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Molluscum Contagiosum

The Pearly White Domed Viral Skin Disease.

Sep 22, 2008 Hanish Babu

Molluscum contagiosum is a common, self limiting viral infection caused by a pox virus, the molluscum contagiosum virus. It appears as pearly white or skin colored bumps.

Molluscum contagiosum is a common, self limiting viral infection caused by a pox virus, the molluscum contagiosum virus. It appears as pearly white or skin colored bumps, and occurs in children and sexually active adults.

What is Unique About Molluscum Contagiosum (MC) Compared to Other Pox Infections like Chickenpox?

Most other pox infections like chickenpox produce a ‘necrotic’ or degenerative pox lesion, while MC produces an epidermal tumor. Rupture and discharge of the infectious white putty material creates a crater or umbilication in the center of the molluscum, which is similar to the umbilication seen in chickenpox and other pox infections.

How is Molluscum Contagiosum Transmitted?

Molluscum contagiosum is transmitted from skin to skin contact and through fomites like towels. In adults, the molluscum seen in the genital area is usually transmitted through sexual contact.

What is the Clinical Presentation of the Molluscum Contagiosum?

Following skin to skin contact, after an incubation period of 2 weeks to 6 months (usually 2-3 months), the lesions appear gradually and enlarge slowly to bumps (papules) of 3-5 mm in diameter. These bumps are skin colored or pearly white, dome shaped and umbilicated in the center. A cheesy material can be expressed through the centre. In some, especially in the HIV infected, the papules can enlarge to 1-2 cm or even larger and is called a giant molluscum contagiosum.

In children the mollusca appear on exposed parts like face, hands, arms, legs, and also on trunk. The lesions may be transferred to the genital area through autoinoculation.

In adults molluscum cantagiosum is usually a sexually transmitted disease and can occur in large numbers on the genitalia and the groin.

The papules of MC are usually asymptomatic, though some children have some itching or tenderness at times.

Is Molluscum Contagiosum a Dangerous Infection Like Herpes Simplex Infection?

No. Actually molluscum contagiosum is a self limiting disease, and resolves by itself in 6 month to 2 years. In low immune status individuals, as in HIV infected, the mollusca can become huge (giant mollusca) and appear in large numbers.

Is There Any Way to Predict Spontaneous Regression?

Yes, usually the host’s immune system produces antibodies against the viral particles after a few months, and this produces a dermatitis halo with scaling and redness around the molluscum. This is indicative of impending spontaneous regression.

Does Molluscum Contagiosum Require Any Treatment?

As it is a self limiting disease, in normal children and adults, it does not require any aggressive treatment. For reasons of preventing spread to other children and cosmetic considerations, the lesions may be treated early.

How is Molluscum Contagiosum Treated?

Usually MC is treated with curettage followed by cauterization of the base with silver nitrate or TCA (trichlor acetic acid), cryo freezing, electro desiccation or laser. In children and on the face, such aggressive therapy is avoided, as there is a potential of scar formation. In such cases medical therapy is advocated.

What is the Medical Treatment for Molluscum Contagiosum?

For tiny papules, especially on the face, antiviral topical applications like 5% Imiquimod and 1-3% Cidofovir ointment applied three times a week till regression.

A technique of producing an inflammatory response by the application of contact irritants like tretinoin, 20% phenol, 5% potassium hydroxide, cantharidin and 0.5% podophyllotoxin cream has also been tried successfully in resistant cases.

A course of Cimetidine tablets have also been found effective in generalized molluscum contagiosum.

In HIV patients with extensive mollusca, anti retroviral medications have been found effective in causing regression of the disease. IV Cidofovir is particularly effective in treating giant molluscum contagiosum.

Related Reading: Treatment Options for Anogenital Warts

References:

Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology, Fifth Ed, pp 762-765.
Dinesh CG, Vinod KS. Miscellaneous Sexually Transmitted Diseases, in Sexually Transmitted Disease and AIDS, Viva Books; 289-290; 2003.

Disclaimer

The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or suite101 will not be responsible for any consequences. The images provided are for illustration purpose only.

The copyright of the article Molluscum Contagiosum in General Medicine is owned by Hanish Babu. Permission to republish Molluscum Contagiosum in print or online must be granted by the author in writing.

Molluscum Contagiosum