Molluscum contagiosum From Wikipedia, the free encyclopedia Jump to: navigation, search Molluscum contagiosum Classification and external resources Typical flesh-colored, dome-shaped and pearly lesions ICD-10 B 08.1 ICD-9 078.0 DiseasesDB 8337 MedlinePlus 000826 eMedicine derm/270 MeSH D008976 Molluscum contagiousm virus EM of Molluscum contagiosum virus Virus classification Group: Group I (dsDNA) Family: Poxviridae Genus: Molluscipoxvirus Molluscum Species: contagiosum virus Molluscum contagiosum (MC) is a viral infection of the skin or occasionally of the mucous membranes. It is caused by a DNA poxvirus called the molluscum contagiosum virus (MCV). MCV has no animal reservoir, infecting only humans. 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. This common viral disease has a higher incidence in children, sexually active adults, and those who are immunodeficient,[1] and the infection is most common in children aged one to ten years old.[2] MC can affect any area of the skin but is most common on the trunk of the body, arms, and legs. It is spread through direct contact or shared items such as clothing or towels. The virus commonly spreads through skin-to-skin contact. This includes sexual contact or touching or scratching the bumps and then touching the skin. Handling objects that have the virus on them (fomites), such as a towel, can also result in infection. The virus can spread from one part of the body to another or to other people. The virus can be spread among children at day care or at school. Molluscum contagiosum is contagious until the bumps are gone-which, if untreated, may be up to 6 months or longer. The time from infection to the appearance of lesions can range up to 6 months, with an average incubation period between 2 and 7 weeks.[3] Contents [hide] • 1 Diagnosis • 2 Symptoms • 3 Treatments ○ 3.1 Cryotherapy ○ 3.2 Astringents ○ 3.3 Australian lemon myrtle ○ 3.4 Benzoyl peroxide ○ 3.5 Cantharidin ○ 3.6 Tea tree oil ○ 3.7 Over-the-counter substances ○ 3.8 Imiquimod ○ 3.9 Systemic treatments ○ 3.10 Surgical treatment ○ 3.11 Laser • 4 Prognosis • 5 See also • 6 References • 7 External links Diagnosis Low magnification micrograph of molluscum contagiosum. H&E stain. High magnification micrograph of molluscum contagiosum, showing the characteristic molluscum bodies. H&E stain. Diagnosis is made on the clinical appearance; the virus cannot routinely be cultured. The diagnosis can be confirmed by excisional biopsy. Histologically, molluscum contagiosum is characterized by molluscum bodies in the epidermis above the stratum basale, which consist of large cells with: • abundant granular eosinophilic cytoplasm (accumulated virons), and • a small peripheral nucleus. 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.[4] 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. Treatments Individual molluscum lesions may go away on their own and are reported as lasting generally from 6 to 8 weeks,[5] to 2 or 3 months.[6] However via autoinoculation, the disease may propagate and so an outbreak generally lasts longer with mean durations variously reported as 8 months,[5] to about 18 months,[7][8] and with a range of durations from 6 months to 5 years.[6] [8] Treatment is often unnecessary[9] depending on the location and number of lesions, and no single approach has been convincingly shown to be effective. It should also be noted that treatments causing the skin on or near the lesions to rupture may spread the infection further, much the same as scratching does.[10] Nonetheless, treatment may be sought for the following reasons: Molluscum lesions on an arm. • 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.[8] The virus lives only in the skin and once the growths are gone, the virus is gone and cannot be spread to others. When treatment has resulted in elimination of all bumps, the infection has been effectively cured and will not reappear unless the patient is reinfected.[11] 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. Cryotherapy Cryotherapy involves killing infected cells by "freezing" them with a pressurized liquid spray, usually liquid nitrogen or nitrous oxide. The procedure can be mildly uncomfortable to painful depending on quantity and location of infected cells. The procedure can be performed by any medical professional. 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.[12] Australian lemon myrtle A 2004 study demonstrated over 90% reduction in the number of lesions in 9 out of 16 children treated once daily for 21 days with essential oil of Australian lemon myrtle (Backhousia citriodora) dissolved in olive oil.[13] However the oil may irritate normal skin at concentrations of 1%.[14][15] Benzoyl peroxide In a small randomized controlled trial twice daily application of 10% benzoyl peroxide cream for 4 weeks was found to be more effective than tretinoin 0.05% cream; after 6 weeks 92% of the benzoyl peroxide group were lesion-free, compared with 45% of the tretinoin group (p = 0.02)[16][17] 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 not painful on application, and so it might be preferred by some when treating small children. It should probably not be used near the eyes or in uncooperative children, as the chemical is caustic if scratched and rubbed on the eyes. It is usually applied with a wooden applicator like the sharp end of a wooden cotton bud. Some advocate leaving it on unoccluded. Some advocate covering it with tape for 1 to 8 hours.[18] Extreme caution should be used when administering Cantharidin. Despite the fact that it is used as an aphrodisiac in some countries, it is highly toxic to humans if ingested.[19] 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.[20] Tea tree oil may cause contact dermatitis to those with sensitive skin, although less often in dilute form. Over-the-counter substances For mild cases, over-the-counter wart medicines, such as salicylic acid may or may not[21] shorten infection duration. Daily topical application of tretinoin cream ("Retin-A 0.025%") may also trigger resolution.[22][23] These treatments require several months for the infection to clear, and are often associated with intense inflammation and possibly discomfort. Imiquimod Doctors occasionally prescribe imiquimod, the optimum schedule for its use has yet to be established.[24] Imiquimod is a form of immunotherapy. Immunotherapy triggers the 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 cure may take 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 [25]. This is not FDA- approved treatment for molluscum contagiosum. Systemic treatments Cimetidine (however, double blind placebo studies seem to refute this[26]), Griseofulvin (single case, anecdotal evidence) and Methisazone have seen some use.[27] 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.[28] Cryosurgery and curette scraping are not painless procedures. They may also leave scars and/or permanent white (depigmented) marks. 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.