Molluscum contagiosum | |
---|---|
Other names | Water warts |
Typical flesh-colored, dome-shaped and pearly lesions | |
Specialty | Dermatology |
Symptoms | Small, raised, pink lesions with a dimple in the center [1] |
Usual onset | Children 1 to 10 years of age [2] |
Duration | Usually 6–12 months, may last up to four years [1] |
Types | MCV-1, MCV-2, MCV-3, MCV-4 [3] |
Causes | Molluscum contagiosum virus spread by direct contact or contaminated objects [4] |
Risk factors | Weak immune system, atopic dermatitis, crowded living conditions [2] |
Diagnostic method | Based on appearance [3] |
Differential diagnosis | Warts, herpes simplex, chickenpox, folliculitis [5] |
Prevention | Hand washing, not sharing personal items [6] |
Treatment | None, freezing, opening up the lesion and scraping the inside, laser therapy [7] |
Medication | Cimetidine, podophyllotoxin [7] |
Frequency | 122 million / 1.8% (2010) [8] |
Molluscum contagiosum (MC), sometimes called water warts, is a viral infection of the skin that results in small raised pink lesions with a dimple in the center. [1] They may become itchy or sore, and occur singularly or in groups. [1] Any area of the skin may be affected, with abdomen, legs, arms, neck, genital area, and face being the most common. [1] Onset of the lesions is around seven weeks after infection. [3] They usually go away within a year without scarring. [1]
The infection is caused by a poxvirus called the molluscum contagiosum virus (MCV). [1] The virus is spread either by direct contact, including sexual activity, or via contaminated objects such as towels. [4] The condition can also be spread to other areas of the body by the person themselves. [4] Risk factors include a weak immune system, atopic dermatitis, and crowded living conditions. [2] Following one infection, it is possible to get re-infected. [9] Diagnosis is typically based on the appearance of the lesions. [3]
Prevention includes hand washing and not sharing personal items. [6] While treatment is not necessary, some may wish to have the lesions removed for cosmetic reasons or to prevent spread. [7] Removal may occur with freezing, laser therapy, or opening up the lesion and scraping the inside. [7] Scraping the lesion can, however, result in scarring. [9] The oral medication cimetidine, or podophyllotoxin cream applied to the skin, may also be used for treatment. [7]
Approximately 122 million people globally were affected by molluscum contagiosum as of 2010 (1.8% of the population). [8] It is more common in children between the ages of one and ten years old. [2] The condition has become more common in the United States since 1966. [2] But having an infection is not a reason to keep a child out of school or daycare. [10]
Molluscum contagiosum lesions are flesh-colored, dome-shaped, and pearly in appearance. They are often 1–5 mm in diameter, with a dimpled center. [11] Molluscum lesions are most commonly found on the face, arms, legs, torso, and armpits in children. Adults typically have molluscum lesions in the genital region and this is considered to be a sexually transmitted infection; because of this, if genital lesions are found on a child, sexual abuse should be suspected. [3] These lesions are generally not painful, but they may itch or become irritated. Picking or scratching the bumps may lead to a spread of the viral infection responsible for molluscum contagiosum, an additional bacterial infection, and scarring. [3] [12] In some cases, eczema develops around the lesions. [13]
Individual molluscum lesions may go away on their own within two months and generally clear completely without treatment or scarring in six to twelve months. [3] Mean durations for an outbreak are variously reported from eight [14] to about 18 months, [15] [16] but durations are reported as widely as six months to five years, lasting longer in immunosuppressed individuals. [16]
As the name implies, molluscum contagiosum is extremely contagious. [3] Transmission of the molluscum contagiosum virus can occur many different ways including direct skin contact (e.g., contact sports or sexual activity), contact with an infected surface (fomite), or autoinoculation (self-infection) by scratching or picking molluscum lesions and then touching other parts of the skin not previously affected by the virus. [3] Children are particularly susceptible to autoinoculation and may have widespread clusters of lesions. [17]
The viral infection is limited to a localized area on the topmost layer of the superficial layer of the skin. [18] Once the virus-containing head of the lesion has been destroyed, the infection is gone. The central waxy core contains the virus.[ citation needed ]
Diagnosis is made on the appearance; the virus cannot routinely be cultured. The diagnosis can be confirmed by excisional biopsy.[ citation needed ]
Histologically, molluscum contagiosum is characterized by molluscum bodies (also known as Henderson-Patterson bodies) in the epidermis, above the stratum basale , which consist of cells with abundant large granular eosinophilic cytoplasmic inclusion bodies (accumulated virions) and a small nucleus that has been pushed to the periphery. [19] [20]
Because molluscum contagiosum usually resolves without treatment and treatment options can cause discomfort to children, initial recommendations are often to simply wait for the lesions to resolve on their own. [21] Of the treatments available, a meta-analysis of randomized controlled trials suggested that there is no difference between treatments in short term improvement, and no single treatment is significantly better than natural resolution of the condition. [22]
Bumps located in the genital area may be treated in an effort to prevent them from spreading. [16] When treatment has resulted in the elimination of all bumps, the infection has been effectively cured and will not reappear unless the person is reinfected. [23]
For mild cases, over-the-counter topical medication, such as potassium hydroxide may provide a modest benefit. There is limited evidence for other topical agents including salicylic acid, benzoyl peroxide, and tretinoin, but none of these agents are recommended above the others to shorten infection duration. [24]
Studies have found cantharidin to be an effective and safe treatment for removing molluscum contagiosum. [25] This medication is usually well tolerated though mild side effects such as pain or blistering are common. [25] There is no high-quality evidence for cimetidine. [26] However, oral cimetidine has been used as an alternative treatment for the pediatric population as it is generally well tolerated and less invasive. [27]
Imiquimod is a form of immunotherapy initially proposed as a treatment for molluscum based on promising results in small case series and clinical trials. [28] However, two large randomized controlled trials, specifically requested by the U.S. Food and Drug Administration under the Best Pharmaceuticals for Children Act both demonstrated that imiquimod cream applied three times per week was no more effective than placebo cream for treating molluscum after 18 weeks of treatment in a total of 702 children aged 2–12 years. [29] In 2007, results from those trials—which remain unpublished—were incorporated into FDA-approved prescribing information for imiquimod, which states: "Limitations of Use: Efficacy was not demonstrated for molluscum contagiosum in children aged 2–12." [29] [30] In 2007, the FDA also updated imiquimod's label concerning safety issues raised in the two large trials and an FDA-requested pharmacokinetic study (the latter of which was published). [29] The updated safety label reads as follows:
Surgical treatments include cryosurgery, in which liquid nitrogen is used to freeze and destroy lesions, as well as scraping them off with a curette. Application of liquid nitrogen may cause burning or stinging at the treated site, which may persist for a few minutes after the treatment. With liquid nitrogen, a blister may form at the treatment site, but it will slough off in two to four weeks. Cryosurgery and curette scraping can be painful procedures and can result in residual scarring. [32]
A 2014 systematic review of case reports and case series concluded that the limited available data suggest pulsed dye laser therapy is a safe and effective treatment for molluscum contagiosum and is generally well tolerated by children. [32] Side effects seen with pulsed dye laser therapy included mild temporary pain at the site of therapy, bruising (lasting up to 2–3 weeks), and temporary discoloration of the treated skin (as long as 1–6 months). [32] No cases of permanent scarring have been reported. [32] As of 2009, however, there is no evidence for genital lesions. [33]
Most cases of molluscum contagiosum will clear up naturally within two years (usually within nine months). So long as the skin growths are present, there is a possibility of transmitting the infection to another person. When the growths are gone, the possibility of spreading the infection is ended. [23]
Unlike herpesviruses, which can remain inactive in the body for months or years before reappearing, molluscum contagiosum does not remain in the body when the growths are gone from the skin and will not reappear on their own. [23]
As of 2010, approximately 122 million people were affected worldwide by molluscum contagiosum (1.8% of the population). [8]
Warts are non-cancerous viral growths usually occurring on the hands and feet but can also affect other locations, such as the genitals or face. One or many warts may appear. They are distinguished from cancerous tumors as they are caused by a viral infection, such as a human papillomavirus, rather than a cancerous growth.
Genital warts are a sexually transmitted infection caused by certain types of human papillomavirus (HPV). They may be flat or project out from the surface of the skin, and their color may vary; brownish, white, pale yellow, pinkish-red, or gray. There may be a few individual warts or several, either in a cluster or merged together to look cauliflower-shaped. They can be itchy and feel burning. Usually they cause few symptoms, but can occasionally be painful. Typically they appear one to eight months following exposure. Warts are the most easily recognized symptom of genital HPV infection.
Chancroid is a bacterial sexually transmitted infection characterized by painful sores on the genitalia. Chancroid is known to spread from one individual to another solely through sexual contact. However, there have been reports of accidental infection through the hand.
Granuloma inguinale is a bacterial disease caused by Klebsiella granulomatis characterized by genital ulcers. It is endemic in many less-developed regions. It is also known as donovanosis, granuloma genitoinguinale, granuloma inguinale tropicum, granuloma venereum, granuloma venereum genitoinguinale, lupoid form of groin ulceration, serpiginous ulceration of the groin, ulcerating granuloma of the pudendum, and ulcerating sclerosing granuloma. Oral manifestations are also notably seen. The lesions of oral cavity are usually secondary to active genital lesions.
Cryosurgery is the use of extreme cold in surgery to destroy abnormal or diseased tissue; thus, it is the surgical application of cryoablation. The term comes from the Greek words cryo (κρύο) and surgery meaning "hand work" or "handiwork". Cryosurgery has been historically used to treat a number of diseases and disorders, especially a variety of benign and malignant skin conditions.
A seborrheic keratosis is a non-cancerous (benign) skin tumour that originates from cells, namely keratinocytes, in the outer layer of the skin called the epidermis. Like liver spots, seborrheic keratoses are seen more often as people age.
Actinic keratosis (AK), sometimes called solar keratosis or senile keratosis, is a pre-cancerous area of thick, scaly, or crusty skin. Actinic keratosis is a disorder of epidermal keratinocytes that is induced by ultraviolet (UV) light exposure. These growths are more common in fair-skinned people and those who are frequently in the sun. They are believed to form when skin gets damaged by UV radiation from the sun or indoor tanning beds, usually over the course of decades. Given their pre-cancerous nature, if left untreated, they may turn into a type of skin cancer called squamous cell carcinoma. Untreated lesions have up to a 20% risk of progression to squamous cell carcinoma, so treatment by a dermatologist is recommended.
Lentigo maligna is where melanocyte cells have become malignant and grow continuously along the stratum basale of the skin, but have not invaded below the epidermis. Lentigo maligna is not the same as lentigo maligna melanoma, as detailed below. It typically progresses very slowly and can remain in a non-invasive form for years.
Fordyce spots are harmless and painless visible sebaceous glands typically appearing as white/yellow small bumps or spots on the inside of lips or cheeks, gums, or genitalia. They are common, and are present in around 80% of adults. Treatment is generally not required and attempts to remove them typically result in pain and scarring.
Imiquimod, sold under the brand name Aldara among others, is a medication that acts as an immune response modifier that is used to treat genital warts, superficial basal cell carcinoma, and actinic keratosis. Scientists at 3M's pharmaceuticals division discovered the drug and 3M obtained the first FDA approval in 1997. As of 2015, imiquimod is generic and is available worldwide under many brands.
Talaromycosis is a fungal infection that presents with painless skin lesions of the face and neck, as well as an associated fever, anaemia, and enlargement of the lymph glands and liver.
Molluscum contagiosum virus (MCV) is a species of DNA poxvirus that causes the human skin infection molluscum contagiosum. Molluscum contagiosum affects about 200,000 people a year, about 1% of all diagnosed skin diseases. Diagnosis is based on the size and shape of the skin lesions and can be confirmed with a biopsy, as the virus cannot be routinely cultured. Molluscum contagiosum virus is the only species in the genus Molluscipoxvirus. MCV is a member of the subfamily Chordopoxvirinae of family Poxviridae. Other commonly known viruses that reside in the subfamily Chordopoxvirinae are variola virus and monkeypox virus.
Clobetasone (INN) is a corticosteroid used in dermatology, for treating such skin inflammation as seen in eczema, psoriasis and other forms of dermatitis, and ophthalmology. Topical clobetasone butyrate has shown minimal suppression of the hypothalamic–pituitary–adrenal axis.
Actinic cheilitis is cheilitis caused by long term sunlight exposure. Essentially it is a burn, and a variant of actinic keratosis which occurs on the lip. It is a premalignant condition, as it can develop into squamous cell carcinoma.
Epidermodysplasia verruciformis (EV) is a skin condition characterised by warty skin lesions. It results from an abnormal susceptibility to HPV infection (HPV) and is associated with a high lifetime risk of squamous cell carcinomas in skin. It generally presents with scaly spots and small bumps particularly on the hands, feet, face and neck; typically beginning in childhood or in a young adult. The bumps tend to be flat, grow in number and then merge to form plaques. On the trunk, it typically appears like pityriasis versicolor; lesions there being slightly scaly and tan, brown, red or looking pale. On the elbows, it may appear like psoriasis. On the forehead, neck and trunk, the lesions may appear like seborrheic keratosis.
Herpes gladiatorum is one of the most infectious of herpes-caused diseases, and is transmissible by skin-to-skin contact. The disease was first described in the 1960s in the New England Journal of Medicine. It is caused by contagious infection with human herpes simplex virus type 1 (HSV-1), which more commonly causes oral herpes. Another strain, HSV-2 usually causes genital herpes, although the strains are very similar and either can cause herpes in any location.
A sexually transmitted infection (STI), also referred to as a sexually transmitted disease (STD) and the older term venereal disease (VD), is an infection that is spread by sexual activity, especially vaginal intercourse, anal sex, oral sex, or sometimes manual sex. STIs often do not initially cause symptoms, which results in a risk of passing the infection on to others. Symptoms and signs of STIs may include vaginal discharge, penile discharge, ulcers on or around the genitals, and pelvic pain. Some STIs can cause infertility.
Skin infections and wrestling is the role of skin infections in wrestling. This is an important topic in wrestling since breaks in the skin are easily invaded by bacteria or fungi and wrestling involves constant physical contact that can cause transmission of viral, bacterial, and fungal pathogens. These infections can also be spread through indirect contact, for example, from the skin flora of an infected individual to a wrestling mat, to another wrestler. According to the National Collegiate Athletic Association's (NCAA) Injury Surveillance System, ten percent of all time-loss injuries in wrestling are due to skin infections.
A cold sore is a type of herpes infection caused by the herpes simplex virus that affects primarily the lip. Symptoms typically include a burning pain followed by small blisters or sores. The first attack may also be accompanied by fever, sore throat, and enlarged lymph nodes. The rash usually heals within ten days, but the virus remains dormant in the trigeminal ganglion. The virus may periodically reactivate to create another outbreak of sores in the mouth or lip.
Eruptive vellus hair cysts are small lesions that occur most often in the chest wall, abdomen and extremities, often with a crusted surface. EVHC may occur randomly, or it can be inherited as an autosomal dominant trait; sporadic cases usually appear at 4–18 years of age. The cysts appear similar clinically to steatocystoma multiplex, as well as acneiform eruptions and milia. Histopathology is the basis of diagnosis. Retinoids, surgery, and lasers are used as treatment modalities.