Molluscum Info 3

Molluscum contagiosum is caused by a virus that is a member of the pox virus family. Pox viruses are notorious for their ability to evade the host's immune system by both active and passive mechanisms. Since the eradication of smallpox, the only pox virus that naturally infects humans is molluscum contagiosum virus (MCV). MCV causes benign proliferative lesions of the skin in normal individuals. There are at least two types of MCV based on DNA restriction analysis. There does not appear to be any predilection for one virus type to infect certain groups of people, certain ages, or certain body areas. Both viruses seem to infect equally. A recent study demonstrated that one of the proteins coded by the MCV genome inhibits the body's lymphocytes and prevents inflammation. This is apparently why it takes so long for the body to rid itself of MCV.

Molluscum contagiosum (MCV) is a common infection throughout the United States. It accounts for approximately 1% of all diagnoses of skin disorders. The exact incidence in the United States is unknown. Higher incidence in children with eczema as well as in immunocompromised individuals has been documented. An Australian study found anti-MCV antibodies in 39% of adults older than 50 years, demonstrating exposure to be very common. There is no well-documented predilection for infection among any racial group. Studies do not demonstrate any definite difference in incidence between the sexes. Cell-mediated immunity is thought to be important in modulating and controlling the infection.

This is a common infection in children. It is frequently seen on the face, neck, arm pit, arms, and hands but may occur anywhere on the body except the palms and soles.

Typically, the lesion of molluscum begins as a small papule which may become raised up to a pearly, flesh-colored nodule. The papule often has a dimple in the center (umbilication). These papules may occur in lines, where the person has scratched. Scratching or other irritation causes the virus to spread in a line or in groups (crops).

The papules are approximately 2 - 5 millimeters in diameter and painless. There is usually no inflammation and subsequently no redness unless the person has been digging or scratching at the lesions. In the mature molluscum, the top of the nodule may be opened with a sterile needle and a small waxy core can be seen and squeezed out of the lesion.

Molluscum contagiosum is a chronic infection and lesions may persist from a few months to a few years. These lesions ultimately disappear without scarring. (Unless there is excessive scratching, which may leave marks.)

Diagnosis is based on the appearance of the lesion and can be confirmed by a skin biopsy.

The skin lesion commonly has the following qualities:

* Small (2 - 5 millimeter diameter)
* Dimple in center
* Initially firm, flesh-colored, pearl-like, dome-shaped
* Later lesions become softer, gray, and may drain
* Central core or plug of white, cheesy or waxy material
* Painless
* Single or multiple (usually multiple)
* Common locations in children: face, trunk, limbs
* Common locations in adults: genitals, abdomen, inner thigh
*Persistence, spread, or recurrence of lesions
* Secondary bacterial skin infections

Figure 1: Typical appearance of molluscum on the abdomen of a 7 year old girl.

Copyright CBR,Inc. 2002 All Rights reserved. May not be reproduced.

New Treatment Options

Essential oils from plants in the Myrtle family have demonstrated anti-viral activity, both in cell culture and in some limited clinical studies. The essential oil of Melaleuca alternifolia is one such species with documented antibacterial, anti-fungal, and anti-viral actions. A recent published clinical study demonstrated the effectiveness of an essential oil preparation in the treatment of molluscum in children (Burke BE, Baille JE, Olson R. Treatment of molluscum contagiosum in children with essential oil of Australian lemon myrtle. Biomedicine & Pharmacotherapy, 2004; vol 58). A product based on this study utilizing essential oil of Melaleuca (tea tree oil) in conjunction with iodine and other essential oils is marketed as ZymaDerm. Our data (see Research) shows a better than a 85% success rate after 4-6 weeks. ZymaDerm represents a breakthrough advancement in the treatment of molluscum contagiosum. The treatment is a painless viable alternative to invasive treatments, or worse yet, useless hucksterism often promoted on the internet.

References

Cohen J, Powderly WG. Infectious Diseases. 2nd ed. New York, NY: Elsevier; 2004:2053-2056.

Kauffman CL. Molluscum contagiosum. eMedicine. January 6, 2005. Available online at http://www.emedicine.com/derm/topic270.htm Accessed October 31, 2005.

Update Date: 10/31/2005

Updated by: Thomas A. Owens, M.D., Departments of Internal Medicine and Pediatrics, Duke University Medical Center, Durham, NC. Review provided by VeriMed Healthcare Network.

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