Wart

Molluscum Contagiosum

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Molluscum Contagiosum

  • 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)
  • 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
  • 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
  1. Staining will show molluscum bodies
    1. Wright's Stain
    2. Giemsa Stain
    3. Gram Stain
  • 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
  • Course
  1. Often spontaneously resolves without treatment (although may be present as long as 2-4 years)
  2. HIV associated molluscum is often severe