Definition
Molluscum contagiosum is a viral skin
infection that causes raised, pearl-like papules or nodules
on the skin.
Causes, incidence, and risk
factors
Molluscum contagiosum is caused by
a virus that is a member of the poxvirus family.
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. Occasionly, it is seen on the genitals.
In adults, molluscum is generally seen
on the genitals as a sexually-transmitted disease. Because
molluscum produces no serious illness and is not of long-term
public health significance, it has not been treated as other
sexually-transmitted diseases. The importance is significant
in the growing population of immunocompromised people with
AIDS, who may develop a fulminating (rapidly worsening) case
of molluscum contagiosum.
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.
Early lesions on the genitalia may be mistaken for herpes
or warts but, unlike herpes, these lesions are painless.
The virus is contagious through direct
contact, as seen in children, but may spread by sexual contact.
It can spread on a person from lesions to adjacent normal
skin areas.
Symptoms
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
Signs and Tests
Diagnosis is based on the appearance
of the lesion and can be confirmed by a skin biopsy. The health
care provider should examine the lesion to rule out other
disorders and to determine other underlying disorders.
Treatment
In people with normal immune systems,
the disorder usually disappears spontaneously over a period
of months to years. The lesions may be extensive in people
with AIDS or other conditions that affect the immune system.
Individual lesions may be removed surgically, by scraping,
de-coring, freezing, or through needle electrosurgery. Surgical
removal of individual lesions may result in scarring. Medications
may be tried with limited success in removal of lesions.
Expectations (prognosis)
Individual lesions of molluscum contagiosum
usually disappear within about 2 - 3 months. Complete disappearance
of all lesions generally occurs within about 18- 30months.
The disorder may persist in immunosuppressed people.
Complications
Persistence, spread, or recurrence
of lesions
Secondary bacterial skin infections
Calling your health care provider
Call for an appointment with your health
care provider if you have symptoms suggestive of molluscum
contagiosum. Also call for an appointment with your health
care provider if lesions persist or spread, or if new symptoms
appear.
Prevention
Avoid direct contact with the skin
lesions.
Total abstinence is the only fullproof
way of avoiding molluscum virus and other STDs. You can also
avoid STDs by having a monogamous sexual relationship with
a partner known to be disease-free.
Male and female condoms cannot fully
protect you, as the virus can be on areas not covered by the
condom. Nonetheless, condoms should still be used every time
the disease status of a sexual partner is unknown. They reduce
your chances of getting or spreading STDs. Use them with spermicide
with nonoxynol 9.
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