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Molluscum contagiosum

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Molluscum contagiosum

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Molluscum contagiosum is a common benign viral cutaneous infection
 caused by a DNA pox virus , observed generally in children

Acronym MC used in this chart to denote Molluscum contagiosum

Caused by a poxvirus of the molluscipox genus in the Poxviridae family Four major subtypes MCV 1 to 4
MCV -1 is the most common subtype ( 98 % in US )
MCV -2 affects teenagers and adults and is mainly sexually transmitted
( including HIV ) MC seen in HIV does not represent recurrence of childhood MCV infection

MC is very common but exact prevalence is uncertain Occurs worldwide – ↑ prevalent in tropical areas Rare in children under 1 yrs of age – occurs typically in 2-5 yr age group In children annual incidence ranges from 2% to 10 % and its prevalence from 5.1 % to 11.5 % MC is associated with poverty , poor hygiene and over crowded conditions Use of community swimming polls is correlated with childhood infections Less common in adults & the spread is mainly by sexual contact Vertical transmission – from mother to infant can happen but is rare Individuals with immunodeficiency ( particularly HIV ) and atopic dermatitis are at ↑↑ risk H/O eczema was found in 67 % of children with MC in Australia

Epidemiology -Estimated incubation period varies from 14 days to 6 months Virus is transmitted by
○ close physical contact
○ autoinoculation ( common in children )
○ contaminated fomites ( occasionally via clothing ,bath ,sponges, towels etc ) Most common is direct transmission via skin contact Sexual transmission can also happen MC does not persist as a latent infection ( unlike herpesvirus ) Infection is localized , subacute and proliferative MC is a STD- using condoms can reduce risk of passing it but risk of transmission via close skin remains

Risk factors –Close contact with an infected person Sexual contact with an infected person H/O previous STI HIV infection Immunosuppression Atopic dermatitis Tropical climate Swimming pool use. MC in immunocompromised individuals – drug induced or due to HIV or any other cause is typically more severe and extensive

Presentation- Diagnosis is clinical – easily recognized Lesions usually 1-5 mm in diameter and < 20 in number Smooth , dome shaped papules with central dell or umbilication Colour can be -
pearly white , yellow , translucent , flesh coloured , pink or red 
( when irritated ) Some lesions can be surrounded by a halo of eczema ( molluscum dermatitis ) In children mostly seen in
○ extremities ( particularly intertriginous areas )
○ trunk
○ face- less commonly In adults ( sexual transmission )
genitalia , pubis, thighs and lower abdomen Usually asymptomatic but may cause symptoms if they become inflamed or develop an eczematous reaction People with immunodeficiency – lesions can be extensive and of large size. Occasionally MC can reach 1 cm in diameter ( giant molluscum contagiosum ) Lesions on soles , palms and mucous membranes are rare


Tests- Easily recognized without any investigations
in > 99 % of cases Magnifying glass or a dermoscope could be used if central umbilication is not visible PCR ( polymerase chain reaction ) could be used but not routinely needed Histopathological examinations
Curretage biopsy can be used in confusing scenarios for eg
children with lesions in genital region which can appear like condylomas ( condylomas can raised suspicion of sexual abuse ) Handheld reflectance confocal microscopy ELISA used for serological surveys HIV testing in refractory or extensive presentation

differential-Acne vulgaris Chicken pox Common warts Papular acrodermatitis of childhood Milia Syringomata 
( small pale papules commonly around the eyes ) Fordyce spots Papular urticaria Eruptive xanthomas Steatocytoma multiplex Folliculitis Condyloma acuminatum Lichen striatus Lichen planus ( uncommon ) Cutaneous cryptococcosis

Advice- Benign self limiting condition Spontaneous clearance within 2-4 yrs in the immunocompetent No therapy needed in immunocompetent Lesions highly contagious as the name indicates
○ avoid sharing towels clothing and baths
○ swimming in pools or contact sports can spread the virus No isolation or school /swimming pools exclusion needed Advice to avoid scratch , rub , pick or squeeze the lesions
( to avoid spread of infection )

Complications –Cosmetically unsightly -emotional and psychological distress 2ary bacterial infection – can cause scarring Irritation Eczematous dermatitis around the lesion One in 10 children will have a very severe effect on quality of life Rarely conjunctivitis , keratitis ( if lesions around eyes )

Treatment –CKS recommends no treatment in primary care BMJ states that cryotherapy , imiquimoid and home extraction techniques for use in primary care Cochrane systemic review found no strong evidence either or against the most commonly used treatment options for MC Studies have repeatedly shown lack of consistent high quality evidence In case active treatment contemplated , the choice depends upon number of lesions , location , potential adverse effects , parental preference and local expertise

Topical treatment – Topical treatment- suitable at home Imiquimod cream Benzoyl peroxide Hydrogen peroxide Potassium hydroxide 
Molludab® Silver nitrate Trichloracetic acid Podofilin Cantharidin Salicylic acid

Destructive methods- Cryotherapy Currettage Electric cauterisation Physical expression Pricking Pulsed dye laser Electron beam therapy

Systemic therapy- Cimetidine Antiviral agents as Cidofovir Griseofulvin Calcarea carbonica
( homeopathy )

References Molluscum Contagiosum : An Update Alexander K.C.Leung et al May 2017 Recent Patents on Inflammation and Allergy Drug Discovery 2017 , 11 ,22-31 Molluscum Contagiosum Medscape e-Medicine Ashish Bhatia MD , FAAD,FACMS Interventions for cutaneous molluscum contagiosum Cochrane Systemic Review – Intervention May 2017 Molluscum contagiosum CKS NHS Molluscum conatgiosum virus infection Xiaoying Chen et al Lancet infectious Diseases , The , 2013-10-01 , Volume 13 , Issue 10 , Pages 877-888 Time to resolution and effect on quality of life of molluscum contagiosum in children in the UK : a prospective community cohort study Jonathan R Olasen MSc et al Lancet Infectious Diseases , The , 2015-02-01 , Volume 15, Issue 2 , Pages 190-195 Update on the Treatment of Molluscum Contagiosum in Children P.Gerlero et al Dermatology
( Actas Dermo-Sifiliograficas , English Edition ) , 2018-06-01 , Volume 109 , Issue 5 , Pages 408-415 BMJ Best Practice Molluscum Contagiosum Molluscum Contagiosum risk factors in adults . A case control study Gemma Martin-Ezquerra et al assessed via http://www.postermedic.com/parcdesalutmar/pparcdesalutmar1513786/
pdfbaja/pparcdesalutmar1513786.pdf

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