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| {{Infobox_Disease | | __NOTOC__ |
| | Name = Molluscum contagiosum
| | {{Molluscum contagiosum}} |
| | Image = Molluscaklein.jpg
| | {{CMG}}; {{AE}} {{MIR}} |
| | Caption = Typical flesh-colored, dome-shaped and pearly lesions
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| | DiseasesDB = 8337
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| | ICD10 = {{ICD10|B|08|1|b|00}}
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| | ICD9 = {{ICD9|078.0}}
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| | ICDO =
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| | OMIM =
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| | MedlinePlus = 000826
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| | eMedicineSubj =
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| | eMedicineTopic =
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| | MeshID =
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| }}
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| {{Taxobox | color=violet
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| | name = ''Vaccinia virus''
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| | image = Molluscum_contagiosum_virus_samp.jpg
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| | image_width = 75px
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| | image_caption = EM of Molluscum contagiosum virus
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| | virus_group = i
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| | familia = ''[[Poxviridae]]''
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| | genus = ''[[Molluscipoxvirus]]''
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| | species = '''''[[Molluscum contagiosum virus|Molluscum Contagiosum Virus]]'''''
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| }} | |
| {{Search infobox}} | |
| {{CMG}} | |
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| ==Overview==
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| '''''Molluscum contagiosum''''' ('''MC''') is a viral infection of the [[skin]] or occasionally of the [[mucous membranes]]. MC has no animal reservoir, infecting only [[human]]s, as did [[smallpox]]. However, there are different pox viruses that infect many other mammals. The infecting human MC virus is a DNA [[Poxviridae|poxvirus]] called the ''[[molluscum contagiosum virus]]'' (MCV). There are 4 types of MCV, MCV-1 to -4, with MCV-1 being the most prevalent and MCV-2 seen usually in adults and often sexually transmitted. The incidence of MC infections in young children is around 17% and peaks between 2-12 years of age. MC affects any area of the skin but is most common on the body, arms, and legs. It is spread through direct contact or shared articles of clothing (including towels).
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| In adults, molluscum infections are often [[sexually transmitted]] and usually affect the [[genitals]], lower [[abdomen]], [[buttocks]], and inner thighs. In rare cases, molluscum infections are also found on the [[lips]], [[mouth]], and eyelids.
| | ==[[Molluscum contagiosum overview|Overview]]== |
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| The time from infection to the appearance of lesions ranges from 1 week to 6 months, with an average incubation period of 6 weeks. Diagnosis is made on the clinical appearance; the virus cannot routinely be cultured.
| | == [[Molluscum contagiosum historical perspective|Historical perspective]] == |
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| ==Symptoms== | | == [[Molluscum contagiosum classification|Classification]] == |
| 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. They may occasionally be complicated by secondary bacterial infections. | |
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| 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 auto-inoculation, and may have widespread clusters of lesions.
| | ==[[Molluscum contagiosum pathophysiology|Pathophysiology]]== |
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| === Physical Examination === | | ==[[Molluscum contagiosum causes|Causes]]== |
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| ====Skin==== | | ==[[Molluscum contagiosum differential diagnosis|Differentiating Molluscum contagiosum from other Diseases]]== |
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| <div align="left">
| | ==[[Molluscum contagiosum epidemiology and demographics|Epidemiology and Demographics]]== |
| <gallery heights="200" widths="200">
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| Image:mulluscum Contagiosum.jpg|Molluscum Contagiosum (Rx: Curettage, Cryotherapy, etc)<ref>http://picasaweb.google.com/mcmumbi/USMLEIIImages/photo#5089143298860559810</ref>
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| Image:Mollusca1klein.jpg|Molluscum lesions on an arm.
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| </gallery>
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| </div>
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| ==Treatments== | | ==[[Molluscum contagiosum epidemiology and demographics|Risk Factors]]== |
| Individual molluscum lesions may go away on their own and are reported as lasting generally from 6 to 8 weeks,<ref name="pmid10591712">{{cite journal |author=Weller R, O'Callaghan CJ, MacSween RM, White MI |title=Scarring in Molluscum contagiosum: comparison of physical expression and phenol ablation |journal=BMJ |volume=319 |issue=7224 |pages=1540 |year=1999 |pmid=10591712 |doi= |url=http://www.bmj.com/cgi/content/full/319/7224/1540}}</ref> to 2 or 3 months.<ref name="eMedicine">{{EMedicine|derm|270}}</ref> However via autoinoculation, the disease may propagate and so an outbreak generally lasts longer with mean durations variously reported as 8 months,<ref name="pmid10591712">{{cite journal |author=Weller R, O'Callaghan CJ, MacSween RM, White MI |title=Scarring in Molluscum contagiosum: comparison of physical expression and phenol ablation |journal=BMJ |volume=319 |issue=7224 |pages=1540 |year=1999 |pmid=10591712 |doi= |url=http://www.bmj.com/cgi/content/full/319/7224/1540}}</ref> to about 18 months,<ref>{{MedlinePlus|000826}}</ref><ref name="pmid14532898">{{cite journal |author=Tyring SK |title=Molluscum contagiosum: the importance of early diagnosis and treatment |journal=Am. J. Obstet. Gynecol. |volume=189 |issue=3 Suppl |pages=S12–6 |year=2003 |pmid=14532898 |doi=}}</ref> and with a range of durations from 6 months to 5 years.<ref name="eMedicine"/><ref name="pmid14532898">{{cite journal |author=Tyring SK |title=Molluscum contagiosum: the importance of early diagnosis and treatment |journal=Am. J. Obstet. Gynecol. |volume=189 |issue=3 Suppl |pages=S12–6 |year=2003 |pmid=14532898 |doi=}}</ref>
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| Treatment is often unnecessary<!--
| | == [[Molluscum contagiosum screening|Screening]] == |
| --><ref name="Prodigy">{{cite web | url=http://www.prodigy.nhs.uk/molluscum_contagiosum/view_whole_guidance | title=Molluscum Contagiosum | accessdate=2006-07-06 | author=Prodigy knowledgebase | year=2003 | month=July | publisher=[[National Health Service]]}} - UK NHS guidelines on Molluscum Contagiosum</ref>
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| depending on the location and number of lesions, with no single approach shown to be convincingly effective.<!--
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| --><ref name="pmid16625612">{{cite journal |author=van der Wouden JC, Menke J, Gajadin S, ''et al'' |title=Interventions for cutaneous molluscum contagiosum |journal=Cochrane Database Syst Rev |volume= |issue=2 |pages=CD004767 |year=2006 |pmid=16625612 |doi=10.1002/14651858.CD004767.pub2}}</ref>
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| Nonetheless, treatment may be sought after for the following reasons:
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| *Medical issues including:
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| **Bleeding
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| **Secondary infections
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| **Itching and discomfort
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| **Potential scarring
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| **Chronic keratoconjunctivitis
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| *Social reasons
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| **Cosmetic
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| **Embarrassment
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| **Fear of transmission to others
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| **Social exclusion
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| Many health professionals recommend treating bumps located in the genital area to prevent them from spreading.<ref name="pmid14532898">{{cite journal |author=Tyring SK |title=Molluscum contagiosum: the importance of early diagnosis and treatment |journal=Am. J. Obstet. Gynecol. |volume=189 |issue=3 Suppl |pages=S12–6 |year=2003 |pmid=14532898 |doi=}}</ref> It is important to realize that treating the bumps does not cure the disease. The virus is in the skin and new bumps will often appear even after all the visible ones are surgically treated. Any surgical option of treatment may therefore have to be repeated each time new bumps occur. The body eventually mounts an effective immune response and rids itself of the virus, but until then, new bumps may occur over the course of a year or more.
| | ==[[Molluscum contagiosum natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ===Betadine=== | | ==Diagnosis== |
| There are a few treatment options that can be done at home. [[Betadine]] surgical scrub can be gently scrubbed on the infected area for 5 minutes daily until the lesions resolve (this is not recommended for those allergic to iodine or betadine). However, the ability of iodine to penetrate intact skin is poor, and without a pin prick or needle stick into each molluscum lesion this method does not work well. Do not use on broken skin.
| | [[Molluscum contagiosum diagnostic criteria|Diagnostic Criteria]] | [[Molluscum contagiosum history and symptoms|History and Symptoms]] | [[Molluscum contagiosum physical examination|Physical Examination]] | [[Molluscum contagiosum laboratory tests|Laboratory Findings]] | [[Molluscum contagiosum chest x ray|X-ray]] | [[Molluscum contagiosum echocardiography or ultrasound|Ultrasound]] | [[Molluscum contagiosum CT|CT]] | [[Molluscum contagiosum MRI|MRI]] | [[Molluscum contagiosum other imaging findings|Other Imaging Studies]]| [[Molluscum contagiosum other diagnostic studies|Other Diagnostic Studies]] |
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| ===Astringents=== | | ==Treatment== |
| [[Astringent]] chemicals applied to the surface of molluscum lesions to destroy successive layers of the skin include [[trichloroacetic acid]], [[podophyllin]] resin, [[potassium hydroxide]], and [[cantharidin]].<ref>{{cite web |title=Molluscum Contagiosum - Treatment Overview |url=http://www.webmd.com/skin-problems-and-treatments/tc/molluscum-contagiosum-treatment-overview |date=January 12, 2007 |publisher=WebMD |accessdate=2007-10-21}}</ref> | | [[Molluscum contagiosum medical therapy|Medical Therapy]] | [[Molluscum contagiosum surgery|Surgery]] | [[Molluscum contagiosum primary prevention|Primary Prevention]] | [[Molluscum contagiosum secondary prevention|Secondary Prevention]] | [[Molluscum contagiosum cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Molluscum contagiosum future or investigational therapies|Future or Investigational Therapies]] |
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| ===Australian lemon myrtle=== | | ==Case Studies== |
| A 2004 study demonstrated over 90% reduction in the number of lesions in 9 out of 16 children treated with 10% strength solution of [[essential oil]] of Australian lemon myrtle (''[[Backhousia citriodora]]'').<ref name="pmid15183850">{{cite journal |author=Burke BE, Baillie JE, Olson RD |title=Essential oil of Australian lemon myrtle (Backhousia citriodora) in the treatment of molluscum contagiosum in children |journal=Biomed. Pharmacother. |volume=58 |issue=4 |pages=245–7 |year=2004 |pmid=15183850 |doi=10.1016/j.biopha.2003.11.006}}</ref> However the oil may irritate normal skin at concentrations of 1%.<ref name="pmid11893412">{{cite journal |author=Hayes AJ, Markovic B |title=Toxicity of Australian essential oil Backhousia citriodora (Lemon myrtle). Part 1. Antimicrobial activity and in vitro cytotoxicity |journal=Food Chem. Toxicol. |volume=40 |issue=4 |pages=535–43 |year=2002 |pmid=11893412 |doi=}}</ref><ref name="pmid12909275">{{cite journal |author=Hayes AJ, Markovic B |title=Toxicity of Australian essential oil Backhousia citriodora (lemon myrtle). Part 2. Absorption and histopathology following application to human skin |journal=Food Chem. Toxicol. |volume=41 |issue=10 |pages=1409–16 |year=2003 |pmid=12909275 |doi=}}</ref>
| | [[Molluscum contagiosum case study one|Case #1]] |
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| ===Over-the-counter substances=== | | ==Related Chapters== |
| For mild cases, [[Over-the-counter substance|over-the-counter]] [[wart]] medicines, such as [[salicylic acid]] may shorten infection duration. Daily topical application of [[tretinoin]] cream ("Retin-A 0.025%") may also trigger resolution.<!--
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| --><ref>{{cite journal |author=Papa C, Berger R |title=Venereal herpes-like molluscum contagiosum: treatment with tretinoin |journal=Cutis |volume=18 |issue=4 |pages=537-40 |year=1976 |id=PMID 1037097}}</ref><!--
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| --><ref>{{cite journal |author= |title=Molluscum Contagiosum |journal=Adolesc Med |volume=7 |issue=1 |pages=57-62 |year=1996 |id=PMID 10359957}}</ref> These treatments require several months for the infection to clear, and are often associated with intense inflammation and possibly discomfort.
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| ===Imiquimod===
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| Doctors occasionally prescribe [[Imiquimod]], the optimum schedule for its use has yet to be established.<ref name="pmid17156002">{{cite journal |author=Hanna D, Hatami A, Powell J, ''et al'' |title=A prospective randomized trial comparing the efficacy and adverse effects of four recognized treatments of molluscum contagiosum in children |journal=Pediatric dermatology |volume=23 |issue=6 |pages=574-9 |year=2006 |pmid=17156002 |doi=10.1111/j.1525-1470.2006.00313.x}}</ref>[[ Imiquimod]], a form of immunotherapy. Immunotherapy triggers your [[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 course may last from 4 to 16 weeks. Small studies have indicated that it is successful about 80% of the time
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| ===Non-medicine treatment===
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| The infection can also be cleared without medicine if there are only a few lesions. First, the affected skin area should be cleaned with an alcohol swab. Next, a sterile needle is used to cut across the head of the lesion, through the central dimple. The contents of the papule are removed with another alcohol swab. This procedure is repeated for each lesion (and is therefore unreasonable for a large infection). With this method, the lesions will heal in two to three days.
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| ===Surgical treatment===
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| Surgical treatments include [[cryosurgery]], in which [[liquid nitrogen]] is used to freeze and destroy [[lesion]]s, as well as scraping them off with a [[curette]]. 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. Although no longer available in the United States, the topical blistering agent [[cantharidin]] can be effective. It should be noted that cryosurgery and curette scraping are not painless procedures. They may also leave scars and/or permanent white (depigmented) marks.
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| ===Laser===
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| Pulsed [[dye laser]] therapy for molluscum contagiosum may be the treatment of choice for multiple lesions in a cooperative patient (Dermatologic Surgery, 1998). 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.<!--
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| --><ref name="laser1">{{cite journal |author=Hammes S, Greve B, Raulin C |title=[Molluscum contagiosum: treatment with pulsed dye laser] |language=German |journal=Der Hautarzt; Zeitschrift für Dermatologie, Venerologie, und verwandte Gebiete |volume=52 |issue=1 |pages=38-42 |year=2001 |pmid=11220237 |doi=}}</ref><!--
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| --><ref name="laser2">{{cite journal | author = Hughes P | title = Treatment of molluscum contagiosum with the 585-nm pulsed dye laser. | journal = Dermatol Surg | volume = 24 | issue = 2 | pages = 229-30 | year = 1998 | month = Feb | pmid=9491117}}</ref>
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| 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 585nm laser. It is important to remember that removal of the visible bumps does not cure the disease. The virus is in the skin and new bumps often appear over the course of a year until the body mounts an effective immune response to the virus. Thus any surgical treatment may require it to be repeated each time new crops of lesions appear.
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| ==Prevent spreading==
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| To prevent molluscum contagiosum from spreading:
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| *Try not to scratch. Put a piece of tape or a bandage over any bumps.
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| *Avoid contact sports, swimming pools, and shared baths and articles of clothing (towels.)
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| *If bumps are on the face, avoid shaving.
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| *If bumps are on the genital area, avoid sexual activity.
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| ==See also==
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| *[[Acrochordon]]s (also called skin tags — similar in appearance and grow in similar areas) | | *[[Acrochordon]]s (also called skin tags — similar in appearance and grow in similar areas) |
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| ==References==
| | ==External Links== |
| {{Reflist|2}}
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| ==External links== | |
| *[http://www.cdc.gov/ncidod/dvrd/molluscum/faq/everyone.htm Center of Disease Control - Molluscum] | | *[http://www.cdc.gov/ncidod/dvrd/molluscum/faq/everyone.htm Center of Disease Control - Molluscum] |
| *[http://www.webmd.com/hw/skin_and_beauty/aa18146.asp WebMD - Molluscum contagiosum]
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| *{{cite journal | author= Daniel Hanson and Dayna G. Diven | title= Molluscum Contagiosum | journal=Dermatology Online Journal | year=2003 | volume=9 | issue=2 | pages= 2 | url=http://dermatology.cdlib.org/92/reviews/molluscum/diven.html }}
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| *[http://www.healthinplainenglish.com/health/skin/molluscum_contagiosum/index.htm Health In Plain English - Molluscum contagiosum]
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| *[http://www.visualdxhealth.com/adult/molluscumContagiosum.htm VisualDxHealth - medical photos and treatment overview]
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| *[http://www.dermatlas.com/derm/result.cfm?Diagnosis=39 Dermatlas: A photo/case gallery]
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