Molluscum contagiosum

Infectious diseases

Clinicals - History

Fact Explanation
Papules like " water blisters", occur in crops over 6-12 months this is a common skin infection of child hood (affect any age, but target group is children over one year ) Molluscum Contagiosum virus (MCV) is a double- stranded DNA virus in the family of poxviridae.
These papules contain foci of epithelial hyperplasia, infected keratinocytes & are infiltrated with inflammatory cells.
MCV has an ability to escape from local immune mechanisms. Genes in these pox viruses target the genes in main host immune mechanisms. ( MHC class 1, chemokines, IFNs, ILs). Once infected the immunogenicity of those host cells is reduced.
Papules like " water blisters", occur in crops over 6-12 months this is a common skin infection of child hood (affect any age, but target group is children over one year )
Molluscum Contagiosum virus (MCV) is a double- stranded DNA virus in the family of poxviridae.
These papules contain foci of epithelial hyperplasia, infected keratinocytes & are infiltrated with inflammatory cells.
MCV has an ability to escape from local immune mechanisms. Genes in these pox viruses target the genes in main host immune mechanisms. ( MHC class 1, chemokines, IFNs, ILs). Once infected the immunogenicity of those host cells is reduced.
Itching Seen in patients who are having atopy Itching
Seen in patients who are having atopy
Excoriated lesions Secondary bacterial infections Excoriated lesions
Secondary bacterial infections
Eye lid lesions, itching, redden, tearing eyes These are seen in ocular molluscum contagiosum. Patients who have Acquired immune deficiency syndrome, atopic dermatitis, arthritis and patients on steroid treatment are more likely to get it.
Eye lid lesion is the commonest finding. But conjunctivitis, keratoconjunctivitis are also seen which are thought to be caused by toxicity & hypersensitivity to the viral proteins released from the eyelid lesions.
Eye lid lesions, itching, redden, tearing eyes
These are seen in ocular molluscum contagiosum. Patients who have Acquired immune deficiency syndrome, atopic dermatitis, arthritis and patients on steroid treatment are more likely to get it.
Eye lid lesion is the commonest finding. But conjunctivitis, keratoconjunctivitis are also seen which are thought to be caused by toxicity & hypersensitivity to the viral proteins released from the eyelid lesions.

Clinicals - Examination

Fact Explanation
Single/Multiple, round, dome shaped, translucent papules (seems like fluid filled vesicles but in fact solid) these are pearly white/ skin colored. These papules are circumscribed, raised lesions.
These papules contain foci of epithelial hyperplasia, infected keratinocytes & are infiltrated with inflammatory cells.
Single/Multiple, round, dome shaped, translucent papules (seems like fluid filled vesicles but in fact solid) these are pearly white/ skin colored.
These papules are circumscribed, raised lesions.
These papules contain foci of epithelial hyperplasia, infected keratinocytes & are infiltrated with inflammatory cells.
1-3 mm in diameter has a central umbilication -punctum Typical lesions are of 1-3 mm size. Early lesions are smaller than this. Atypical lesions are larger than this. > 15mm sometimes.
By squeezing the papule curd like white material can be expressed through umbilication.
1-3 mm in diameter has a central umbilication -punctum
Typical lesions are of 1-3 mm size. Early lesions are smaller than this. Atypical lesions are larger than this. > 15mm sometimes.
By squeezing the papule curd like white material can be expressed through umbilication.
Lesions found commonly in face,hands, lower abdomen & genitals. Lesions are more common in trunk, limb & face in the children. In the genitals, inner thighs and abdomen in adults Lesions spread by autoinoculation.
Close sexual contact also is a way of transmission.
Lesions found commonly in face,hands, lower abdomen & genitals. Lesions are more common in trunk, limb & face in the children. In the genitals, inner thighs and abdomen in adults
Lesions spread by autoinoculation.
Close sexual contact also is a way of transmission.
Kobner phenomenon is seen ( i.e. new lesions occur at sites of skin trauma) Kobner phenomenon is seen
( i.e. new lesions occur at sites of skin trauma)
Red eye, tearing, eye lid lesions These are manifestations of ocular molluscum contagiosum. Patients who have Acquired Immune Deficiency Syndrome (AIDS), atopic dermatitis, arthritis and patients on steroid treatment are more likely to contract this virus. They can also have findings compatible with above, e.g joint swelling & redness, cushingoid features etc.
Conjunctivitis, keratoconjunctivitis thought to be caused by toxicity and hypersensitivity to the viral proteins released from the eyelid lesions.
Red eye, tearing, eye lid lesions
These are manifestations of ocular molluscum contagiosum. Patients who have Acquired Immune Deficiency Syndrome (AIDS), atopic dermatitis, arthritis and patients on steroid treatment are more likely to contract this virus. They can also have findings compatible with above, e.g joint swelling & redness, cushingoid features etc.
Conjunctivitis, keratoconjunctivitis thought to be caused by toxicity and hypersensitivity to the viral proteins released from the eyelid lesions.

Investigations - Diagnosis

Fact Explanation
This is mainly a clinical diagnosis Typical lesions are easy to identify by proper clinical examination. Single/Multiple, round, dome shaped, translucent papules
(seems like fluid filled vesicles but in fact solid). Pearly white/ skin colored. 1-3 mm in diameter
has a central umbilication -punctum
This is mainly a clinical diagnosis
Typical lesions are easy to identify by proper clinical examination. Single/Multiple, round, dome shaped, translucent papules
(seems like fluid filled vesicles but in fact solid). Pearly white/ skin colored. 1-3 mm in diameter
has a central umbilication -punctum
Microscopy of the lesion Histopathological confirmation is considered in atypical lesions. This will show -cup like epidermal hyperplasia. Large inclusion bodies (molluscum bodies) in cells of stratum corneum and granulosum layers of skin (presence of molluscum bodies is diagnostic), numerous virions in the inclusion bodies (virus replicate inside the cellular cytoplasm causing the infected cell increasing in size, eventually this virions form inclusion bodies in size of 35 microns) Microscopy of the lesion
Histopathological confirmation is considered in atypical lesions. This will show -cup like epidermal hyperplasia. Large inclusion bodies (molluscum bodies) in cells of stratum corneum and granulosum layers of skin (presence of molluscum bodies is diagnostic), numerous virions in the inclusion bodies (virus replicate inside the cellular cytoplasm causing the infected cell increasing in size, eventually this virions form inclusion bodies in size of 35 microns)

Investigations - Management

Fact Explanation
HIV screening In an adult with extensive lesions, this gives rise to the suspicion of underlying immunosuppressed state. Atypical lesions commonly seen in immunocompromised patients. Atypical lesions are larger than the typical lesions (up to 15mm). There are a large number of lesions. These lesions coalesce together and form nodules. HIV screening
In an adult with extensive lesions, this gives rise to the suspicion of underlying immunosuppressed state. Atypical lesions commonly seen in immunocompromised patients. Atypical lesions are larger than the typical lesions (up to 15mm). There are a large number of lesions. These lesions coalesce together and form nodules.

Management - Supportive

Fact Explanation
Avoid direct contact by avoiding contact sports such as swimming is also advised. Avoid sharing fomites such as sharing towels, razors, clothes, make up etc and disinfect them after use. Avoid contact with the lesions, keep them covered by using cloths, bandages or any possible way. Maintain good hand hygiene This virus transmits via contact. So avoiding contact with the skin lesions and with the contaminated objects are ways of avoiding infection. Auto inoculation is also seen. This causes the virus to spread to other parts of the body. Avoid direct contact by avoiding contact sports such as swimming is also advised. Avoid sharing fomites such as sharing towels, razors, clothes, make up etc and disinfect them after use. Avoid contact with the lesions, keep them covered by using cloths, bandages or any possible way. Maintain good hand hygiene
This virus transmits via contact. So avoiding contact with the skin lesions and with the contaminated objects are ways of avoiding infection. Auto inoculation is also seen. This causes the virus to spread to other parts of the body.
Safe sexual practices, maintain a monogamous sexual relationship with a known disease free person. This virus is known to transmit via sexual contact. Safe sexual practices, maintain a monogamous sexual relationship with a known disease free person.
This virus is known to transmit via sexual contact.
In immunocompetent this resolve spontaneously This is a self- limiting skin infection. It takes 6- 12 months to achieve a spontaneous recovery. In immunocompetent this resolve spontaneously
This is a self- limiting skin infection. It takes 6- 12 months to achieve a spontaneous recovery.

Management - Specific

Fact Explanation
Curettage - with or without light electrodissection. In this method the individual lesion is removed. As this is an invasive method anesthetic cream should be used prior to the curettage. Curettage provides reliable tissue samples for tissue diagnosis. Curettage - with or without light electrodissection.
In this method the individual lesion is removed. As this is an invasive method anesthetic cream should be used prior to the curettage. Curettage provides reliable tissue samples for tissue diagnosis.
Cantharidin- 0.9% sollution of collodion & acetone This is a blister inducing agent.
Cantharidin is carefully applied to the dome of the lesion and after 4 hours it should be washed off. As this can cause severe blistering first test on few lesions. Don't use on facial lesions. treatment should be repeated weekly till patient is free of lesions.
Cantharidin- 0.9% sollution of collodion & acetone
This is a blister inducing agent.
Cantharidin is carefully applied to the dome of the lesion and after 4 hours it should be washed off. As this can cause severe blistering first test on few lesions. Don't use on facial lesions. treatment should be repeated weekly till patient is free of lesions.
Cidofovir cream (3%) This is a nucleoside analog, has antiviral effects. This can be locally applied as a cream. Cidofovir cream (3%)
This is a nucleoside analog, has antiviral effects. This can be locally applied as a cream.
5% imiquimod cream Exact mechanism of action of imiquimod is not known. This activates immune cells via Toll like receptor 7(TLR7) which is situated in cell surface & helps to recognize pathogens. Secretes cytokines from immune cells (IFN alpha, IL 6, TNF alpha). Activates Langerhan cells which in turns activates the adaptive immune system. Also activates Natural killer cells, Macrophages & B Lymphocytes. Local application of imiquimod stimulate innate immune system & cell mediated immunity. It has an antiviral and antitumour activity. 5% imiquimod cream
Exact mechanism of action of imiquimod is not known. This activates immune cells via Toll like receptor 7(TLR7) which is situated in cell surface & helps to recognize pathogens. Secretes cytokines from immune cells (IFN alpha, IL 6, TNF alpha). Activates Langerhan cells which in turns activates the adaptive immune system. Also activates Natural killer cells, Macrophages & B Lymphocytes. Local application of imiquimod stimulate innate immune system & cell mediated immunity. It has an antiviral and antitumour activity.
Antibiotic- hydro cortisone ointment For secondarily infected excoriated lesions Antibiotic- hydro cortisone ointment
For secondarily infected excoriated lesions
Local application of potassium hydroxide- 10%- 15% This is a safe, effective way of treating Molluscum Contagiosum. It has less side effects, easy to use & also it is proven to decrease the number of dermatology referrals.
This is applied on all lesions twice daily using a cotton swab. If the patient gets a superficial ulcers or inflammatory response, stop the treatment.
Local application of potassium hydroxide- 10%- 15%
This is a safe, effective way of treating Molluscum Contagiosum. It has less side effects, easy to use & also it is proven to decrease the number of dermatology referrals.
This is applied on all lesions twice daily using a cotton swab. If the patient gets a superficial ulcers or inflammatory response, stop the treatment.
Pulsed dye laser This method of treatment is well tolerated, no residual scars or pigmentation is noted after the treatment. Pulsed dye laser
This method of treatment is well tolerated, no residual scars or pigmentation is noted after the treatment.

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