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Molluscum Contagiosum - Causes, Symptoms and Treatment

Definition:

Molluscum contagiosum is a benign viral skin infection characterized by skin-colored to pearl-like papules or nodules on the skin. Incidence of infection is higher in males, with the greater incidence occurring in children under age 5 and in young adults. In adults, it occurs as a sexually transmitted disease, appearing in the genitalia. In some cases, molluscum contagiosum is a chronic infection; however, it produces no systemic illness and poses no public health significance.

Causes of Molluscum Contagiosum

Molluscum contagiosum is caused by a virus of the Proxvirus family known as Molluscipoxvirus. It spreads through direct contact and autoinoculation; fomites may also aid in viral spread. The virus spreads in children through direct contact and through sexual contact in adults. It spreads to other parts of the body by autoinoculation; when scratching the infected area, the virus gets under the fingernails and is reinoculated when another area of the body is scratched.

Signs and Symptoms of Molluscum Contagiosum

The virus infects the epidermis, with lesions appearing on the face, neck, axilla, arms and hands, or other parts of the body, excluding palms and soles of the feet. In some cases it can also be seen in and around the genitalia. The lesions, usually detected by accident while examining for other sexually transmitted diseases, present as small papules, which become raised and form pearly, flesh-colored nodules. Classically, these papules have been characterized as "umbilicated;' in reference to the dimple in the center of the lesion. Nodules are 2 to 5 mm in diameter, appear in lines or crops, and may persist from months to years. In general, spontaneous involution of invisible lesions occurs within 8 weeks. Usually there's no inflammation or redness unless the patient has been scratching the lesions. When the molluscum matures, the nodule can be opened to reveal a white, cheesy, or waxy center.

Complications include secondary bacterial skin infections and the spread and recurrence of the nodules. The initial infection begins in the basal layer with a latent period up to 6 months. Incubation is usually 2 to 7 weeks. New viral particles form when the spindle and granular layers of the epidermis are compromised. These lesions can become inflamed with attendant edema, increased vascularity and infiltration by lymphocytes, neutrophils, and monocytes. This occurs only if there is a secondary bacterial infection and infiltration of the dermis. Since children and HIV-infected patients experience more widespread lesions, cell-mediated immunity is necessary to control the infection. Widespread lesions may also occur in immunocompromised patients, such as those with sarcoidosis or undergoing treatment with prednisone and methotrexate.

Diagnosis for Molluscum Contagiosum

Lesions are usually found in the pubic area. Skin biopsy confirm the virus. Staining with Giemsa, Gram, or Wright's stain should indicate infection. Giemsa staining typically reveals classic molluscum bodies, aiding in diagnosis. Individual virus particles can also be detected by electron microscopy. Differential diagnoses to consider include basal cell carcinoma, folliculitis, furunculosis, keratocanthomas, warts, pyrogenic granuloma, and vesicular skin disorders.

Treatment for Molluscum Contagiosum

Usually the infection disappears within months to a few years in patients with a healthy immune system. In patients with AIDS or who are otherwise immunocompromised compromised, the lesions may be more extensive. Surgical removal of individual nodules by scraping, de-coring, and freezing may cause scarring. Needle electrosurgery can be used.

Special Considerations and Prevention Tips for Molluscum Contagiosum

  • To prevent transfer of the disorder, teach the patient scrupulous personal and family hygiene measures.
  • Prohibit sharing of clothing or towels, as well as physical contact with the infected area.
  • Encourage thorough hand washing.
  • Limiting sexual partners and using condoms can prevent the spread of the molluscum virus.
  • Take necessary precautions to prevent spreading the infection, including washing hands thoroughly before and after patient contact.
  • Assist the patient with appropriate hygiene practices.
  • Consider cutting the patient's fingernails to help maintain the integrity of the skin barrier.

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