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{{Molluscum contagiosum}}
{{Molluscum contagiosum}}
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==Overview==
==Overview==
Treatment is often unnecessary<!--
Molluscum contagiosum is typically a self-limiting disease and does not require treatment in all patients. Treatment may be provided in cases where the lesions are in a visible location that may be the source of social or psychological distress to the patient (e.g. face, neck, limbs, genitals). In these cases, the mainstay of therapy for molluscum contagiosum is topical treatment. Topical medical therapies for molluscum contagiosum include [[cryotherapy]] and topical application of [[Caustic (substance)|caustic agents]].
  --><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><!--
  --><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>. 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>
depending on the location and number of lesions, with no single approach shown to be convincingly effective.


==Medical Therapy==
== Medical therapy ==
Nonetheless, treatment may be sought after for the following reasons:
Molluscum contagiosum (MC) is a self limited disease. Treatment is often unnecessary<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><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>. The most common chosen treatment method for MC is supportive counseling. Molluscum contagiosum [[lesions]] usually resolve spontaneously within 2-6 months with a maximum resolve time that can last for years.<ref name="eMedicine" /><ref name="pmid14532898" /> Although it can resolve spontaneously, it can be a great source of embarrassment and may lead to a limited social activity in some patients.<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><ref name="eMedicine">{{EMedicine|derm|270}}</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>
*Medical issues including:  
**Bleeding
**Secondary infections
**Itching and discomfort
**Potential scarring
**Chronic keratoconjunctivitis
*Social reasons
**Cosmetic
**Embarrassment
**Fear of transmission to others
**Social exclusion


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.
Although there are different treatment options, there is not enough evidence of treatment efficacy for molluscum contagiosum.<ref name="pmid19821333">{{cite journal |vauthors=van der Wouden JC, van der Sande R, van Suijlekom-Smit LW, Berger M, Butler CC, Koning S |title=Interventions for cutaneous molluscum contagiosum |journal=Cochrane Database Syst Rev |volume= |issue=4 |pages=CD004767 |year=2009 |pmid=19821333 |doi=10.1002/14651858.CD004767.pub3 |url=}}</ref> Health professionals usually recommend treatment of genital lesions to prevent them from spreading.<ref name="pmid14532898" /> Despite local treatment, the [[virus]] may still be present, because the virus may still be present in the [[Cutaneous|cutaneous tissue]] and recurrent [[lesions]] will often appear even after all the visible ones are surgically excised. As a result, multiple interventional treatments may be needed each time new lesions appear. It is recommended to examine the whole body before starting of any topical treatment to determine all visible lesions, in order to decrease the possibility of treatment failure. Typically, after a period of time, the body will develop [[immunity]] against [[disease]].  Until this is achieved, [[Skin lesion|multiple skin lesion]] may occur.<ref name="pmid17156002">{{cite journal |vauthors=Hanna D, Hatami A, Powell J, Marcoux D, Maari C, Savard P, Thibeault H, McCuaig C |title=A prospective randomized trial comparing the efficacy and adverse effects of four recognized treatments of molluscum contagiosum in children |journal=Pediatr Dermatol |volume=23 |issue=6 |pages=574–9 |year=2006 |pmid=17156002 |doi=10.1111/j.1525-1470.2006.00313.x |url=}}</ref>


===Betadine===
=== Cryotherapy ===
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.
* Apply [[liquid nitrogen]] with a [[Cotton swabs|cotton-tipped swab]] to the lesion for 6 to 10 seconds.
* It is a rapidly effective therapy.<ref name="pmid19804497">{{cite journal |vauthors=Al-Mutairi N, Al-Doukhi A, Al-Farag S, Al-Haddad A |title=Comparative study on the efficacy, safety, and acceptability of imiquimod 5% cream versus cryotherapy for molluscum contagiosum in children |journal=Pediatr Dermatol |volume=27 |issue=4 |pages=388–94 |year=2010 |pmid=19804497 |doi=10.1111/j.1525-1470.2009.00974.x |url=}}</ref>
* As it is a painful procedure, its usage is limited in young children.


===Astringents===
=== Topical treatment choice ===
[[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>


===Australian Lemon Myrtle===
====== [[Cantharidin]] ======
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>
* It should be applied directly to lesions by physician with a [[cotton swab]].
* It should stay on the skin with a bandage and washed off with [[soap]] and water 2-6 hours after application or when the first sign of [[Blister|blistering]] appeared.
* Treatment should be avoided on the [[face]], [[Genital area|genital]], or perianal areas.
* There are some data establishing associated with some common adverse effects including transient [[Burn|burning]], [[pain]], [[erythema]], and [[pruritus]].


===Over-the-counter substances===
==== [[Podophyllotoxin]] ====
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.<!--
* It is an [[antimitotic agent]] that is commercially available as [[podofilox]] 0.5% (Condylox) in a [[solution]] or [[gel]].
  --><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><!--
* There are some data establishing associated with some common adverse effects including local [[erythema]], burning, [[pruritus]], [[inflammation]], and erosions.
  --><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.


===Imiquimod===
=== Other treatment choices ===
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


===Non-medicine treatment===
==== [[Imiquimod]] ====
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.
* It is recommended to be applied at night and washed off in the morning, but there is limited data evaluating its [[efficacy]].
 
==== [[Potassium hydroxide]] ====
* Dose concentration of 5 or 10% can be used for treatment of [[lesions]], but there is limited data evaluating its [[efficacy]].


==References==
==References==
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Latest revision as of 22:45, 29 July 2020

Molluscum contagiosum Microchapters

Home

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Overview

Historical Perspective

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Pathophysiology

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Differentiating Molluscum contagiosum from other Diseases

Epidemiology and Demographics

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Natural History, Complications and Prognosis

Diagnosis

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Physical Examination

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Cost-Effectiveness of Therapy

Future or Investigational Therapies

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]

Overview

Molluscum contagiosum is typically a self-limiting disease and does not require treatment in all patients. Treatment may be provided in cases where the lesions are in a visible location that may be the source of social or psychological distress to the patient (e.g. face, neck, limbs, genitals). In these cases, the mainstay of therapy for molluscum contagiosum is topical treatment. Topical medical therapies for molluscum contagiosum include cryotherapy and topical application of caustic agents.

Medical therapy

Molluscum contagiosum (MC) is a self limited disease. Treatment is often unnecessary[1][2]. The most common chosen treatment method for MC is supportive counseling. Molluscum contagiosum lesions usually resolve spontaneously within 2-6 months with a maximum resolve time that can last for years.[3][4] Although it can resolve spontaneously, it can be a great source of embarrassment and may lead to a limited social activity in some patients.[5][3][4]

Although there are different treatment options, there is not enough evidence of treatment efficacy for molluscum contagiosum.[6] Health professionals usually recommend treatment of genital lesions to prevent them from spreading.[4] Despite local treatment, the virus may still be present, because the virus may still be present in the cutaneous tissue and recurrent lesions will often appear even after all the visible ones are surgically excised. As a result, multiple interventional treatments may be needed each time new lesions appear. It is recommended to examine the whole body before starting of any topical treatment to determine all visible lesions, in order to decrease the possibility of treatment failure. Typically, after a period of time, the body will develop immunity against disease. Until this is achieved, multiple skin lesion may occur.[7]

Cryotherapy

  • Apply liquid nitrogen with a cotton-tipped swab to the lesion for 6 to 10 seconds.
  • It is a rapidly effective therapy.[8]
  • As it is a painful procedure, its usage is limited in young children.

Topical treatment choice

Cantharidin
  • It should be applied directly to lesions by physician with a cotton swab.
  • It should stay on the skin with a bandage and washed off with soap and water 2-6 hours after application or when the first sign of blistering appeared.
  • Treatment should be avoided on the face, genital, or perianal areas.
  • There are some data establishing associated with some common adverse effects including transient burning, pain, erythema, and pruritus.

Podophyllotoxin 

Other treatment choices

Imiquimod

  • It is recommended to be applied at night and washed off in the morning, but there is limited data evaluating its efficacy.

Potassium hydroxide

  • Dose concentration of 5 or 10% can be used for treatment of lesions, but there is limited data evaluating its efficacy.

References

  1. ↑ Prodigy knowledgebase (2003). "Molluscum Contagiosum". National Health Service. Retrieved 2006-07-06. Unknown parameter |month= ignored (help) - UK NHS guidelines on Molluscum Contagiosum
  2. ↑ van der Wouden JC, Menke J, Gajadin S; et al. (2006). "Interventions for cutaneous molluscum contagiosum". Cochrane Database Syst Rev (2): CD004767. doi:10.1002/14651858.CD004767.pub2. PMID 16625612.
  3. ↑ 3.0 3.1 derm/270 at eMedicine
  4. ↑ 4.0 4.1 4.2 Tyring SK (2003). "Molluscum contagiosum: the importance of early diagnosis and treatment". Am. J. Obstet. Gynecol. 189 (3 Suppl): S12–6. PMID 14532898.
  5. ↑ Weller R, O'Callaghan CJ, MacSween RM, White MI (1999). "Scarring in Molluscum contagiosum: comparison of physical expression and phenol ablation". BMJ. 319 (7224): 1540. PMID 10591712.
  6. ↑ van der Wouden JC, van der Sande R, van Suijlekom-Smit LW, Berger M, Butler CC, Koning S (2009). "Interventions for cutaneous molluscum contagiosum". Cochrane Database Syst Rev (4): CD004767. doi:10.1002/14651858.CD004767.pub3. PMID 19821333.
  7. ↑ Hanna D, Hatami A, Powell J, Marcoux D, Maari C, Savard P, Thibeault H, McCuaig C (2006). "A prospective randomized trial comparing the efficacy and adverse effects of four recognized treatments of molluscum contagiosum in children". Pediatr Dermatol. 23 (6): 574–9. doi:10.1111/j.1525-1470.2006.00313.x. PMID 17156002.
  8. ↑ Al-Mutairi N, Al-Doukhi A, Al-Farag S, Al-Haddad A (2010). "Comparative study on the efficacy, safety, and acceptability of imiquimod 5% cream versus cryotherapy for molluscum contagiosum in children". Pediatr Dermatol. 27 (4): 388–94. doi:10.1111/j.1525-1470.2009.00974.x. PMID 19804497.

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