Molluscum contagiosum is a viral infection of the skin or occasionally of the mucous membranes. It is caused by a DNA poxvirus called the molluscum contagiosum virus (MCV).

MCV has no animal reservoir, infecting only humans.
There are four types of MCV, MCV-1 to -4; MCV-1 is the most prevalent and MCV-2 is seen usually in adults and often sexually transmitted. This common viral disease has a higher incidence in children, sexually active adults, and those who are immunodeficient, and the infection is most common in children aged one to ten years old. MC can affect any area of the skin but is most common on the trunk of the body, arms, and legs. It is spread through direct contact or shared items such as clothing or towels.

The virus commonly spreads through skin-to-skin contact. This includes sexual contact or touching or scratching the bumps and then touching the skin. Handling objects that have the virus on them (fomites), such as a towel, can also result in infection. The virus can spread from one part of the body to another or to other people. The virus can be spread among children at day care or at school. Molluscum contagiosum is contagious until the bumps are gone (which, if untreated, may last up to 6 months or longer).

The time from infection to the appearance of lesions can range up to 6 months, with an average incubation period between 2 and 7 weeks.

Diagnosis is made on the clinical appearance; the virus cannot routinely be cultured. The diagnosis can be confirmed by excisional biopsy but is often unnecessary.

Symptoms

Molluscum contagiosum lesions are flesh-colored, dome-shaped, and pearly in appearance. They are often 1–5 millimeters in diameter, with a dimpled center. They are generally not painful, but they may itch or become irritated.

Picking or scratching the bumps may lead to further infection or scarring. In about 10% of the cases, eczema develops around the lesions. Bleeding may occur if the lesions are scratched.

The viral infection is limited to a localized area on the topmost layer of the epidermis. Once the virus containing head of the lesion has been destroyed, the infection is gone. The central waxy core contains the virus.

In a process called autoinoculation, the virus may spread to neighboring skin areas. Children are particularly susceptible to autoinoculation, and may have widespread clusters of lesions.

Individual molluscum lesions are usually self limiting and can go away on their own. The infection is generally 6 weeks to 3 months. However via a process call “autoinoculation”, in which the infected person reinfecting one’s self. The disease may propagate lasts longer with mean durations variously reported as 8 months, to about 18 months, and with a range of durations from 6 months to 5 years.

Treatment for Molluscum Contagiosum is often unnecessary depending on the location and number of lesions, and no single approach has been convincingly shown to be effective. It should also be noted that treatments causing the skin on or near the lesions to rupture may spread the infection further, much the same as scratching does. Nonetheless, treatment may be sought for the following reasons:

Medical issues including:

1.Bleeding
2.Secondary infections
3.Itching and discomfort
4.Potential scarring
5.Chronic keratoconjunctivitis

Social reasons

1.Cosmetic
2.Embarrassment
3.Fear of transmission to others
4.Social exclusion

Many health professionals recommend treating bumps located in the genital area to prevent them from spreading. The virus lives only in the skin and once the lesions stop multiplying, the virus is gone and cannot be spread to others.

When treatment has resulted in elimination of all bumps, the infection has been effectively cured and will not reappear unless the patient is reinfected. In practice, it may not be easy to see all of the molluscum contagiosum bumps. Even though they appear to be gone, there may be some that were overlooked. If this is the case, one may develop new bumps by autoinoculation, despite their apparent absence.

Cryotherapy involves killing infected cells by "freezing" them with a pressurized liquid spray, usually liquid nitrogen or nitrous oxide. The procedure can be mildly uncomfortable to painful depending on quantity and location of infected cells. The procedure can be performed by any medical professional.

Application of liquid nitrogen may cause burning or stinging at the treated site, which may persist for a few minutes after the treatment. Scarring or loss of color can complicate both these treatments. With liquid nitrogen, a blister may form at the treatment site, but it will slough off in two to four weeks. Cryosurgery and curette scraping are not painless procedures. They may also leave scars and/or permanent white (depigmented) marks.


For mild cases, over-the-counter wart medicines, such as salicylic acid may or may nothorten infection duration. Daily topical application of tretinoin cream ("Retin-A 0.025%") may also trigger resolution. These treatments require several months for the infection to clear, and are often associated with intense inflammation and possibly discomfort.

Imiquimod (Aldara)

Doctors occasionally prescribe Imiquimod, though the optimum schedule for its use has yet to be established. Imiquimod is a form of immunotherapy. Immunotherapy triggers the immune system to fight the virus causing the skin growth.

Imiquimod is applied 3 times per week, left on the skin for 6 to 10 hours, and washed off. A cure may take from 4 to 16 weeks. Small studies have indicated that it is successful about 80% of the time. Another dose regimen: apply imiquimod three times daily for 5 consecutive days each week.

Imiquimod has not been approved by the FDA as a treatment for molluscum contagiosum. This treatment regimen is reserved for 1% Imiquimod cream. If a higher concentration is used in a similar method, chemical burns or plausible nerve damage are possible.

Laser

Pulsed dye laser therapy for molluscum contagiosum may be the treatment of choice for multiple lesions in a cooperative patient. The use of pulsed dye laser for the treatment of MC has been documented with excellent results. The therapy was well tolerated, without scars or pigment anomalies. The lesions resolved without scarring at 2 weeks. Studies show 96%–99% of the lesions resolved with one treatment. The pulsed dye laser is quick and efficient, but its expense makes it less cost effective than other options. Also, not all dermatology offices have this 585 nm laser.

Most cases of molluscum will clear up naturally within two years (usually within nine months). So long as the lesion growths are present, there is a possibility of transmitting the infection to another person. When the growths are gone, the possibility for spreading the infection is ended.

Unlike herpes viruses, which can remain inactive in the body for months or years before reappearing, molluscum contagiosum does not remain in the body when the growths are gone from the skin and will not reappear on their own. However, there is no permanent immunity to the virus, and it is possible to become infected again upon exposure to an infected person.

Advantage of treatment is to hasten the resolution of the virus. This limits the size of the "pox" scar. If left untreated, molluscum growth can reach sizes as large as a pea or a marble. Spontaneous resolution of large lesions can occur, but will leave larger crater like growth. As many treatment options are available, prognosis for minimal scarring is best if treatment is initiated while lesions are small.


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