Molluscum Contagiosum

1. See Also
   1. Verruca plana (Flat wart)
   2. Verruca Vulgaris (Common Wart)
   3. Condyloma acuminata (Genital Wart)
   4. Verrucae plantaris (Plantar Wart)
2. Pathophysiology
   1. Not a wart virus (But often confused with these)
   2. Caused by DNA containing Poxvirus
   3. Transmission
      1. Direct contact
      2. Fomites
      3. Autoinoculation (e.g. scratching)
3. Epidemiology
   1. Children
      1. Associated with Atopic Dermatitis
   2. Adults
      1. Sexually Transmitted Infection
      2. Signifiant outbreaks associated with HIV
4. Signs
   1. Characteristics
      1. Discrete single or clustered lesions (<30 in group)
      2. Raised firm Papules 3-5 mm diameter
      3. Skin colored or pearly white
      4. Waxy-appearing
      5. Central punctate umbilication
   2. Distribution
      1. Face
      2. Trunk
      3. Lower Abdomen
      4. Pubis, inner thigh and genitalia (adults with STD)
      5. Mucosa may be involved
      6. Rarely affects palms and soles
5. Labs: Microscopy of Incision and Drainage material
   1. Staining will show molluscum bodies
      1. Wright's Stain
      2. Giemsa Stain
      3. Gram Stain
6. Management
   1. General
      1. Treatment is optional as these resolve on their own
         1. Avoid painful procedures for this benign, self-limited condition (especially in children)
         2. If treatment is desired, consider Aldara instead of Cryotherapy
      2. Red and inflamed lesions are in the process of resolution
         1. Do not treat these lesions with cyrotherapy or topical medications
         2. Expect spontaneous resolution soon after inflammation appears
   2. Cryotherapy
      1. Consider topical anesthetic pretreatment in children
         1. Apply under Occlusion 15 to 30 minutes before
         2. Products
            1. EMLA
            2. ELA-Max
   3. Electrodessication and Curettage (not recommended due to scarring risk)
      1. Consider following curettage with application of:
         1. Iodine
         2. Trichloroacetic Acid 30%
   4. Vesicant Application
      1. Keratolytic Agents
      2. Cantharidin
      3. Imiquimod 5% cream (Aldara)
         1. Preferred option by many dermatologists
         2. Apply to skin lesion for 6-10 hours, then wash off
         3. Apply 3 times weekly for 4 to 16 weeks
         4. Do not use on mucous membranes
   5. HIV patients
      1. Cidofovir has been used in advanced molluscum
7. Course
   1. Often spontaneously resolves without treatment
   2. HIV associated molluscum is often severe
8. References
   1. Gottlieb (1994) Int J Dermatol 33:453-61
   2. Stulberg (2003) Am Fam Physician 67(6):1233-44