Molluscum Contagiosum

molluscum contagiosum

 

In this article, we will talk about a benign lesion of the skin surface called Molluscum contagiosum, which is caused by the poxvirus. It is usually recognized as pearly and dome-shaped granules (papules) with depression in the middle, about two to five millimeters in size, with the following characteristics:

 

  • White bumps surrounded by a pink halo (If the lesion is inflamed, it will be red and swollen).
  • Lesions in people are usually seen as a group, but sometimes may also appear individually.
  • Molluscum contagiosum lesions are usually not itchy.
  • They are painless (unless they have secondary infection and inflammation).
  • Except for the palms and soles of the feet, lesions can appear on any part of the body (so, contrary to popular believes, they are not limited to the genital area).
  • Losses in immunocompromised individuals will be chronic, prolonged, and extensive.
  • It is sunken in the middle of these lesions, which is one of their diagnostic features and is called umbilical cord.
  • Molluscum contagiosum is more common in childhood. In children, umbilical dome lesions are more common in the limbs, abdomen and torso.

What you will read next:

 

Molluscum contagiosum in children

Does Molluscum contagiosum also occur in adults?

Does the smallpox vaccine protect against the virus?

What is the Incubation period of this virus?

Ways of transmission of Molluscum contagiosum

Is Molluscum contagiosum virus curable?

Molluscum contagiosum and immunodeficiency

Who is most at risk?

Differential diagnoses of Molluscum contagiosum

Treatment of contagious molluscum

Types of treatment for molluscum contagiosum

Treatment of molluscum contagiosum with oral drugs

Other treatment recommendations

Treatment of molluscum contagiosum in people with AIDS and immunodeficiency

 

Molluscum contagiosum in children:

Molluscum contagiosum lesions are very common in children with atopic dermatitis, because in atopic dermatitis, the barrier protecting skin (which is the body's defense barrier) is destroyed, so the infectious agent can more easily enter and form molluscum.

Sometimes in children with molluscum contagiosum, we see a red halo and scaling around the lesion, indicating eczema alongside the infectious molluscum lesion. Controlling eczema and avoiding stimulants along with topical medications can relieve the lesion.

Is Molluscum contagiosum also seen in adults?

Although Molluscum contagiosum is more common in children, but it is not limited to childhood. In adults, the lesions are usually present in the genital areas, groins, and lower abdomen and are transmitted through sexual contacts.

Does the smallpox vaccine protect against the virus?

As we have said, the cause of Molluscum contagiosum disease is a type of virus from the Pox virus family or the smallpox virus family. It should be noted that even people who were vaccinated against classical smallpox may not be immune to the virus that causes molluscum contagiosum.

 

What is the incubation period of this virus?

The incubation period of the virus will be two weeks to six months, during which a person can be a carrier of the virus and infect people who he or she is in contact with.

 

Ways of transmission of Molluscum contagiosum:

In adults beside the direct sexual contact, the following can also be the source of transmission of the virus:

  • Contaminated toilet towels and napkins
  • Bath towel
  • Sauna
  • Swimming pool
  • Toilet

It should be noted that the virus that causes Molluscum contagiosum is located in the epidermis, the most superficial layer of the skin, and does not enter the bloodstream, and therefore the virus does not spread through coughing and sneezing.

 Is Molluscum contagiosum virus curable?

Molluscum contagiosum infection is a self-limiting disease, so in an immunocompetent person (anyone who has healthy immune system) it clears up automatically within six to twelve months. However, in an immunocompromised person it can take up to four years. So in summary:

  • Lesions are more common in children and on the face, trunk and limbs.
  • In healthy adults, it is mostly seen in the inner surface of the groin and lower abdomen, mostly in the genital area, due to sexual contacts. 
  • In people with immunodeficiency (for example AIDS patients) the disease progresses faster and is more difficult to treat.

Molluscum contagiosum and immunodeficiency

Molluscum contagiosum lesions in AIDS patients and immunosuppressed patients (such as those who have had organ transplants and are taking immunosuppressive drugs or people with rheumatic diseases who have been taking immunosuppressive drugs for a long time) may have the following differences:

  • Giant lesions: each papule is larger than one and a half centimeters
  • Disseminated and pervasive lesions in several areas of the body
  • Their lesions are resistant to classic and common treatments

 

Who is most at risk?

The virus has a higher risk in some people carrying more risk. This includes the following groups:

  • People with weak or defective immune systems
  • People with AIDS
  • People undergoing chemotherapy and radiotherapy
  • People who have had organ transplants
  • People with chronic rheumatic diseases who have been taking immunosuppressive drugs for a long time
  • People with atopic dermatitis (due to broken skin barrier)
  • People living in humid and hot geographical areas

Differential diagnoses of Molluscum contagiosum

This virus can cause conditions similar to other viruses in the human body. Among the diseases that need to be differentiated from this virus are the following:

 

Treatment of contagious molluscum

In general, the disease is self-limiting in healthy people, meaning that a healthy person's immune system will be able to eventually remove the virus from the body. Therefore, in healthy people (without immunodeficiency) treatment should be done only in the following cases:

  • The lesion is in a place that is visible (the patient insists on treatment)
  • The patient is afraid of transferring it to his partner
  • The patient has underlying atopic dermatitis

 

Types of treatment for molluscum contagiosum:

There are several treatments for this virus. Depending on the unique conditions of the infected person, the following treatments may be applied:

  • Treatment through physical removal of the lesion
  • Cryotherapy in which lesion is frozen with the help of liquid nitrogen
  • Curettage meaning the removal of infectious contents of the lesion by perforation of the lesion center
  • Laser therapy

The above methods must be performed by an experienced and specialized physician. Never evacuate or dig up the lesion yourself, as there is a possibility of infection spreading and scarring of the manipulated site.

 

Treatment of molluscum contagiosum with topical medication

Topical podophyllotoxin cream (half a percent) may be used for treating the molluscum contagiosum. Apply a sufficient amount of cream on each lesion. The important point to consider about this drug is its prohibition in pregnant women. This drug is very toxic to the fetus, so it should be avoided during pregnancy. Other drugs may include:

  • Iodine
  • Salicylic acid
  • Potassium hydroxide
  • Tretinoin
  • Imiquimod (this drug is not approved in children and in adults must be taken with a doctor's prescription and with strict instructions)

Avoid taking or applying the above drugs arbitrarily on your skin lesions.

Treatment of molluscum contagiosum with oral drugs:

For the gradual elimination of the lesion, especially in children, painless treatment with oral drugs is performed. We use oral medications for children and people who are unable to tolerate cryotherapy and laser, and for people with a history of keloids and hypertrophic scars. Oral cimetidine is very effective, especially in lesions on the body and organs in children. Unfortunately,  facial lesions do not respond well to this drug.

Other treatment recommendations:

Here are more tips when dealing with this disease:

  • Avoid stress
  • Try low fat, low sugar, high fiber and protein diet along with healthy fluids
  • Have enough sleep
  • Adequate exercise and physical activity

 

Treatment of molluscum contagiosum in people with AIDS and immunodeficiency  

These people are usually resistant to the treatments mentioned above. In other words, their lesions do not respond well to the above treatments. Treatment methods for large and advanced lesions in immunocompromised individuals include:

  • Intravenous injection of interferon (this treatment is usually annoying for patients due to unpleasant side effects of interferon such as fatigue, pain, regional tenderness, and mild flu-like syndrome.
  • Radiotherapy (this method is effective to some extend)

Finally, in people with immunodeficiency (and AIDS), strengthening the immune system is the most effective treatment for molluscum contagiosum. Interferon therapy is more effective in healthy adults than in immunocompromised patients.

 

 

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