Molluscum contagiosum (MC), sometimes called water warts, is a viral infection of the skin that results in small raised pink lesions with a dimple in the center. They may become itchy or sore, and occur singularly or in groups. Any area of the skin may be affected, with abdomen, legs, arms, neck, genital area, and face being the most common. Onset of the lesions is around seven weeks after infection. They usually go away within a year without scarring. The infection is caused by a poxvirus called the molluscum contagiosum virus (MCV). The virus is spread either by direct contact, including sexual activity, or via contaminated objects such as towels. The condition can also be spread to other areas of the body by the person themselves. Risk factors include a weak immune system, atopic dermatitis, and crowded living conditions. Following one infection, it is possible to get re-infected. Diagnosis is typically based on the appearance of the lesions. Prevention includes hand washing and not sharing personal items. While treatment is not necessary, some may wish to have the lesions removed for cosmetic reasons or to prevent spread. Removal may occur with freezing, laser therapy, or opening up the lesion and scraping the inside. Scraping the lesion can, however, result in scarring. The oral medication cimetidine, or podophyllotoxin cream applied to the skin, may also be used for treatment. Approximately 122 million people globally were affected by molluscum contagiosum as of 2010 (1.8% of the population). It is more common in children between the ages of one and ten years old. The condition has become more common in the United States since 1966.
Signs and symptoms
Molluscum contagiosum lesions are flesh-colored, dome-shaped, and pearly in appearance. They are often 1–5 mm in diameter, with a dimpled center. Molluscum lesions are most commonly found on the face, arms, legs, torso, and armpits in children. Adults typically have molluscum lesions in the genital region, and this is considered to be a sexually transmitted infection; because of this, if genital lesions are found on a child, sexual abuse should be suspected. These lesions are generally not painful, but they may itch or become irritated. Picking or scratching the bumps may lead to a spread of the viral infection responsible for molluscum contagiosum, an additional bacterial infection, and scarring. In some cases, eczema develops around the lesions. Individual molluscum lesions may resolve on their own within two months and generally clear completely without treatment or scarring in six to twelve months. Mean durations for an outbreak are variously reported from eight to about 18 months, but durations are reported as widely as six months to five years, lasting longer in immunosuppressed individuals.
Transmission As the name implies, Molluscum contagiosum is extremely contagious. Transmission of the virus can occur many different ways, including direct skin contact (e.g., contact sports or sexual activity), contact with an infected surface (fomite), or autoinoculation (self-infection) by scratching or picking molluscum lesions and then touching other parts of the skin not previously affected by the virus. Children are particularly susceptible to autoinoculation and may have widespread clusters of lesions. The viral infection is limited to a localized area on the topmost layer of the superficial layer of the skin.
Diagnosis Histologically, molluscum contagiosum is characterized by molluscum bodies (also known as Henderson-Patterson bodies) in the epidermis, above the stratum basale, which consist of cells with abundant large granular eosinophilic cytoplasmic inclusion bodies (accumulated virions) and a small nucleus that has been pushed to the periphery.
Management Because molluscum contagiosum usually resolves without treatment and treatment options can cause discomfort to children, initial recommendations are often to wait for the lesions to resolve on their own. Of the treatments available, a meta-analysis of randomized controlled trials suggested that there is no difference between treatments in short term improvement, and no single treatment is significantly better than natural resolution of the condition. Bumps located in the genital area may be treated to prevent them from spreading. When treatment has resulted in the elimination of all bumps, the infection has been effectively cured and will not reappear unless the person is reinfected.
Medications For mild cases, over-the-counter topical medication, such as potassium hydroxide, may provide a modest benefit. There is limited evidence for other topical agents including salicylic acid, benzoyl peroxide, and tretinoin, but none of these agents are recommended over the others to shorten infection duration. Studies have found cantharidin to be an effective and safe treatment for removing molluscum contagiosum. This medication is usually well tolerated, though mild side effects such as pain or blistering are common. There is no high-quality evidence for cimetidine. However, oral cimetidine has been used as an alternative treatment for the pediatric population as it is generally well tolerated and less invasive.
Berdazimer sodium
Imiquimod Imiquimod is a form of immunotherapy initially proposed as a treatment for molluscum based on promising results in small case series and clinical trials. However, two large randomized controlled trials, specifically requested by the U.S. Food and Drug Administration under the Best Pharmaceuticals for Children Act both demonstrated that imiquimod cream applied three times per week was no more effective than placebo cream for treating molluscum after 18 weeks of treatment in a total of 702 children aged 2–12 years. In 2007, results from those trials—which remain unpublished—were incorporated into FDA-approved prescribing information for imiquimod, which states: "Limitations of Use: Efficacy was not demonstrated for molluscum contagiosum in children aged 2–12." In 2007, the FDA also updated imiquimod's label concerning safety issues raised in the two large trials and an FDA-requested pharmacokinetic study (the latter of which was published). The updated safety label reads as follows:
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