PLEASE

Molluscum
contagiosum

SANJAY KUMAR YADAV

 The very root of the word molluscum is
mollis(mollusk: invertebrate having a
soft unsegmented body) which means
soft and contagiosum meaning infectious.
Synonyms- Molluscum epitheliale;Epithelioma
mollus-cum; Epithelioma contagiosum; Acné
varioliforme

Definition- A contagious disease of the

skin characterized by pin-head­ to pea-sized
or larger, rounded, semiglobular or slightly
flat­tened, pearl-like elevations,of whitish or
pinkish color,and with minute central
depression(umbilication).
 FACTS….

• Caused by a member of the poxvirus group, molluscum

contagiosum virus (MCV). The virus is one of the largest that causes
human disease, measuring 240-320 nm in diameter.

• Bateman first described the disease in 1817.

• The term molluscum was used to describe the soft pedunculated

appearance, and the term contagiosum was used to connote that
the disease is transmissible.

• Cell-mediated immunity is thought to be important in modulating

and controlling the infection because children and HIV-infected
patients are noted to have more widespread and persistent lesions.

• The virus infrequently induces antibody formation; therefore, it is

not strongly immunogenic, and reinfection is common.

• Virus infects only epidermis, rarely dermis, so cardinal signs of

inflammation are absent.
How is it transmitted?

•Molluscum contagiosum may be sexually transmitted by skin-

to-skin contact (does not have to be mucous membranes)
and/or lesions. Transmission through sexual contact is the
most common form of transmission for adults.

•MCV may be transmitted from inanimate objects such as

towels and clothing that come in contact with the lesions. MCV
transmission has been associated with swimming pools and
sharing baths with an infected person.

•MCV also may be transmitted by autoinoculation, such as

touching a lesion and touching another part of the body. To
stop from further spreading the infection, do not shave over or
close to areas that are visibly infected.
 Direct inoculation

Basal layer of epidermis

Viral DNA replication and cuplike

verrucous epidermal hyperplasia

Occasionally secondary bacterial

infection
Molluscum contagiosum usually presents as
single or multiple (ie, usually no more than 20)
discrete, painless, flesh colored papules that
classically have a central umbilication.
They may spontaneously resolve and are
sometimes dismissed by both patients and
clinicians. If very mild, they may not be noticed
by the patient.
If superinfection already has taken place, the
lesions may present as pustules, possibly
painful, with erythema and induration.
Their diameter usually is 2-6 mm; however, it
may be up to 3 cm.
The lesions may be tender or pruritic.
Beneath the umbilicated center is a white
curdlike core.
The lesions may be located anywhere, but they
If children present with genital
lesions, sexual abuse should be
considered, although autoinoculation
is considered the most likely cause of
spread to the genitalia in children.
In general, the disorder is not
accompanied by systemic symptoms
(eg, fever, nausea, malaise).
Patients may be able to recall
contact with an infected sexual
partner, family member, or other
Patients with HIV/AIDS and
other immunocompromising
conditions (e.g., solid organ
transplant recipients) can
develop “giant” lesions (≥15
mm in diameter), larger
numbers of lesions, and
lesions that are more
resistant to standard therapy.
 Immune reconstitution inflammatory
syndrome (IRIS) is a recently described entity
in which severely immunodepressed HIV
patients, after being started on HAART,
develop inflammatory reactions to several
pathogens. Several skin manifestations have
been reported in association with IRIS
including herpes zoster and herpes simplex
Infections, MAC infection, Hansen disease,
Kaposi's sarcoma, Reiter's syndrome,
sarcoidosis , foreign body granulomas, acne
vulgaris, and dishydrosis and Molluscum
contagiosum.
 Laboratory Studies
• The diagnosis of molluscum contagiosum
usually is clinically based upon the
appearance and locations of the lesions.
• Staining of thin smears with Giemsa,
Gram, or Wright stain should reveal
infected cells with molluscum
bodies(ellipsoid, homogenous,
cytoplasmic inclusion bodies)
 Other Tests
• Molluscum contagiosum viral (MCV) antigens
can be detected by fluorescent antibody
studies.
• Electron microscopy may identify individual
viral particles.
Procedures
• Biopsy
Lesions may be biopsied. With hematoxylin and
eosin (H&E) staining, the clinician can
demonstrate characteristic changes in the
epidermis.
Biopsy is particularly important in cases where the
diagnosis is not clear.
 TOPICAL
CRYOTHERAPY CURRETTAGE
VESICANTS

ANTIHISTAMINICS TREATMENT

ANTIVIRAL RETINOIDS IMIQUIMOD

Liquid N itr ogen
Liquid nitrogen (-195.8˚ Centigrade) freezes the wart and the
surrounding superficial skin into a solid ice ball for several
minutes.
Cant haridin (V er r-C anth)
Causes inflammatory reaction to lesion, causing expulsion of
lesion contents. Unlikely to scar. Painful if applied to
surrounding, intact skin. 90% successful in clearing of lesion.
Imiquimod (Aldar a)
Imiquimod 5% cream has been used topically to treat MCV.
Induces secretion of interferon alpha and other cytokines;
mechanism of action are unknown. It is a potent
immunomodulatory agent. May be more effective in women than
in men.
 Curettage is another method of
removal. It can be used with and
without light electrodessication.
This method is more painful, and it
is recommended that a topical
anesthetic cream be applied to the
lesions before the procedure to
decrease the pain. This method
has the advantage of providing a
reliable tissue sample to confirm
Tr et inoin (R etin-A, Ren ova)
Inhibits microcomedo formation and eliminates lesions. Makes
keratinocytes in sebaceous follicles less adherent and easier to
remove. Available as 0.025%, 0.05%, and 0.1% creams. Available
also as 0.01% and 0.025% gels. Begin with lowest tretinoin
formulation and increase as tolerated.

Cimeti di ne (T agam et )
H2 antagonist useful in treating pruritus, urticaria, and contact
dermatitis. Mechanisms of action in the treatment of molluscum
contagiosum are poorly understood.

Antibiotics
If secondary infection is suspected, then appropriate
antistaphylococcal antibiotic coverage should be prescribed.