Molluscum contagiosum

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at April 13, 2016
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Molluscum Contagiosum (MC) is a skin infection characterized by small (2-5mm) to large (10-15mm) dome-looking and fluid-filled bumps, with a dimple in their centers. The mildly contagious molluscum contagiosum virus (MCV) resides inside them and is generally spread through skin-to-skin contact with infected people or contaminated objects. Healing could take from a few months to years, while scarring and recurrences are not uncommon.

Contents

Definition & Facts

Recognized nearly 200 years ago, MC is caused by MCV, a member of the poxvirus family. The virus replicates in the jelly-like substance (cytoplasm) within the cells of infected individuals. A relative of MCV is smallpox, which has been nearly eradicated throughout the world.

It is especially adapted for skin cells and in rare cases can occur on the mucous membranes, such as lips, inside the mouth or in the conjunctiva of the eyes. Children are the most frequently affected; however, people with HIV or weakened immune systems, as well as sexually active teens and adults, are susceptible to this viral infection.

Symptoms & Complaints

The major symptom and complaint for MC is the appearance of bumps on the skin, which may be itchy. These bumps could be pink, flesh-colored, white, translucent, or light yellow in appearance and when they are squeezed, rubbed, scratched or traumatized, a white, cheesy drainage comes out. When this occurs, the MCV can be spread to other parts of the body.

The virus mainly affects the top layer of the skin in places like the face, neck, armpits, arms, trunk, genitals and tops of the hands in children. In adults and teens, it may be seen in the genitals, lower abdomen and inner upper thighs, especially if it is sexually transmitted. There are a greater number of bumps for those with HIV than for other patients, with many of the bumps located on their faces.

Causes

MC is caused by the MCV virus. It is generally characterized through three patterns in three different groups of people in the following manner:

  • Children: Through direct skin-to-skin contact or indirect contact with fomites (something that harbors and transmits diseases) on clothing, gymnasium equipment, towels public baths, and so on.
  • Adults and teens with healthy immune systems: Considered to be a sexually transmitted disease (STD), with bumps being limited to the perineum, genitalia, buttocks and lower abdomen.
  • Children, teens or adults with very weakened immune systems: People with or without HIV who have severely weakened immune systems, may experience a longer course with numerous and atypical bumps. Additionally, in individuals living with HIV, they frequently occur on the face.

Diagnosis & Tests

Due to the broad and unusual clinical appearance of MC, it is sometimes difficult to make a correct diagnosis, even with the characteristic dimpling in the bumps. That is because a single bump could have more than one area of dimpling, leading the examiner to think it is a different type of skin disorder.

Skin biopsies and microscopic examination of the liquid in the dimples of the bumps are very helpful. Additionally, if there are numerous bumps on an individual’s face, the physician will consider testing for HIV infection. According to the CDC, low CD4 cell counts have been linked to widespread facial mollusca and therefore have become a marker for severe HIV disease.

Treatment & Therapy

MC is benign in healthy people, but both medical and surgical treatments are warranted to help prevent transmission of the disease to others and the spread of the disease to other parts of the body as well as unwanted and severe complications. Current treatments are based on many factors, such as a person's condition and age.

Three common ones include medications placed on the bumps to help them heal (topical medication), scraping (curettage) and freezing them off (cryotherapy) as well as destruction of tissue by means of a high-frequency electric current (electrodissection). Oral medications may be best for children and some adults while therapies that strengthen the immune system are a preferred treatment for people with severely weakened immune systems or HIV.

Prevention & Prophylaxis

The best overall prophylaxis is good hygiene and frequent hand washing. Infected individuals should avoid using or touching objects that could transfer the disease.

They should also keep their hands away from the bumps; stop scratching them; bandage them; avoid swimming pools because it is not clear whether chlorinated water will kill MCV; avoid sharing clothing, towels or toys while infected, and be careful during sports activities.

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