Molluscum Contagiosum

Symptoms of molluscum contagiosum include painless pinkish raised nodules or bumps on the skin.

Molluscum contagiosum is a mild skin disease (skin infection) caused by a virus (molluscum contagiosum virus, a member of the Poxviridae family) that causes usually painless small bumps or lumps (flesh-colored or skin-colored, dome-shaped papules); some may be umbilicated, meaning the lesion has a central depression with a spot in the middle that resembles a navel on the skin (umbilication). The disease occurs worldwide but is more prevalent in warm, humid climates.

The disease is usually not serious and, in most people, resolves in about 6 to 12 months without treatment. It is a common infection in children; direct person-to-person contact, sexual contact, and contaminated items like clothing, towels, or other objects may transmit the infection. Some consider it to be a sexually transmitted disease (STD), but many others simply consider it to be a skin disease that is contagious by any skin-to-skin and indirect incidental contact with the infecting virus in adults, the elderly, and children.

The virus can infect all other parts of the body, including the face, by autoinoculation (self-transfer of the virus to another area of the skin).

With part of its name being contagiosum, you can be sure it is contagious. The virus spreads by direct skin-to-skin contact and by indirect contact (for example, towels or personal items (fomites) used in contact sports that an infected person touches, allowing the virus to pass from the towel or other item to another person's skin).

The average time from exposure to the development of symptoms (incubation period) is about 2 to 7 weeks and may be as long as 6 months in some individuals.

The skin lesions last about 6 to 12 months although some individuals have had lesions that last up to 4 years. Once the lesions spontaneously resolve, the person is not contagious. The contagious period is quite variable and depends on when the lesions resolve.

The cause is a virus, molluscum contagiosum, which is a member of the poxvirus family. The virus only survives in the skin, and when the lesions are gone, the person no longer is contagious.

The highest risk factor is when an uninfected person touches a skin lesion on an infected person's skin or contacts an item such as a towel that an infected person recently used. People with weakened immune systems are at risk of getting the infection and having it rapidly spread with larger lesions.

Other people at high risk include:

• Wrestlers
• Swimmers
• Gymnasts
• People who use steam baths and saunas

It's also possible to transmit the infection sexually (genital infection). It is theoretically possible to contract the virus from a toilet seat, though no one has documented this.

Pictures of molluscum contagiosum; SOURCE: CDC

The first signs and symptoms of molluscum contagiosum are small painless papules (raised bumps or lumps) on the skin (molluscum lesions). It often appears as a raised, pearly pinkish, or pearl-like nodule or redness on the skin; some nodules contain a dimple in the center.

• Most molluscum lesions are small, about 2-5 mm in diameter.
• Inside the nodule, sometimes there is a cheesy whitish core.
• The lesions may become itchy if scratched.
• The lesions may develop redness or become red and inflamed.

The lesions can appear anywhere on the body (face, mouth, inner thighs, genital area, penis, or vagina, for example). The skin lesions may go through 3 stages, which include:

1. The first stage is a small whitish and/or reddish bump on the skin.
2. Over a few weeks, the bumps can enlarge to about 2-5 mm with a whitish pus head that develops into a small crater when it bursts. This is stage two, and doctors advise patients not to attempt "popping" these pus-containing bumps or pimples.
3. Stage three occurs when the burst craters develop into reddish sores; other organisms (secondary infections) may infect these open sores.

Doctors or other health care providers diagnose molluscum contagiosum based on the person's history and physical exam. A skin biopsy or tissue scraping that shows the viral infection is a definitive diagnosis usually made by a pathologist or a board-certified dermatologist.

This definitive diagnosis is sometimes helpful to distinguish molluscum contagiosum from many other skin conditions like herpes, genital warts (HPV), hives, atopic dermatitis, skin cancer, bacterial infections, or folliculitis.

Although primary care providers and pediatricians can treat this disease, consultants like board-certified dermatologists, infectious disease specialists, and pathologists may provide consultations for diagnosis and treatment.

Most people need no treatment because the lesions spontaneously disappear (termed a self-limited disease) in about 6 to 12 months, although for a few, it may take up to 4 years. There are many treatment options. Discuss any treatment method with a doctor.

• Cryotherapy (freezing with liquid nitrogen), curettage (cutting out the lesions), and laser therapy may remove lesions.
• In addition, creams that include podophyllotoxin cream, salicylic acid, tretinoin (Retin A, Atralin, Renova, Avita, Altinac), and cantharidin may remove lesions.
• An antiviral medication (Valtrex) has been used to treat the disease.
• Physicians may use cimetidine (Tagamet) to treat molluscum contagiosum in small children.
• A new medication, imiquimod (Aldara), helps to strengthen the skin's immune response and may help to get rid of the lesions in some people.
• Topical desonide cream (a low-dose corticosteroid) reduces any symptoms that may accompany scratching the nodules.
• Some physicians may treat the disease with topical anti-inflammatory medications like diclofenac gel. Research is ongoing.
• Novan Inc. has B-SIMPLE4 in a pivotal phase 3 study of SB206, a topical antiviral gel.
• YCANTH and VP-102 are two other potential treatments for this disease.

There is a wide range of home remedies available for this disease. People have tried remedies such as apple cider vinegar, tea tree oil, alcohol, iodine, hydrogen peroxide, elderberry extract, and duct tape occlusion.

Unfortunately, there is little data to support these remedies although some claim to cure the disease. Some are easily available at pharmacies (for example, ZymaDerm). It is important to discuss the situation with your doctor before trying a home remedy.

Most people who get molluscum contagiosum have an excellent prognosis because the infection is usually self-limiting; it typically affects only the skin and resolves without treatment over about 6 to 12 months in most people. However, immunosuppressed people have a more guarded prognosis as the disease may persist for years and become widespread on the skin; some people may get secondary bacterial skin infections; the major complication of the disease.

Some treatments listed above (cryotherapy, curettage, laser, and some chemical treatments) may leave small scars. Even if you get the disease and are cured, you can be reinfected and get the disease again.

It is possible to reduce the chance of getting the disease by taking some preventative measures, such as:

• Avoiding any direct skin-to-skin contact with an infected person can protect from the disease.
• Direct contact with items touched recently by an infected person (clothing, towels, and benches used in contact sports like football, for example) should also be avoided.
• Either not having sexual contact (genital or oral) or using condoms can prevent some individuals from getting the disease, but if the condom does not cover an infected area, it's still possible to infect a sex partner.
• Washing clothes, cleaning surfaces, and limiting skin-to-skin contact may reduce the chances of becoming infected.