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molluscum contagiosum

Self-limited viral infection of the skin. Etiology: 1) molluscum contagiosum virus, types 1 & 2 (poxvirus) 2) spread is probably by direct contact (contagious) & by fomites (towels) [13] Epidemiology: 1) children & sexually active adults - up to 11% of children < 16 years of age [7] 2) increased incidence is observed in AIDS patients 3) males > females Pathology: 1) epidermal cells contain intracytoplasmic inclusion bodies (molluscum bodies or Henderson-Patterson bodies) 2) epidermis grows down into the dermis 3) epithelium and hair follicles also infected 4) larger lesions may extend through the dermis to the subcutaneous fat Clinical manifestations: 1) small lobular bodies on the mucosa of the lips & eyelids 2) lesions may occur anywhere on the body - except, does not occur on the palms or soles 3) lesions appear as pearly flesh-colored, small, round or oval papules (1-2 mm) or nodules 2-10 mm in diameter with central umbilication 4) NOT associated with telangiectasias or bleeding [4] 5) painless, rarely pruritic (case with pruritic lesions) [5] 6) develop in crops & resolve over a period of weeks to several years 7) lesions in sexually active adults are frequently observed in genital regions 8) AIDS patients a) may have hundreds of lesions on the face b) spontaneous regression does not occur 9) 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) Differential diagnosis: 1) multiple small mollusca - flat warts - condyloma acuminata - syringoma - sebaceous hyperplasia 2) solitary large mollusca - keratoacanthoma - squamous cell carcinoma - regional lymph node involvement with metastatic disease - basal cell carcinoma - epidermal inclusion cyst 3) multiple facial mollusca in AIDS patient - cryptococcosis - histoplasmosis - coccidioidomycosis Complications: - rarely causes serious complications - dyspigmentation, scarring - can exacerbate eczema - psychosocial distress, frustration for parents [7] Management: 1) 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 2) lesions can be removed by curettage 3) cryotherapy with liquid nitrogen 4) electrodesiccation for lesions refractory to cryotherapy a) local lidocaine anesthesia b) may require several cycles of electrodesiccation combined with curretage for larger lesions 5) cantharidin (Ycanth) applied sparingly to non genital lesions 6) berdazimer gel (Zelsuvmi) FDA-approved for at home use 7) prevention: avoid skin to skin contact with infected individual - infection is contagious

Related

molluscum body; Henderson-Patterson body Molluscum contagiosum virus

General

viral infection sexually-transmitted disease; sexually-transmitted infection; venereal disease (STD, STI)

References

  1. DeGowin & DeGowin's Diagnostic Examination, 6th edition, RL DeGowin (ed), McGraw Hill, NY 1994, pg 912
  2. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 966
  3. Color Atlas & Synopsis of Clinical Dermatology, Common & Serious Diseases, 3rd ed, Fitzpatrick et al, McGraw Hill, NY, 1997, pg 772-75
  4. Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
  5. Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018.
  6. 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: 19821333
  7. 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: 25641168
  8. Molluscum contagiosum (image) American Academy of Dermatology https://www.aad.org/public/diseases/contagious-skin-diseases/molluscum-contagiosum
  9. Bhatia AC, Elston DM (images) Medscape: Molluscum Contagiosum http://emedicine.medscape.com/article/910570-overview
  10. DermNet NZ. Molluscum contagiosum (images) http://www.dermnetnz.org/viral/molluscum-contagiosum.html
  11. Brady MP (images) Cutaneous and Mucosal Manifestations of Viral Diseases. Medscape. March 2017 http://reference.medscape.com/features/slideshow/viral-skin
  12. NEJM Knowledge+ Question of the Week. Aug 22, 2017 https://knowledgeplus.nejm.org/question-of-week/1424/
  13. Damevska K, Emurlai A. Molluscum Contagiosum in a Patient with Atopic Dermatitis. N Engl J Med 2017; 377:e30. Nov 23, 2017 PMID: 29166239 http://www.nejm.org/doi/full/10.1056/NEJMicm1705273
  14. NEJM Image Challenge: http://www.nejm.org/image-challenge
  15. 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: 37636015 PMCID: PMC10453397 Free PMC article
  16. Badri T. Gandhi R Molluscum Contagiosum StatPearls[Internet] Merch 27, 2023 National Library of Medicine https://www.ncbi.nlm.nih.gov/books/NBK441898/