II. 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)

III. Epidemiology

  1. Children
    1. Most commonly affects ages 2 to 11 years old
    2. More rapid spread associated with Atopic Dermatitis
  2. Adolescents and Adults
    1. Sexually Transmitted Infection
    2. Significant outbreaks associated with HIV

IV. 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
    7. Extensive involvement in HIV

V. Labs: Microscopy of Incision and Drainage material

  1. Staining will show molluscum bodies
    1. Wright's Stain
    2. Giemsa Stain
    3. Gram Stain

VI. Management

  1. General
    1. Treatment is optional as these resolve on their own (over as long as 2-4 years)
      1. Avoid painful procedures for this benign, self-limited condition (especially in children)
      2. If treatment is desired, consider Aldara instead of Cryotherapy
      3. Treat those with Atopic Dermatitis or other underlying cause to prevent spread
    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

VII. Course

  1. Often spontaneously resolves without treatment (although may be present as long as 2-4 years)
  2. HIV associated molluscum is often severe

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Related Studies

Ontology: Molluscum Contagiosum (C0026393)

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, デンセンセイナンゾクシュウイルスカンセン, デンセンセイナンゾクシュ
Swedish Molluscum contagiosum
Czech molluscum contagiosum, Infekce virem molluscum contagiosum, Virová infekce způsobená virem molluscum contagiosum, Molluscum contagiosum
Finnish Tarttuva ontelosyylä
Korean 전염 물렁종
Polish Mięczak zakaźny
Hungarian Molluscum ragályos, molluscum contagiosum, Molluscum contagiosum vírusos fertőzések, Molluscum contagiosum vírus fertőzés
Norwegian Vannvorter, Molluscum contagiosum