molluscum contagiosum
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Introduction
Self-limited viral infection of the skin.
Etiology
- molluscum contagiosum virus, types 1 & 2 (poxvirus)
- spread is probably by direct contact (contagious) & by fomites (towels)[13]
Epidemiology
- children & sexually active adults
- up to 11% of children < 16 years of age[7]
- increased incidence is observed in AIDS patients
- males > females
Pathology
- epidermal cells contain intracytoplasmic inclusion bodies (molluscum bodies or Henderson-Patterson bodies)
- epidermis grows down into the dermis
- epithelium and hair follicles also infected
- larger lesions may extend through the dermis to the subcutaneous fat
Clinical manifestations
- small lobular bodies on the mucosa of the lips & eyelids
- lesions may occur anywhere on the body
- lesions appear as pearly flesh-colored, small, round or oval papules (1-2 mm) or nodules 2-10 mm in diameter with central umbilication
- NOT associated with telangiectasias or bleeding[4]
- painless, rarely pruritic (case with pruritic lesions)[5]
- develop in crops & resolve over a period of weeks to several years
- lesions in sexually active adults are frequently observed in genital regions
- AIDS patients
- may have hundreds of lesions on the face
- spontaneous regression does not occur
- no regional lymph node involvement
* images[8][9][10][11][13][14]
Laboratory
- biopsy if indicated
- examination under microscope, can not be cultured[16]
- screening for HIV1 (adults)
Complications
- rarely causes serious complications
- dyspigmentation, scarring
- can exacerbate eczema
- psychosocial distress, frustration for parents[7]
Differential diagnosis
- multiple small mollusca
- solitary large mollusca
- keratoacanthoma
- squamous cell carcinoma
- regional lymph node involvement with metastatic disease
- basal cell carcinoma
- epidermal inclusion cyst
- multiple facial mollusca in AIDS patient
Management
- generally resolves spontaneously within weeks to several years except in patients with HIV1 infection
- ~50% of cases resolve in 1 year[7]
- observation is 1st line
- lesions can be removed by curettage
- cryotherapy with liquid nitrogen
- electrodesiccation for lesions refractory to cryotherapy
- local lidocaine anesthesia
- may require several cycles of electrodesiccation combined with curretage for larger lesions
- cantharidin (Ycanth) applied sparingly to non genital lesions
- berdazimer gel (Zelsuvmi) FDA-approved for at home use
- prevention: avoid skin to skin contact with infected individual
- infection is contagious
More general terms
Additional terms
References
- ↑ DeGowin & DeGowin's Diagnostic Examination, 6th edition, RL DeGowin (ed), McGraw Hill, NY 1994, pg 912
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 966
- ↑ Color Atlas & Synopsis of Clinical Dermatology, Common & Serious Diseases, 3rd ed, Fitzpatrick et al, McGraw Hill, NY, 1997, pg 772-75
- ↑ Jump up to: 4.0 4.1 Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
- ↑ Jump up to: 5.0 5.1 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018.
- ↑ van der Wouden JC, van der Sande R, van Suijlekom-Smit LW et al Interventions for cutaneous molluscum contagiosum. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD004767 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19821333
- ↑ Jump up to: 7.0 7.1 7.2 7.3 Basdag H et al. Molluscum contagiosum: To treat or not to treat? Experience with 170 children in an outpatient clinic setting in the northeastern United States. Pediatr Dermatol 2015 May/Jun; 32:353. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25641168
- ↑ Jump up to: 8.0 8.1 Molluscum contagiosum (image) American Academy of Dermatology https://www.aad.org/public/diseases/contagious-skin-diseases/molluscum-contagiosum
- ↑ Jump up to: 9.0 9.1 Bhatia AC, Elston DM (images) Medscape: Molluscum Contagiosum http://emedicine.medscape.com/article/910570-overview
- ↑ Jump up to: 10.0 10.1 DermNet NZ. Molluscum contagiosum (images) http://www.dermnetnz.org/viral/molluscum-contagiosum.html
- ↑ Jump up to: 11.0 11.1 Brady MP (images) Cutaneous and Mucosal Manifestations of Viral Diseases. Medscape. March 2017 http://reference.medscape.com/features/slideshow/viral-skin
- ↑ NEJM Knowledge+ Question of the Week. Aug 22, 2017 https://knowledgeplus.nejm.org/question-of-week/1424/
- ↑ Jump up to: 13.0 13.1 13.2 Damevska K, Emurlai A. Molluscum Contagiosum in a Patient with Atopic Dermatitis. N Engl J Med 2017; 377:e30. Nov 23, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29166239 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMicm1705273
- ↑ Jump up to: 14.0 14.1 NEJM Image Challenge: http://www.nejm.org/image-challenge
- ↑ NEJM Knowledge+ Question of the Week. Dec 12, 2023 https://knowledgeplus.nejm.org/question-of-week/4079/
Bhatia N et al. Comprehensive management of molluscum contagiosum: assessment of clinical associations, comorbidities, and management principles. J Clin Aesthet Dermatol 2023 Aug; 16:S12 PMID: https://www.ncbi.nlm.nih.gov/pubmed/37636015 PMCID: PMC10453397 Free PMC article - ↑ Jump up to: 16.0 16.1 Badri T. Gandhi R Molluscum Contagiosum StatPearls[Internet] Merch 27, 2023 National Library of Medicine https://www.ncbi.nlm.nih.gov/books/NBK441898/