Updated: 9/27/2020

Molluscum contagiosum

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Snapshot
  • A 3-year-old girl presents to her pediatrician’s office with several pink spots on her body. Her parents report that she seems mostly unbothered by these lesions but occasionally scratches at them. Several of her friends have similar lesions. On physical exam, there are several 2-3 mm flesh-colored papules with central umbilication. Her pediatrician counsels them that this viral infection is benign and self-resolves. However, if the lesions seem to bother the patient, then there are treatment options such as cryotherapy or topical cantharidin.
Introduction
  • Clinical definition
    • painless and umbilicated cutaneous lesions caused by the molluscum contagiosum virus
  • Epidemiology
    • incidence
      • up to 30% in patients with HIV
    • demographics
      • school-aged children
        • most common
        • the children are typically immunocompetent
      • adolescents and young adults
        • transmitted via sexual contact and can present as genital lesions
      • immunocompromised individuals
        • transmitted via physical or sexual contact
    • risk factors
      • atopic dermatitis
      • immunocompromised states
  • Etiology
    • molluscum contagiosum virus
      • an enveloped DNA poxvirus
  • Pathogenesis
    • the molluscum contagiousum virus is transmitted via
      • autoinoculation
      • physical and sexual contact from an infected person
    • after the virus invades epidermal cells, it proliferates and creates lobulated epidermal growths
  • Associated conditions
    • if patient has genital molluscum
      • other sexually transmitted infections may be found
    • in adults
      • may be an indicator of HIV
  • Prognosis
    • lesions resolve spontaneously within 9 months
    • no scarring
Presentation
  • Symptoms
    • primary symptoms
      • usually asymptomatic
      • may have pruritus and/or tenderness
  • Physical exam
    • immunocompetent patients
      • single or grouped lesions
      • .1-1 cm papules with central umbilication
        • pearly
        • flesh-colored
      • location
        • trunk
        • extremities
        • head
        • neck
        • genitals
    • immunocompromised patients
      • > 30 lesions
      • > 1 cm lesions
      • lesions on the eyelid
Studies
  • Dermatoscope exam
    • central umbilication
  • Biopsy
    • indication
      • confirms the diagnosis when it is clinically uncertain
  • Histology
    • molluscum bodies 
      • Henderson-Patterson bodies
      • large cells with granular eosinophilic cytoplasm that contain accumulated virons
  • Making the diagnosis
    • a clinical diagnosis
Differential
  • Chicken pox
  • Verruca vulgaris
  • Milia
Treatment
  • Management approach
    • treatment is usually not necessary as lesions resolve within 6-9 months
    • multiple first-line therapies are available and chosen based on shared-decision making by the physician and the patient or the patient's family
  • Medical
    • cryotherapy
      • indications
        • well tolerated in adolescents and adults
        • can be too painful for young children, especially with multiple lesions
    • topical podophyllotoxin 0.5% cream    
      • indication
        • ideal for genital lesions
    • cantharidin
      • indication
        • treatment is applied topically in the office and blistering occurs hours later
        • ideal for children with multiple lesions
  • Operative
    • curretage
      • indication
        • well tolerated in adolescents and adults
        • can be too painful for young children, especially with multiple lesions
        • ideal for those who wish for more immediate resolution
Complications
  • Secondary bacterial infection

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Questions (2)

(M1.MC.17.4723) A 7-year-old boy with no past medical history presents to his pediatrician after his mother notices several small bumps on his trunk. The boy does not remember when they appeared but he says that they are not painful or itchy. Vital signs are normal and physical exam shows 5 mm flesh-colored papules scattered across his abdomen. The papules are shown in Figure A. The remainder of the physical exam is unremarkable. The virus most likely responsible for this rash has what kind of genetic material?

QID: 108550
FIGURES:
1

Single-stranded, linear RNA

8%

(12/148)

2

Double-stranded, linear RNA

7%

(11/148)

3

Single-stranded, linear DNA

14%

(21/148)

4

Double-stranded, linear DNA

57%

(85/148)

5

Double-stranded, circular DNA

12%

(18/148)

M 1 C

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