Question

Definition Of Molluscum Contagiosum!

Dr.Radhika A (Md) · Accepted Answer

Definition of Molluscum contagiosum:
Molluscum contagiosum is the infection of the skin caused by the Molluscum contagiosum virus, which belongs to the same family as the pox. It is a common infection but is contagious. It causes raised nodules on the epidermal layer of the skin. This condition is also commonly known as the molluscipoxvirus. It is classified as a chronic infection and can be resolved in anywhere between six to nine months, generally.

Molluscum contagiosum is known to be more prevalent in the humid and warmer regions of the world, though it can occur anywhere. Being a contagious infection, it can spread from person to person by means of physical contact, sexual contact or sharing of contaminated articles of personal use. The mode of transfer is usually autoinoculation, meaning self-transfer by the virus from one area of the epidermal surface to another. More often than not, the incubation time for the virus in anywhere between two and seven weeks. For some people, the symptoms may show up even up to six months later.

After the healing process is complete, scars or marks are not left behind on the skin. They heal with time. In severe cases, the infection can take up to four years to be resolved completely.

Symptoms of Molluscum contagiosum:
The most common areas of the body where Molluscum contagiosum generally appear are the epidermal surfaces of limbs, face, chest and trunk. In children, the symptoms of Molluscum contagiosum are often seen occurring on the limbs. In adults, the same symptoms can be found specifically on the inner thighs, abdomen and genital areas.

The lesions or raised nodes can be itchy but do not pain in general cases. The lesions or nodes are small in size, with a diameter of 2 5 millimetre each. The unique character of this infection is that the lesions and nodes have a dimple lie resemblance in the central area.

In the initial stages of the infection, the lesions or nodes have a dome-shaped structure and are the colour of flesh, but during the course of time, change in appearance to become more soft with a light or white shade at the centre, with the presence of a waxy, almost semi-solid material.

For people who have normal to healthy immune systems, this infection can disappear naturally in the span of a few months. People who have other chronic diseases may face problems in resolving the issue naturally and spontaneously. This infection also further deteriorates their immune systems. The lesions may spread slowly or rapidly and become extensive in nature.

Causes of Molluscum contagiosum:
Molluscum contagiosum is caused by a virus of the same name. This virus belongs to the pox family. The infection can spread by means of physical contact such as scratches, rubbing or touch. It can also spread by mode of sexual contact. Usage of personal articles or objects touched by an already infected individual can be a mode in which this auto inoculating virus spreads from person to person.

People with weakened immune systems are more prone to not only Molluscum contagiosum, but any other infection, communicable or non-communicable. The idea is that the virus can survive and thrive in surfaces that have been in contact with the human skin which is infected by the same virus. So articles of personal use and public articles and objects are literally a breeding ground for the virus.

The virus can survive only for a limited period of time on the epidermal surface of the human body, the skin. The presence of lesions or nodes on the skin surface indicates the activity of the virus. During the healing process, the lesions and nodes disappear, leaving no scars behind. This is an indication that the virus is no longer active and has left the body of the host.

Diagnosis of Molluscum contagiosum:
Usually, the diagnosis of this viral infection is relatively easy because of its unique appearance of a dome-shaped node or lesion, which is between 2 and 5 millimetres in diameter. With due course, the appearance of the lesion changes from flesh coloured and dome-shaped to flattened and pale or white appearance with the presence of a semi-solid like waxy material.

At the beginning of the infection, the eruptions are small and almost flat. In the next stage, the lesions become dome-shaped and are filled with a whitish, cheesy, wax-like substance that when punctured, can spread the virus. The semi-solid filled dome has a small navel-like depression in the centre. Towards the later stages, the nodules dry out or break on their own and the liquid is washed off. The skin takes time to heal the aberrations. In most cases, scars are not left behind. As new skin grows, there may be white patches of skin in the area affected by the viral infection. This eventually disappears and the lesions go away completely, leaving the skin fresh and without scars.

Scars are left behind in very rare cases due to complicated infection or treatment of the viral infection by means of a surgical method.

However, the doctor can confirm the presence of Molluscum contagiosum with a simple skin biopsy. In this method of diagnosis, the skin surface is scraped for a sample for testing. A pathologist can then easily determine the presence of the viral infection. This diagnosis is definitive and helps the doctor to distinguish from other conditions such as rashes, herpes, dermatitis, folliculitis or other common infections of the skin.

Treatment of Molluscum contagiosum:
In most cases of a Molluscum contagiosum infection, the infection will take a few months to heal on its own. The lesions or nodules completely disappear from the epidermal surface. People with a healthy immune system do not require a medical intervention unless it is a complicated or very advanced stage of the infection.

The cases where medical assistance and treatment is required is when the lesions are large, i.e. more than 15 millimetres in diameter and if the nodes have affected the face or neck region.

Patients who are already suffering from any other skin related issue of any kind do need the medical intervention of a doctor to prevent complications of the infection.

There are various treatment options to choose from:
- Curettage: In this method, a local anaesthetic is administered and the lesions filled with the cheese like waxy substance are scooped out with a sterilized spoon like an instrument. The anaesthetic is administered because the instrument has a sharp edge and the process might be a little painful.

- Cryotherapy: Used as a treatment option for many skin infections, skin tags, warts, etc., this is a process used to treat Molluscum contagiosum as well. In this treatment, a frozen liquid under high pressure is sprayed over the affected area to freeze the nodule. The nodules take around 10 seconds to get frozen completely. This is indicated by a layer of ice that forms over the raised lesion and its immediate surroundings. If it is a large lesion, more than one session is required.

- Diathermy: The exact opposite of cryotherapy, this method uses high heat from an electrical device to burn off the extra growth or raised nodule. A local anaesthetic is used to reduce the pain.

- Laser therapy: An intense beam of the laser is used to kill the infected cells and the immediate cells around it. This prevents the infection from spreading to other areas around the infected skin.

- Chemical Treatment: Though it is one of the methods of treatment, it is generally not recommended because of the pain and scarring that it causes. In this method, the doctor dips a sharp, sterilized instrument into a phenol or podophyllin compound and then pricks each of the lesions, releasing the cheese like waxy liquid in them. They burst and their contents are emptied and cleaned and sterilized. In some cases, a secondary infection may develop around the punctured lesion, leading to complications. Usually, for such cases, a hydrocortisone based cream is recommended. It helps to relieve the discomfort and itches. This is strictly not applied on the lesion, but only on the area of secondary infection or eczema.

Other than these, the doctor may prescribe medication to hasten the healing process and to prevent the occurrence of secondary infections. This includes trichloroacetic acid compounds, imiquimod, cantharidin based medicine or podophyllotoxin creams.

Whether the patient is pregnant, planning to get pregnant or breastfeeding is an important factor that the doctor considers before the treatment. In case the patient is affected by HIV, then antiretroviral therapy is used exclusively. Rather than directly treating the Molluscum contagiosum, it strengthens the immune system of the body to help it fight the virus naturally. This is considered safe because it prevents the occurrence of secondary infections along with the pre-existing condition.

There are home remedies for Molluscum contagiosum that have been tried by patients, but there is no documented evidence of the same. Some of the effective home remedies as claimed by patients are iodine, alcohol, tea tree oil, apple cider vinegar, elderberry extract, hydrogen peroxide, etc.

It is known that once the Molluscum contagiosum is cured, it does not recur. Even after a long time, the virus is unlikely to appear again unless there is a new, complicated infection.

Some common treatment options involve the prescription of medicines such as salicylic acid, Valtrex, tretinoin, Tagamet, cimetidine, Aldara, Retin A, Avita, Atralin, Altinac, Renova, Corticosteroid creams, etc.

Prevention of Molluscum contagiosum:
Some of the best ways to prevent the infection of Molluscum contagiosum are:

- Wash hands frequently with soap and water.

- Children who are more prone to this infection must be instructed to wash hands with antiseptic soap especially before eating.

- Avoid sharing articles of personal use such as towels, comb, soap bars, clothes, etc.

- If you are using public objects such as gym equipment or objects in the parks, you are at a higher risk of contracting this contagious infection. Make sure to wash up after use.

- Do not indulge in physical or sexual contact with an individual who is likely to be suffering from this viral infection.

- Avoid shared sports gear or contact sports if you are not taking proper preventive measures.

- Keep the nodules clean and do not scratch or pick at them. Do not shave the affected area until the infection is completely gone.

- If your abdomen or genitals are affected, avoid sexual contact until the healing process is complete.

Complications due to Molluscum contagiosum:
Though this viral infection is not fatal or painful, sometimes there are chances of secondary infection. Eczema might develop in and around the lesions on the affected epidermal layer. This can cause discomfort, swelling, itching and more often than not, leads to the spread of infection due to scratching of the affected area. This breaks the papules on the skin due to viral infection and the issue could amplify.

Puncturing or scratching the nodules or lesions may leave the wound open and this could lead to multiple other infections. If the site of the viral infection is in the area surrounding the eyes, there is a high chance of contracting conjunctivitis through contact with the waxy substance in the nodule.

Myths relating to Molluscum contagiosum:
Myth #1: Molluscum contagiosum is fatal.

No, Molluscum contagiosum is not fatal. More often than not, it doesn t require treatment if the affected individual has a normal to the healthy immune system.

Myth #2: Once the infection is gone, it may recur.

No, once healed completely, the infection does not recur in the individual. The immune system of the body will have the required antibodies to fight the infection after the occurrence of the first bout.

Myth #3: Even after the lesions are gone, the person can transmit the viral disease to others.

No, once the infection has healed completely, the virus is no longer present in the body and the person cannot transmit the viral infection to other people.

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