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Wednesday, June 27, 2012

What Is Molluscum Contagiosum? What Causes Molluscum Contagiosum?

Molluscum contagiosum is a contagious skin infection caused by the molluscum contagiosum virus (MCV) that causes raised, pearl-like nodules or papules on the skin - these growths are called molluscum bodies, mollusca or condyloma subcutaneum. The virus belongs to the family called the Poxviridae. The molluscum contagiosum virus is also known as the molluscipoxvirus.

MCV does not infect animals; only humans.

Molluscum contagiosum is more commonly seen in children under the age of 15 years, about 80% of reported cases - children aged between 1 and 4 years are affected the most. When it appears in teenagers or adults it is frequently transmitted sexually, and therefore may be considered an STD (sexually transmitted disease).

Molluscum contagiosum can spread via close, direct contact with an infected individual - most commonly through skin-to-skin contact, including sexual contact or touching or scratching the bumps and then touching the skin - and also by touching contaminated objects, such as flannels or towels.

Adults with altered immune systems are more susceptible to becoming infected. Some health care professionals say that MCV infection is more common among patients with eczema; however, there is little medical evidence to support this.

In most cases molluscum contagiosum clears up on its own - however, it may take a long time to clear completely. The papules are generally painless and usually disappear within a year without treatment. Most doctors recommend medical treatment, especially for adults, because MCV can spread easily.

In some cases, if the papules are scratched or rubbed an infection may spread to the surrounding skin.

According to health authorities in the USA and UK, molluscum contagiosum is a common infection. As a significant number of infected people never seek medical advice, it is not possible to accurately know how many are affected annually.

As most humans have a natural resistance to MCV, health authorities do not generally advise parents to keep infected children away from school.

There are 4 types of MCV:
  • MCV-1 (the most prevalent)
  • MCV-2 (most commonly seen in adults, often sexually transmitted)
  • MCV-3
  • MCV-4
Molluscum contagiosum can affect any area of skin. The most commonly affected areas are the trunk of the body, arms, and legs. The virus can spread from one part of the body to another. This viral disease is contagious until the bumps are gone.

According to Medilexicon's medical dictionary, Molluscum contagiosum virus is "The poxvirus causing molluscum contagiosum of humans."

What are the signs and symptoms of Molluscum contagiosum?

A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign.

In the vast majority of cases symptoms only appear on the skin. After initial infection it can take from seven days to six months for symptoms to appear.

Small, firm, flesh-colored, dome-shaped, pearly, wart-like spots or papules appear on the skin. They are typically 1-5 millimeters in diameter, with a dimpled center. They are called mollusca and usually develop on any part of the skin that is not usually covered, such as the:
  • Arms
  • Face
  • Hands
  • Neck
  • Sometimes the chest and stomach may be affected.
When transmitted sexually mollusca generally appear on the individual's genitalia, groin, lower abdomen and inner thighs.

The mollusca usually develop in small clusters. Eventually they can spread to any part of the body. Some of them have a small white dot with pus. When it ruptures a thick-white fluid is released. In some cases the dimpled section may bleed once or twice.

The infection is limited to a localized area on the topmost layer of the epidermis.

Although most patients have no more that about 20 mollusca, some people may develop over 100 of them. The National Health Service (NHS), UK, advises patients with many mollusca, or if they are more than 5mm across to see their doctor. In such cases it is likely the individual's immune system is faulty.

After about 6 to 12 weeks the mollusca will crust over and then heal. Often a tiny patch of lighter skin or a pitted mark may remain, but there will not usually be any scars.

New mollusca may form in other parts of the body as old ones crust over and heal, extending the duration of molluscum contagiosum, sometimes to over a year. In some rare cases the condition may persist for years. In a process called autoinoculation, the virus can spread to neighboring skin areas. Children are particularly at risk of autoinoculation, and may have extensive clusters of lesions.

Experts say that recurrence of molluscum contagiosum is highly unlikely once it has gone completely.

There is not usually any itching or pain.

Eczema - in approximately 10% of cases eczema can develop around the mollusca, where it may itch, swell, and sometimes cause pain.

Infection - a mollusca can become infected with bacteria, causing itching. This is usually caused by picking or scratching the bumps.

Molluscum contagiosum does not have serious complications and is not linked to genital warts, which are caused by HPV (human papillomavirus). Adults with genital mollusca should be screened for other sexually transmitted diseases.

What are the risk factors for molluscum contagiosum?

A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2.

If a person has a weakened immune system he/she has a higher risk of developing more severe lesions. Examples include patients receiving chemotherapy, or people with HIV/AIDS.

Individuals who take part in activities which put them in contact with infected individuals or contaminated objects have a higher risk of developing molluscum contagiosum.

What are the causes of molluscum contagiosum?

Molluscum contagiosum is an infection of the MCV (molluscum contagiosum virus), a member of the poxvirus family. The infection spreads easily via:
  • Skin-to-skin contact
  • Skin contact with contaminated objects, such as towels, flannels, clothes, doorknobs and faucet handles (UK: water taps)
  • Sexual contact with an infected person
Rubbing or scratching the papules can cause spreading to nearby skin. Shaving may also cause the infection to spread to other parts of the body.

Molluscum contagiosum is highly infectious, it can be transmitted easily among children at school and nurseries (playschools, day centers), where children are in close physical contact and share toys. People are contagious until the last spot completely heals.

The majority of people have a natural resistance to MCV and do not develop molluscum contagiosum, even if they come into contact with it.

Diagnosing molluscum contagiosum

Diagnosis is usually made if the doctor detects the pearly or flesh-colored bumps (mollusca) on the skin. The virus cannot routinely be cultured. Any part of the body can be affected, except for the palm of the hands or soles of the feet. Diagnosis by visible signs and symptoms is usually straightforward.

Excisional biopsy - if the doctor is not sure, or if one spot that looks different from the rest, he/she may take skin scrapings from the infected area and examine them under a microscope.

Fluid sample - the doctor may take a sample of fluid from the center of the mollusca and have it tested for MCV.

Genitals - if the patient has molluscum contagiosum in their genitals the doctor may refer them to a genitor-urinary medicine clinic to be tested for other STDs (sexually transmitted diseases).

Referral to a specialist - if the patient's eyelid or eye is red, if they are HIV positive and their mollusca are severe, or if their immune system is faulty the doctor may refer them to a specialist.

What are the treatment options for molluscum contagiosum?

In the majority of cases, molluscum contagiosum heals completely without treatment within 6 to 12 months, and occasionally longer. If a child's immune system is not fully developed the infection may persist for longer. Adults with weakened immune systems may also experience longer periods of infection.

Most doctors recommend treatment because molluscum contagiosum spreads easily and rapidly, especially for adults. This may include the removal or bursting of the papules by:
  • Squeezing the mollusca - this is usually the first type of treatment. The aim is to remove the pus-like core at the center of each mollusca. This may be done by a doctor, nurse or the patient himself/herself. A health care professional typically uses a small pair of forceps or tweezers. Patients may prefer to use their fingers.

    Squeezing your or your child's mollusca after a bath is easier, as the skin is softer then. It is important to wash your hands before and afterwards. Disposable gloves should be worn. The gloves and the contents of the mollusca (which contain the virus) should be disposed of carefully. If tweezers are used they should be thoroughly sterilized afterwards, either with an antiseptic solution or boiling water.

    Doctors advise squeezing a small number at a time, as the process may be painful. As soon as the contents of a mollusca have been removed they will probably heal in one to four weeks.
  • Curettage - the papule is scraped away using a curet (or curette); a spoon-shaped instrument with a sharp edge. The patient may be given a local anesthetic beforehand.
  • Cryotherapy - the papule is frozen with pressurized liquid spray, usually liquid nitrogen or nitrous oxide, and then re-thawed. Cryotherapy literally means "cold therapy". Each lesion is frozen for up to ten seconds, or until a layer of ice forms over the spot and surrounding skin. Sometimes several sessions are needed.
  • Diathermy - a heated electrical device burns off the mollusca. The patient is given a local anesthetic beforehand.
  • Laser therapy - intense, narrow beams of light are used.
  • Chemical treatment - the doctor dips a sharp metal instrument into either podophyllin or phenol and then pricks each mollusca, which eventually burst and empty out their contents. This treatment may cause scarring and is said to be particularly uncomfortable.
Associated dermatitis or eczema treatment - in rare cases of molluscum contagiosum the patient may develop dermatitis or eczema around the papules. The doctor may recommend OTC (over-the-counter, no prescription required) 1% hydrocortisone creams or ointments for itching caused by dermatitis. Sometimes a prescription topical steroid may be used. It is important to apply these medications to the areas of dermatitis and not to the papules.

Treatment for patients with weakened immune systems - this will be carried out by a specialist. Treatment will depend on several factors; including how progressive and extensive the molluscum contagiosum is, as well as what is causing the patient's weakened immune system.

Once the growths are gone, the virus is gone and cannot spread to other parts of the body. Molluscum contagiosum is not like the herpes virus, which can stay dormant in the body for long periods and then reappear. Therefore, when all the bumps have been eliminated the infection has been effectively cured and will not reappear unless the individual is reinfected.

Sometimes it may not be easy to see all the mollusca. Even though they may appear to be gone, there is a chance that some were overlooked. In such cases the patient might develop new bumps by autoinoculation, despite their apparent absence.

What are the possible complications for molluscum contagiosum?

Molluscum contagiosum rarely results in complications. If they do occur, they tend to be with patients who have weakened immune systems, including:
  • Patients who are HIV positive
  • Individuals who are receiving chemotherapy
  • People who are taking immunosuppressant medications
Infection - sometimes the mollusca may become infected with bacteria, especially if the patient has atopic eczema or a weakened immune system. In such cases the doctor will usually prescribe an antibiotic.

Eczema - patients with eczema may need treatment for itching. Scratching increases the risk of infection, spreading, as well as slowing down the healing process.

Scarring - small patches or paler skin or very small indented scars may be left behind after the infection has gone. If the mollusca became infected there may be scars later on. Some treatments may also cause scarring. Scarring is more likely in areas of skin with more fatty tissue, such as the thighs.

Eye complications - if molluscum contagiosum occurs around the eyes, the patient may develop conjunctivitis or keratitis:
  • Conjunctivitis - there is a thin layer of cells (membrane) between the inner surface of the eyelids and the whites of the eyes, called the conjunctiva. Conjunctivitis is when the conjunctiva becomes inflamed. Another name for conjunctivitis is pink eye. Inflammation causes tiny blood vessels (capillaries) in the conjunctiva to become more prominent, giving the eye a red or pink look. The eyes become red, swollen and watery. A sticky coating may develop on the eyelashes - this is most noticeable and annoying when waking up after a long sleep. Sometimes the eyelids are stuck together, as if by glue. The sticky coating is pus which is produced by the infection. Sometimes the coating can harden into a kind of crust.
  • Keratitis - inflammation of the cornea (the clear front window of the eye that transmits and focuses light into the eye). The eyes may be sensitive to light, painful, and vision may be blurred.
Patients with molluscum contagiosum who develop such eye complications will be referred to an eye specialist (ophthalmologist).

Prevention of molluscum contagiosum

The following steps may help stem the spread of MCV:
  • Good hand hygiene - wash your hands regularly and thoroughly, especially if there is somebody in the house who is infected.
  • Touching mollusca - do not touch, scratch or rub the papules. If you do touch them, wash your hands straight away with warm water and soap.
  • Shaving - do not shave over affected areas of skin; this can encourage the infection to spread.
  • Personal items - if somebody in the household is infected, do not share clothing, towels, flannels, combs, hairbrushes and other personal items.
  • Sexual contact - refrain from sexual contact until the mollusca have cleared up completely. Condoms do not provide total protection from MCV spread. The virus can be passed from and to areas of skin that are not covered by a condom.
  • Cover the mollusca - if there is a risk of other people having skin-to-skin contact. Where possible, keep affected areas of skin covered with clothing.
  • Swimming pools - experts are not sure whether MCV can spread in swimming pool chlorinated water. Most likely, infection that occurs in swimming facilities is transmitted through items that are touched outside the pool, such as towels and diving boards. Papules should be covered with watertight bandages before swimming.
  • Contact sports - infected people should avoid playing contact sports, such as judo, wrestling, or rugby.

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