the molluscum contagiosum
Molluscum contagiosum is a benign viral skin tumour. The causative agent is a member of the Poxvirus family.
1 - Molluscum contagiosum, a contagious infection
Occurring frequently in children between the ages of 2 and 10 years, molluscum contagiosum is contagious by direct contact, or by sharing soiled objects (towels, bath sponges, in particular in swimming pools, etc.). In adults, molluscum contagiosum can be sexually transmitted (by skin to skin contact). in this case, an examination to check for other stds should be conducted.
Lesion propagation is promoted by self-inoculation (e.g.: by scratching), or by shaving in adults. a warm and moist environment favours infections and their propagation.
The incubation ranges from 2 weeks to 6 months post-contact.I
2 - Clinical aspect
Molluscum contagiosum lesions are small, firm, hemispherical white or flesh-coloured papules ranging in diameter from 1 to 5 mm, with a dimple in their centre.
The central dimple, which when pressed leak a whitish substance corresponding to altered epidermal cells, is very characteristic.
They can be found either isolated or in clusters, on various parts of the skin.
They are most often found on the face, eyelids, neck, truck, arms (inside of elbow), buttocks, thighs, or on eczema plaques.
In adults, in the context of stds, they can be found on the pubis, genitalia, buttocks and on the inner thighs. contrary to condylomata, they rarely affect the mucosa.
The clinical aspect is generally highly characteristic, allowing their easy identification. only when faces with certain isolated, large, non-dimpled and highly inflammatory elements is histological analysis required.
3 - Differential diagnosis can be between :
During early stages of the disease, the micro-vesicles may resemble molluscum contagiosum papules, though these rapidly progress to crusty and pruritic lesions. moreover, there are a number of general signs.
Small flat papules found mainly on the face, neck, chest and on the back of the hands, non-dimpled.
Filiform viral skin lesions frequently found on the face (beard and eyelids)
Large number of small tumours, ranging from the size of a grain of millet to that of a large chickpea, found around the nose and mouth. these adenomas appear during late childhood; they are frequently familial.
Small excrescences of a few millimetres in size, similar in texture to skin warts. located on the skin and/or mucosa, they sometimes form only slight pink or brownish bumps.
Benign filiform or bell clapper-shaped skin lesion ending in verrucosities.
4 - Management of molluscum contagiosum
Spontaneous recovery occurring generally within 6 months to 2 years.
Physical and medicinal treatments
> 5% or 10% potassium hydroxide solutions have demonstrated their efficacy
Applied topically to each molluscum contagiosum lesion
the most common treatment is probably excision of the papules with a curette, though this procedure is somewhat painful. curettage involves the use of a small and extremely precise (in expert hands) sterile scalpel to remove only the infected skin.
Cryotherapy consists in burning the lesions with nitrogen, but this method is quite painful.
Electrocoagulation destroys the lesions by means of an electric current. this treatment may, however, leave unsightly scars. the dermatologist may also use laser photovolatilization.
Topical application of retinoid-based creams or corrosive substances may be recommended in rare cases.
5 - Tips for avoiding molluscum contagiosum proliferation
- Temporarily prevent contaminated children from bathing with others, from pool activities, or from practising contact sports.
- Avoid sharing bath towels with infected patients.
- Advise against scratching the papules as this promotes dissemination.
- Avoid sexual contact while carrying Molluscum contagiosum.
- Molluscum contagiosum can take from 2 to 3 months to develop, though the symptoms may appear in less than one week, or only after 6 months.
If in doubt, talk to your doctor.
6 - Frequently asked questions
a. Does molluscum contagiosum affect children only?
No, adults are also concerned by mc. in this case, infection is generally sexually transmitted.
b. Are there several modes of contagion?
> By direct contact :
- from a contaminated person to an uninfected person
- self-contagion (from one part of a person's body to the next).
> By indirect contact :
when using fabric items belonging to an infected person.
Contamination is by simple contact. moreover, as the disease incubation period is of several weeks and as the papules do not appear immediately, an infected person can contaminate others unawares.
c. Le Molluscum Contagiosum peut-il guérir spontanément ?
Oui, le molluscum a tendance à guérir spontanément en l'absence de traitement : l'excroissance devient rouge puis finit par se résorber. On pourrait donc envisager de ne rien faire, mais il est fortement conseillé de les traiter pour éviter leur contamination.
d. Est-ce une maladie fréquente ?
C’est une maladie assez fréquente qui touche 2 à 8 % de la population suivant les études et en croissance constante depuis 30 ans.
7 - Bibliography
- T. Jansen, R. Romiti – Evaluation of the efficacy and tolerability of 5% Potassium Hydroxide Solution in the treatment of Molluscum contagiosum in Childhood – Clinic of Dermatology – Sao Paulo – Brazil – Akt Dermatol – 2007.
- R. Romiti, M.D. – Treatment of Molluscum contagiosum with Potassium Hydroxide: A clinical Approach in 35 children – Departement of Dermatology – Sao Paulo – Brazil – Pediatric Dermatology – 1999