Molluscum contagiosum – symptoms, treatment and photos

What is molluscum contagiosum?

Molluscum contagiosum is a relatively common and contagious viral skin infection caused by the virus of the same name.

The molluscum contagiosum virus has the human being as its only host and causes characteristic skin lesions, which consist of multiple, rounded, pink papules, about 2 to 5 mm in diameter (we explain the symptoms in more detail below).

Despite having a pompous name, molluscum contagiosum is, in most cases, a benign skin disease that cures itself without leaving sequelae.

The peak incidence of the disease occurs around 3-4 years of age and in adolescence/early adulthood, when the individual begins his sexual life.

Symptoms of Molluscum contagiosum

Molluscum contagiosum virus is characterized by causing multiple small papules (elevated skin lesions), dome-shaped and pink and shiny. A small depression in the center of the lesion, like an umbilicus, is common.

Molluscum contagiosum

Occasionally, papule growth can cause lesions that look like polyps, with a thin base (exemplified in the image in the lower left corner).

In children, lesions usually appear on the face, neck, armpits, arms and tops of the hands. In adults, the genital region, the lower abdomen and the inner thighs are the most affected areas.

The injury does not hurt and does not always itch. If the patient keeps touching the wounds, they can become contaminated with skin bacteria and become very inflamed.

By scratching or shaving, the papules can be removed. This, in addition to facilitating the infection of the wound, helps to spread the virus, increasing the risk of contagion to other parts of the skin and to people nearby.

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The papules usually appear 2 to 6 weeks after exposure to the virus. The illness can last from several months to more than a year. During this time, some injuries may disappear on their own and new ones may appear. In rare cases, the disease can take more than 3 years to disappear.

When molluscum lesions disappear, they can leave lighter patches on the skin, which disappear over time. It is not common for the disease to leave permanent scars or marks.

In HIV-positive and immunosuppressed patients, the lesions are usually larger and more diffuse.

complications

Molluscum contagiosum is not a disease that usually causes complications. The most common is infection of the wounds by bacteria, if the patient is scratching or touching them frequently. Infected wounds can cause severe inflammation and scarring.

Patients with lesions near the eyes may develop conjunctivitis .

Streaming

The molluscum contagiosum virus is spread through direct physical contact from person to person and through contaminated personal objects such as clothing, sheets, towels, bath sponges and toys.

The virus can spread to other parts of the body if the patient scratches one of the lesions and then touches another part of the body with the same hand. The act of shaving or waxing can also spread the virus, as it causes lesions to break.

We still don’t know if the disease can spread by simple contact with apparently intact lesions. It is believed that it is necessary to cause some kind of rupture in the lesion for the virus to be able to spread. This can occur through the act of scratching, plucking lesions with a finger, friction in the bed, trauma to the lesions, etc. When in doubt, the ideal is not to touch the papules.

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Child-to-child transmission is more common in countries with a hot climate, where it is common for children to walk and play without a shirt and with little clothing covering their skin.

In adults, the main form of transmission of the mollusc is through sexual contact.

The molluscum contagiosum virus remains in the upper layer of the skin (epidermis) and does not circulate throughout the body. Therefore, there is no transmission through coughing or sneezing.

As the virus only lives in the superficial layer of the skin, when the lesions disappear, the virus disappears with it. Molluscum contagiosum is not like the herpes virus , which can lie dormant in your body for long periods and then reappear.

Diagnosis

In the vast majority of cases, the diagnosis is made through a simple examination of the skin, as the lesions are quite characteristic. A dermatologist makes this diagnosis with peace of mind.

Some skin lesions that can look like molluscum contagiosum and deceive less experienced doctors. Examples are lesions caused by cryptococcosis, histoplasmosis, Penicillium marneffei infection , flat warts, condyloma acuminatum, condylomata lata, pyogenic granuloma, adnexal tumors, Langerhans cell histiocytosis, basal cell carcinoma and amelanotic melanoma.

If there is any doubt, a scaling or biopsy of the lesion can be done to confirm the diagnosis.

Treatment

As the molluscum heals spontaneously after a few weeks or months in most cases, treatment is not necessary if the lesions are few and not bothersome.

There is no need to prevent children from going to day care or school. Just guide them to:

  • Don’t mess around with injuries.
  • Do not share personal items such as towels and clothing.
  • Wash your hands often.
  • Cover injuries with clothing, if possible.
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Treatment, while not strictly necessary, is often done because it speeds up healing and prevents transmission of the virus to others.

When the patient and the doctor opt for treatment, the main options are:

Cryotherapy

Cryotherapy is performed by applying liquid nitrogen to each of the lesions using swabs (a type of large cotton swab).

As the treatment involves “freezing” the papules, there is some pain during the application of liquid nitrogen, which makes it difficult to perform it in young children. Adolescents and adults tolerate this technique better.

Temporary or permanent scarring and hypopigmentation (light spots) of the skin are potential adverse effects of cryotherapy.

Curettage

removal of molluscum lesions

Curettage is the removal of molluscum lesions by scraping with an instrument called a curette.

Pain and bleeding from the lesions make this technique more difficult for children.

Cantharidin

Cantharidin is a chemical that is applied to the lesions, causing blisters to form and then disappearance of the lesion without leaving a mark. Treatment should be repeated for 2 to 4 weeks until all lesions have disappeared.

This method is most used in children and has a success rate above 90%. The medicine must be applied by the doctor.


References