Molluscum

[too true]

Just had my 3 year old to a dermatologist on the weekend and turns out he's got molluscum - he's got the spots on his torso and left arm and has had them for a few months. He's started saying he'd really like to be rid of them, so I'm actively searching a way to help him out. And the let's just wait and let it run its course has worn well thin by now.

Doctor recommended a wart removal acid treatment, but I really can't face hurting him if I don't have to.

Read on the internet about using tea tree oil and lemon myrtle (not together of course). Anyone have experience with this? Or know someone who's had it? Or knows where I can get these oils in Bangkok?

He may also need an immune system boost to get it going. He's been a sick kid (despite almost 2 years of breastfeeding) most of his life and the doctors have also said that because he carries the thalessemia trait he might always take longer to get over viral infections.

Help my baby, please!

Cheers

TT

[sonicdragon]

Best of luck resolving this ! Is it salyclic acid that the doctor recommended ? If so then I wouldn't worry about it too much - it sounds much worse than it is - it's basically the same thing that teenagers put on their face to control acne.

As for the oils, a good friend is an experienced, qualified aromatherapist and she just told me that treating young children with essential oils should be done with extreme caution under the guidance of someone who knows what they are doing - she strongly advises against buying it yourself and applying it - for one thing, you can't be sure about the concentration or quality of the oils you buy in thailand. Apparently tea tree oil is a lot safer than lemon myrtle oil, though she doesn't know anything about your sons skin condition.

Edited October 8, 2007 by sonicdragon

[taxexile]

from dermatology online journal

Abstract

Molluscum contagiosum is a disease caused by a poxvirus of the Molluscipox virus genus that produces a benign self-limited papular eruption of multiple umbilicated cutaneous tumors. This common viral disease is confined to the skin and mucous membranes. Transmission requires direct contact with infected hosts or contaminated fomites. It is generally thought to infect humans exclusively, but there are a few isolated reports of Molluscum contagiosum occurring in chickens, sparrows, pigeons, chimpanzees, kangaroos, a dog, and a horse. The infection is found worldwide and has a higher incidence in children, sexually active adults, and those who are immunodeficent.

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Introduction

Molluscum contagiosum, a cutaneous and mucosal eruption caused by a Molluscipox virus, was first described and later assigned its name by Bateman in the beginning of the nineteenth century.[1] In 1841 Henderson and Paterson described the intracytoplasmic inclusion bodies now known as molluscum or Henderson-Paterson bodies.[2] In the early twentieth century, Juliusberg, Wile, and Kingery were able to extract filterable virus from lesions and show transmissibility.[3,4] Goodpasture later described the similarities of molluscum and vaccinia.[5] Though generally thought to infect only humans, case reports of the virus occurring in other animals have been published. [6,7,8,9]

Incidence

Molluscum contagiosum virus (MCV) can be found worldwide with a higher distribution in the tropical areas. The disease is more prevalent in children with the lesions involving the face, trunk, and extremities. In adults the lesions are most often found near the genital region. The disease is endemic with a higher incidence within institutions and communities where overcrowding, poor hygiene, and poverty potentiate its spread.[10] Over the last 30 years its incidence has been increasing, mainly as a sexually transmitted disease, and it is particularly rampant as a result of concurrent human immunodeficiency virus (HIV) infection.[11] The worldwide incidence is estimated to be between 2% and 8%.[12] Less then 5% of the children in the United States are believed to be infected. Between 5% and 20% of patients with HIV have symptomatic MCV.[13,14] There are four main subtypes of molluscum contagiosum: MCV I, MCV II, MCV III, and MCV IV.[15,16] All subtypes cause similar clinical lesions in genital and nongenital regions. Studies show MCV I to be more prevalent (75%–90%) than MCV II, MCV III, and MCV IV, except in immunocompromised individuals.[17,18] There are, however, regional variations in the predominance of a given subtype and differences between individual subtypes in different countries.[19]

Pathogenesis

This disease is transmitted primarily through direct skin contact with an infected individual. Fomites have been suggested as another source of infection, with molluscum contagiosum reportedly acquired from bath towels, tattoo instruments, and in beauty parlors and Turkish baths.[10] The average incubation time is between 2 and 7 weeks with a range extending out to 6 months. Infection with the virus causes hyperplasia and hypertrophy of the epidermis.[12] Free virus cores have been found in all layers of the epidermis. So-called viral factories are located in the malpighian and granular cell layers.[12] The molluscum bodies contain large numbers of maturing virions. These are contained intracellularly in a collagen-lipid-rich saclike structure that is thought to deter immunological recognition by the host.[20] Rupture and discharge of the infectious virus-packed cells occur in the center of the lesion. MCV induces a benign tumor instead of the usual necrotic pox lesion associated with other poxviruses.[21]

Clinical manifestations

MCV produces a papular eruption of multiple umbilicated lesions. The individual lesions are discrete, smooth, and dome shaped. They are generally skin colored with an opalescent character. The central depression or umbilication contains a white, waxy curdlike core. The size of the papule is variable, depending upon the stage of development, usually averaging 2–6 mm. Papules may exceed 1 cm in size in immunosuppressed hosts. The papules may become inflamed spontaneously or after trauma and present atypically in size, shape, and color. The lesions are often grouped in small areas but may also become widely disseminated.

Any cutaneous surface may be involved, but favored sites include the axillae, the antecubital and popliteal fossae, and the crural folds. Rarely, MCV lesions occur in the mouth or conjunctivae.[22,23,24] Autoinoculation is common. Children usually acquire molluscum nonsexually at both genital and nongenital areas. MCV in adults affects the groin, genital area, thighs, and lower abdomen and is often acquired sexually. Around 10% of cases develop an eczematous dermatitis around the lesions, but this disappears as the infection resolves.[25] Patients with atopic dermatitis can have a disseminated eruption. Eruptions in immunocompromised indiviuals are very resistant to treatment.[13,26]

Dermatopathology

Histologically, molluscum contagiosum exhibits intraepidermal lobules with central cellular and viral debris. In the basal layer, enlarged basophilic nuclei and mitotic figures are seen. Progressing upward, the cells show cytoplasmic vacuolization and then eosinophilic globules. The nucleus becomes compressed at the level of the granular cell layer, and the molluscum bodies lose their internal structural markings. Undisrupted lesions show an absence of inflammation, but dermal changes can include an infiltrate that is lymphohistiocytic, neutrophilic, or granulomatous. The latter has been seen in solitary lesions. Antibody to MCV by indirect immunofluorescence has been found in 69% of patients with visible lesions.[27] Polymerase chain reaction can detect MCV in skin lesions.[28] Currently, there is no in-vitro or animal model for MCV. MCV can undergo an abortive infection in some cell lines, which can cause confusion with herpes simplex virus by laboratories.[29] Two sets of investigators have infected human skin with molluscum contagiosum and grafted it onto athymic mice, although there was no continued viral replication.[30,31]

Diagnosis

The clinical appearance of molluscum contagiosum is in most cases diagnostic. Though molluscum cannot be cultured in the laboratory, histological examination of a curetted or biopsied lesion can also aid in the diagnosis in cases that are not clinically obvious. The thick white central core can be expressed and smeared on a slide and left unstained or stained with Geimsa, Gram, Wright, or Papanicolaou stains to demononstrate the large brick-shaped inclusion bodies. Electron microscopy has also been used to demonstrate the poxivirus structures. Immunohistochemical methods using a polyclonal antibody allows recognition of molluscum contagiosum in fixed tissue.[32] In-situ hybridization for MCV DNA has also been utilized.[33] Molluscum contagiosum lesions must be differentiated from verruca vulgaris, condyloma accuminata, varicella, herpes simplex, papillomas, epitheliomas, pyoderma, cutaneuos cyptococcosis, epidermal inclusion cyst, basal cell carcinoma, papular granuloma annulare, keratoacanthoma, lichen planus, and syringoma or other adenexal tumors.

Treatment

Molluscum cantagiosum is a self-limited disease, which, left untreated, will eventually resolve in immunocompetent hosts but may be protracted in atopic and immunocompromised individuals. Some patients pick and scratch at the lesions, a habit that may lead to scarring. In addition, some schools and daycare centers will not admit children with visible molluscum papules. When patients seek medical attention and desire to rid themselves of the papules, there are several means of therapeutic destruction to help speed resolution. The decision whether treatment is necessary depends on the needs of the patient, the recalcitrance of their disease, and the likelihood of treatments to leave pigmentary alteration or scarring. Most of the common treatments consist of various means to traumatize the lesions. Antiviral and immune-modulating treatments have recently been added to the options. The following is a brief summary of some of the more common treatments.

Cryosurgery

One of the most common, quick, efficient methods of treatment is cryotherapy. Liquid nitrogen, dry ice, or Frigiderm are applied to each individual lesion for a few seconds. Repeat treatments in 2–3-week intervals may be required.[34] Hyper- or hypopigmentation and scarring may be caused by this treatment.

Evisceration

An easy method to remove the lesions is eviscerating the core with an instrument such as a scalpel, sharp tooth pick, edge of a glass slide, or any other instrument capable of removing the umbilicated core. Because of its simplicity, patients, parents, and caregivers may be taught this method so new lesions can be treated at home.[35,36] This method is simple but may not be tolerated by small children.

Curettage

Curettage is another method of removal. It can be used with and without light electrodessication. This method is more painful, and it is recommended that a topical anesthetic cream be applied to the lesions before the procedure to decrease the pain. This method has the advantage of providing a reliable tissue sample to confirm the diagnosis.[35,37]

Tape stripping

Another reported treatment involves the use of adhesive tape. The adhesive side of the tape is repeatedly applied to and removed from the lesion for 10–20 cycles. This action effectively removes the superficial epidermis from the top of the lesion.[38] However, repeated use of the same strip has the potential to spread the virus to adjacent, uninvolved skin.

Podophyllin and podofilox

A 25% suspension in a tincture of benzoin or alcohol may be applied once a week. This treatment requires some precautions. It contains two mutagens, quercetin and kaempherol. Some of the listed side effects include severe erosive damage in adjacent normal skin that may cause scarring and systemic effects such as peripheral neuropathy, renal damage, adynamic illeus, leucopenia, and thrombocytopenia, especially if used generously on mucosal surfaces. Podofilox is a safer alternative to podophyllin and may be used by the patient at home. The recommended use usually consists of application of 0.05 ml of 5% podofilox in lactate buffered ethanol twice a day for 3 days.[35,38] The active agent is absolutely contraindicated in pregnancy.

Cantharidin

Cantharidin (0.9% solution of collodian and acetone) has been used with success in the treatment of MCV. This blister-inducing agent is applied carefully and sparingly to the dome of the lesion with or without occlusion and left in place for at least 4 hours before being washed off. Cantharidin can cause severe blistering. It should be tested on individual lesions before treating large numbers of lesions. It should not be used on the face. When tolerated, this treatment is repeated every week until the lesions clear. Usually 1–3 treatments are necessary.[39]

Iodine solution and salicylic acid plaster

A 10% iodine solution is placed on the molluscum papules and, when dry, the site is covered with small pieces of 50% salicylic acid plaster and tape. The process is repeated daily after bathing. After the lesions have become erythematous in 3–7 days, only the iodine solution is applied. Resolution has been reported in a mean of 26 days.[40] Maceration and erosion can result.

Tretinoin

Tretinion 0.1% cream has been used in the treatment of MCV. It is applied twice daily to the lesions. Resolution was reported by day 11. Trace erythema at the site of prior lesions was a noted side effect.[41] Tretinion 0.05% cream has also been used with success and decreased irritation.[35]

Cimetdine

Oral cimetidine has successfully been used in extensive infections.[42] The histamine 2-receptor antagonist stimulates delayed-type hypersensivity. One uncontrolled study showed resolution in 9 of 13 patients. In this study, the dosage was 40 mg/kg/day in two divided doses for 2 months.[43] The authors recommended further placebo-controlled, double-blind studies be completed to determine the efficacy of cimetidine in treating MCV. Because cimetadine interacts with many systemic medications, a review of the patient's other medications is recommended.

Potassium hydroxide

Another treatment option is the use of potassium hydroxide. In one study, an aqueous solution of 10% KOH was applied topically twice daily to all lesions with a swab. The treatment was discontinued when an inflammatory response or superficial ulcer became evident. Resolution occurred in a mean of 30 days.[44] This treatment had some complications including hypertrophic scar formation and persistent or transitory hyper- and hypopigmentation. A subsequent study in pediatric patients recommended the use of 5% KOH and found it equally effective with many fewer side effects.[45]

Pulsed dye laser

The use of pulsed dye laser for the treatment of MC has also been documented with excellent results. The therapy was well tolerated, without scars or pigment anomalies. The lesions resolved without scarring at 2 weeks. Studies show 96%–99% of the lesions resolved with one treatment.[46,47] The pulsed dye laser is quick and efficient, but its expense makes it less cost effective than other options.

Imiquimod

Imiquimod 5% cream has been used topically to treat MCV by inducing high levels of IFN-α and other cytokines locally.[48,49] This potent immunomodulatory agent is well tolerated, although application site irritation is common. It has had no known systemic or toxic effects in children.[50] It is applied to the area nightly for 4 weeks. Clearing can take up to 3 months.

Cidofovir

Cidofovir is a nucleoside analog that has potent antiviral properties. Several small studies and case reports describe the successful use of cidofovir applied topically or administered by intralesional injection in several virally induced cutaneous diseases.[51] Cidofovir cream 3% has been used successfully to treat MCV in studies, with clearing in 2–6 weeks.[52] Its high cost, need for extemporaneous preparation, and carcinogenicity in some studies have limited its use.[51]

Conclusion

Molluscum Contagiosum is a common, generally benign, viral infection of the skin. It is common in children, sexually active adults, and immunodeficient patients. It is caused by the molluscipox virus, a member of the poxviridae family. This virus differs from other poxviruses in that it causes spontaneously regressing, umbilicated tumors of the skin rather than poxlike vesicular lesions. In immunocompetent, nonatopic patients molluscum contagiosum is usually a self-limited disease for which treatment is not mandatory. However, when treatment is deemed appropriate, multiple local therapeutic options are available. For patients with impaired immune functions with widespread and potentially disfiguring eruptions, the usual local destructive therapies are ineffective; antiviral and immunomodulatory medications have been more successful.

References

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2. Brown ST, Nalley JF, Kraus SJ. Molluscum contagiosum Sex Transm Dis 1981;8:227-234.

3. Juliusberg M. Zur Kenntnis des virus des Molluscum contagiosum. Dtsch Med Wochenschr 1905;31:1598-1599.

4. Wile and Kingery, J Cutan Dis., 1917 XXVII, p.431.

5. Bretz S. Molluscum Contagiosum. Emedicine Juournal April 25,2001;2(4).

6. Pusey WA. Moluscum contagiosum In: The Principals and Practice of Dermatology, 4th ed. Appleton, 1924, pp 989-990.

7. Douglas JD, Tanner KN, Prine JR, Van Riper DC, Derwelis SK. Molluscum contagiosum in chimpanzees. J Am Vet Med Assoc 1967;151:901-904.

8. Dangall BG, Witson GR: Molluscum contagiosum in a red kangaroo. Australas J Dermatol 1974;15:115.

9. IB Van Resburg, MG Collett, N Ronen, T Gerdes. Molluscum contagiosum in a horse. J S Afr Vet Assoc 1991;62:72-74.

10. Postlethwaite R. Molluscum contagiosum: A review. Arch Environ Health 1970; 21: 432-452.

11. Becker TM, Blout JH, Douglas J, Judson FM. Trends in molluscum cantagiosum in the United States, 1966-1983. Sex Transm Dis 1986;13:88-92.

12. Billstein SA. Mattaliano VJ Jr. The "nuisance" sexually transmitted diseases: Molluscum contagiosum, scabies, and crab lice. Med Clin North Am 1990; 74: 1487-1505.

13. Schwartz JJ. Myskowski PL: Molluscum contagiosum in patients with human immunodefificiency virus infection. J Am Acad Dermatol 1992;27:583.

14. Lombardo PC. Molluscum contagiosum and the acquired immunodeficiency syndrome. Arch Dermatol 1985; 121: 834-835.

15. Scholz J, Rosen-Wolff A, Burgert K et al. Epidemiology of molluscum contagiosum using genetic analysis of the viral DNA. J Med Virol 1989; 27: 87-90.

16. Porter CD, Archard LC: Characterization by restriction mapping of three subtypes of molluscum contagiosum virus. J Med Virol 1992;38:1.

17. Gottlieb SL, Myskowki PL. Molluscum contagiosum. Int J Dermatol 33: 453-461,1994.

18. Yamashita H, Uemura T, Kawashima M. Molecular epidemiologic analysis of Japanese patients with molluscum contagiosum. Int J Dermatol 1996;35:99-105.

19. Nakamura J, Muraki Y, Yamada M, Hatano Y, Nii S. J Med Virol 1995;46(4):339-48.

20. Burgert JJ, Darai G. Recent advances in molluscum contagiosum virus research. Arch Virol Suppl 1997;13:35-47.

21. Diven DG, An overview of poxviruses, J AM Acad Dermatol 2001;44:1-14.

22. Whitaker SB, Wiefand SE, Budnick SD. Inraoral molluscum contagiosum. Oral Surg Oral Med Oral Pathol. 1991;72: 334-336.

23. Ingraham HJ, Schoenleber DB. Epibulbar molluscum contagiousm. Am J ophthalmol 1998;125:394-396.

24. Vannas S, Lapinleimu K. Molluscum contagiosum of the skin, caruncle, and conjunctiva. Acta Ophthalmol 1967;45:314-321.

25. De Oreo GA, Johnson HH, Binkley GW. An eczematous reaction associated with molluscum contagiosum. Arch Dermatol 1956; 74: 344-8.

26. Cotton DW, Cooper C, Barrett DF, Leppard BJ. Severe atypical molluscum contagiosum infection in an immunocommpromised host. Br J Dermatol 1987;116:871-876.

27. Shirodaria PV, Mattews RS. Observations on the antibody responses in molluscum contagiosum. Br J Dermatol 1997;96:29-34.

28. Thompson CH. Identification and typing of molluscum contagiosum virus in clinical specimens by polymerase chain reaction. J Med Virol 1997;53:205-211.

29. Hovenden JL, Bushhell TE. Molluscum contagiosum: possible culture misdiagnosis as herpes simplex[letter]. Genitourin Med 1991;67:270.

30. Fife KH, Whitfield M, Faust H, Goheen MP, Bryan J, Brown DR. Growth of molluscum contagiosum virus in a human foreskin xenograft model. Virology 1996;226:95-101.

31. Buller RM, Burnett J Chen W, Kreider J. Replication of molluscum contagiosum virus. Virology 1995;213:655-659.

32. Penneys NJ, Matsuo S, Mogollon R. The identification of molluscum infection of immunohistochemical means. J Cutan Pathol 1986;13:97-101.

33. Thompson CH, Biggs IM, DeZwart-Steffe RT. Detection of molluscum contagiosum virus DNA by in-situ hybridization. Pathology 1990;22:181-186.

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35. Valentine CL, Diven DG, Treatment modalities for molluscum contagiosum. Dermatologic Therapy 2000;13: 285-289.

36. Epstein WL. Molluscum contagiosum. Semin Dermatol 1992;11: 184-189.

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38. Arndt KA. Manualof dermatologic therapeutics, 5th ed. Boston: Little Brown, 339-340, 1995.

39. Silverburg NB, Sidbury R, Mancini AJ. Childhood molluscum contagiosum: Experience with cantharidin therapy in 300 patients. J Am Acad Dermatol 2000;43: 503-507.

40. Ohkuma M. Molluscum contagiosum treated with iodine solution and salicylic acid plaster. Int J Dermatol 1990;29:443-445.

41. Papa CM, Berger RS. Venereal herpes-like molluscum contagiosum: treatment with tretinoin. Curis 1976;18:537-540.

42. Avella J, Binder H, Madsen J, Ashkenase P. Effect of histamine H2 receptor antagonists on delayed hypersensitivity. Lancet 1978:1:624-626.

43. Dohil M, Prendiville JS. Treatment of Molluscum contagiosum with oral cimetidine: clinical experience on 13 patients. Pediatric Dermatol 13:310-312.

44. Romiti R, Ribeiro AP, Grinblat BM. Treatment of molluscum contagiosum with potassium hydroxide: A clinical approach in 35 children. Pediatr Dermatol 1999;16: 228-231.

45. Romiti R, Ribeiro AP, Romiti N. Evaluation of the effectiveness of 5% potassium hydroxide for the treatment of molluscum contagiosum. Pediatr Dermatol 2000;17(6):495.

46. Hammes S, Greve B, Raulin C. [Molluscum contagiosum: treatment with pulsed dye laser] Hautarzt 2001;52;38-42.

47. Hughes PS. Treatment of molluscum contagiosem with the 585-nm pulsed dye laser. Dermatol Surg 1998;24: 229-230.

48. Hengge UR, Esser S, Schultewolter T, Behrendt C, Meyer T, Stockfleth E. Goos M. Self administered topical 5% imiquimod for the treatment of common warts and molluscum contagiosum. British Journal of Dermatology 2000;143: 1026-1031.

49. Tyring SK, Arany I, Stanley MA et al. A randomized, controlled, molecular study of condylomata acuminate clearance during treatment with imiquimod. J Infec Dis 1998;178:551-5.

50. Barba Ar, Kapoor S, Berman B. An open label safety study of topical imiquimod 5% cream in the treatment of Molluscum contagiosum in children. Dermatol Online J 2001; Vol 7(1), 20.

51. Zabawski EJ Jr. A review of topical and intralesional cidofovir. Dermatology Online J 2000;6(1):3

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© 2003 Dermatology Online Journal

[bina]

my daughter has them; they come and go ( my daughters immune system is not very good); we were given some kind of laquer stuff to put on and it worked (doesnt hurt) but they do go away by themselves eventually... they are very contagious among kids and kibbutz kids are always together running in herds going to the swimming pool, camping, hanging out, sleep overs, etc so it tends to go thru same age groups, same as the darn lice...

dont worry to much

bina

[too true]

I know they're not serious and they'll go away, but they're just so nasty (the shallow me coming out here). And I've been reading on an internet forum for parents of kids who have them, and some of them take up to a year and a half to go away.

Neither his brother nor any of the kids in his class at school have caught them, thank God. But I fear that if they spread to his face I may be asked to take him out of school or something.

Is there anything I can give him to boost his immune system?

Bina, what was the lacquer stuff, do you know?

Cheers,

TT

[Sheryl]

The treatment your doctor is suggesting will not be painful.

The lesions don't always go away by themselves, especially if the immune system is weak.

[bina]

cant remember as we got it from our clinic, but i think we tossed it out... my daughter had them about a year or so and they did eventually go away; it isnt on the list of things that our kids get that require isolation ... they were on her arms which is where most of the kids i saw had them (arms back legs)...

try the stuff u got and see what happens...

my child seems to still get any kind of skin infection that is possible, simple scratches with her get infected quickly but she is improving with age and for a while we used polidine soap for washing her cuts etc. now we use lavender oil we get from the clinic.

bina

[too true]

Haven't tried any medicine on him yet. BUT, and I don't know if this is okay to do, last night I was looking at one that seemed to be getting bigger and had that hard white head in the middle, and I yanked it off. He didn't cry or flinch or anything. It bled a lot and he was able to keep tissue on it. And then he pointed to another big one and let me rip that one off, too. This morning they're still a bit red, but they've shrunk so that they just look like little red dots.

My colleague gave me some tea tree oil from Australia that has directions for using with children and says to use for cuts, abrasions or insect bites. Thought I might put that on them tonight and see if it helps them heal.

I was very careful to wash my hands straight away each time I touched the nasty white part.

Have you ever noticed that loads of Thai kids are covered with strange round scars on their bodies and legs? I always thought they were scars from mosquito bites, but I suppose they could be scars from molluscum, couldn't they? My husband says that loads of kids get the spots in his village and their parents just sterilize a needle and poke them and squeeze the junk out. Or they sterilize a blade and cut the top off. Sounds kind of scary.

Thanks a lot guys.

Cheers,

TT

[Soboringtochooseaname]

Hello,,

Did it work when you did it by yourself (open it)

And doctors car freeze it with nitrogen at hospital, do you know how much it costs ?

Thanks a lot.

[RandomSand]

I had these Molluscum contagiosum, on my abdomen, visual confirmation in a European STD clinic by a specialist.

The nurse told me to cover my fingers with clean tissue and literally rip them off.

I did just that. Problem solved.

Maybe this might help someone instead of doctors getting rich selling snake oil.

Edit;

1. Helps if you have fingernails... If not, either grow some or get another person to pick 'em off.

2. After removal... make sure to scrub your fingers and nails clean and apply anti-bacterial solution where the Molluscum were.

Edited November 1, 2012 by RandomSand