II. Pathophysiology
III. Epidemiology
- Children
- Most commonly affects ages 2 to 11 years old
- More rapid spread associated with Atopic Dermatitis
- Adolescents and Adults
- Sexually Transmitted Infection
- Significant outbreaks associated with HIV
IV. Signs
- Characteristics
- Discrete single or clustered lesions (<30 in group)
- Raised firm Papules 3-5 mm diameter
- Skin Colored or pearly white
- Waxy-appearing
- Central punctate umbilication
- Distribution
- Face
- Trunk
- Lower Abdomen
- Pubis, inner thigh and genitalia (adults with STD)
- Mucosa may be involved
- Rarely affects palms and soles
- Extensive involvement in HIV
V. Labs: Microscopy of Incision and Drainage material
- Staining will show molluscum bodies
- Wright's Stain
- Giemsa Stain
- Gram Stain
VI. Management
-
General
- Treatment is optional as these resolve on their own (over as long as 2-4 years)
- Avoid painful procedures for this benign, self-limited condition (especially in children)
- If treatment is desired, consider Aldara instead of Cryotherapy
- Treat those with Atopic Dermatitis or other underlying cause to prevent spread
- Red and inflamed lesions are in the process of resolution
- Do not treat these lesions with cyrotherapy or Topical Medications
- Expect spontaneous resolution soon after inflammation appears
- Treatment is optional as these resolve on their own (over as long as 2-4 years)
-
Cryotherapy
- Consider Topical Anesthetic pretreatment in children
- Apply under Occlusion 15 to 30 minutes before
- Products
- EMLA
- ELA-Max
- Consider Topical Anesthetic pretreatment in children
-
Electrodessication and Curettage (not recommended due to scarring risk)
- Consider following curettage with application of:
- Iodine
- Trichloroacetic Acid 30%
- Consider following curettage with application of:
-
Vesicant Application
- Keratolytic Agents
- Cantharidin
- YCanth
- Single use applicator of Cantharidin FDA approved for age >2 years (in 2023, approaches $700/applicator)
- Applied by medical provider every 3 weeks for 4 visits
- Clearance of molluscum in 3 months (NNT 3)
- (2023) Presc Lett 30(10): 58-9
- YCanth
- Imiquimod 5% cream (Aldara)
- Preferred option by many dermatologists, although evidence of significant efficacy is lacking
- Apply to skin lesion for 6-10 hours, then wash off
- Apply 3 times weekly for 4 to 16 weeks
- Do not use on mucous membranes
-
Berdazimer (Zelsuvmi)
- Applied daily for up to 12 weeks
- HIV patients
- Cidofovir has been used in advanced molluscum
VII. Course
- Often spontaneously resolves without treatment (although may be present as long as 2-4 years)
- Molluscum is often severe in HIV Infection, other immunocompromising conditions and Atopic Dermatitis
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| Definition (MSH) | A common, benign, usually self-limited viral infection of the skin and occasionally the conjunctivae by a poxvirus (MOLLUSCUM CONTAGIOSUM VIRUS). (Dorland, 27th ed) |
| Concepts | Disease or Syndrome (T047) |
| MSH | D008976 |
| ICD9 | 078.0 |
| ICD10 | B08.1 |
| SnomedCT | 154360009, 40070004 |
| French | MOLLUSCUM CONTAGIOSUM, Infection par le virus Molluscum contagiosum, Molluscum contagieux, Infections virales à Molluscum contagiosum, Molluscum contagiosum |
| English | MOLLUSCUM CONTAGIOSUM, molluscum contagiosum, molluscum contagiosum (diagnosis), Molluscum contagiosum viral infections, Molluscum contagiosum virus infection, Molluscum contagious, Molluscum Contagiosum [Disease/Finding], mollusca contagiosa, water wart, Mollusca contagiosum, molluscum contagious, warts water, contagiosum molluscum, Molluscum contagiosum (disorder), Molluscum contagiosum, Molluscum contagiosum infection, MC - Molluscum contagiosum, Molluscum verrucosum, Molluscum contagiosum infection (disorder), Molluscum Contagiosum, mollusca contagiosum |
| Portuguese | MOLUSCO CONTAGIOSO, Infecção vírica de molusco contagioso, Molusco contagioso, Infecções a vírus de molluscum contagiosum, Molusco Contagioso |
| German | MOLLUSCUM CONTAGIOSUM, Molluscum contagiosum Virusinfektion, Dellwarzen-Virusinfektion, Dellwarze, Molluscum contagiosum |
| Italian | Infezioni virali da mollusco contagioso, Infezione virale da mollusco contagioso, Mollusco contagioso |
| Dutch | molluscum contagiosum virusinfectie, molluscum contagiosum virusinfecties, molluscum contagiosum, Molluscum contagiosum |
| Spanish | Infección por el virus del molluscum contagiosum, Mollusco contagioso, infección por molusco contagioso (trastorno), infección por molusco contagioso, molusco contagioso, molusco verrucosum, molusco verrugoso, Molluscum contagiosum, Infecciones por el virus del molusco contagioso, Molusco Contagioso |
| Japanese | 伝染性軟属腫ウイルス感染, 伝染性軟属腫, ﾃﾞﾝｾﾝｾｲﾅﾝｿﾞｸｼｭｳｲﾙｽｶﾝｾﾝ, ﾃﾞﾝｾﾝｾｲﾅﾝｿﾞｸｼｭ |
| Swedish | Molluscum contagiosum |
| Czech | molluscum contagiosum, Infekce virem molluscum contagiosum, Virová infekce způsobená virem molluscum contagiosum, Molluscum contagiosum |
| Finnish | Tarttuva ontelosyylä |
| Russian | MOLLIUSK ZARAZNYI, МОЛЛЮСК ЗАРАЗНЫЙ |
| Korean | 전염 물렁종 |
| Polish | Mięczak zakaźny |
| Hungarian | Molluscum ragályos, molluscum contagiosum, Molluscum contagiosum vírusos fertőzések, Molluscum contagiosum vírus fertőzés |
| Norwegian | Vannvorter, Molluscum contagiosum |
