Persons involved in sports also risk contracting the disease by touching the ball or other equipment touched by an infected person in bare hands as the virus can stay on surfaces that have been touched by an infected person. And so, the spread of the virus is also possible sharing personal items, toys, etc.

Molluscum contagiosum can spread from one part of the body to another by touching, scratching, or shaving the lesion with the hands and touching other parts of the body with the same infected hands.

How Does Molluscum Contagiosum Present?

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

• Lesions are primarily 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.

• The atypical presentation can occur over the scalp, lips, palms, and soles and is 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 grape-like clusters of multiple small lesions may occur, especially in the beard area.

What Is the Course of Action of Molluscum Contagiosum?

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.

What Increases the Risk of Developing Molluscum Contagiosum?

• Children between the age of one to ten years.

• Immunocompromised individuals after organ transplants or cancer treatment.

• People with atopic dermatitis.

• People living in tropical areas.

• People who play sports where there is physical contact.

How Is Molluscum Contagiosum Diagnosed?

1. In immunocompetent patients, the diagnosis is quickly made 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.

What Is the Treatment for Molluscum Contagiosum?

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

• Antibiotics are required if there is a secondary infection.

• Cryotherapy is the treatment of choice.

• The total physical excision of the molluscum body is done by squeezing the 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 carefully after piercing the bumps 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 Tretinoin or 5% Fluorouracil has been used in the treatment of recurrences in the immunocompromised host.

2. IV Cidofovir resolved recalcitrant lesions in the HIV infected. A topical gel is also being tried.

3. Antiretroviral therapy in HIV infected patients also causes regression of the lesions.

4. Electron beam therapy and pulsed dye laser have been found helpful in recalcitrant molluscum contagiosum in immunocompromised hosts.

How Can We Prevent Molluscum Contagiosum?

• The only way molluscum contagiosum can be prevented is by avoiding touching the skin of an infected person or the things touched by an infected person. Following preventive measures should be taken:

• Practice proper handwashing with the help of soap and warm water. Especially, teach your kids about the proper handwashing techniques as they are more susceptible to catching these infections from other children.

• Do not touch or prick areas where lesions are present to avoid the spread of the infection to other parts of the body.

• Avoid sharing personal items like hair brushes, soaps, towels, and clothing as they can harbor the infectious virus.

• Avoid sexual contact with infected persons or when you have genital bumps.

• When infected, try to clean your bumps and cover them to avoid spreading the infection to other people.

• Avoid sharing sports gear that comes in contact with the bare skin of an individual.

• Avoid shaving the areas where the lesion is present.

Conclusion:

Although molluscum contagiosum is a contagious disease, the spread of the infection

can be prevented by following adequate measures. Do educate your child about the mode of virus spread and steps that can be taken to avoid it. Practice good hygiene measures and keep yourself away from the infection.