Updated: 12/13/2019

Molluscum Contagiosum

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Snapshot
  • PhotoA 30-year-old man presents to his primary care clinic for a new rash. He reports that the rash appeared about a week ago and is easily irritated. His history includes multiple sexually transmitted infections, intravenous drug use, and past incarcerations. On physical exam, he has dozens of 5-15 mm pink or flesh-colored papules and plaques with central umbilication. Some are erythematous, as if someone had scratched or rubbed at the lesions. He is immediately sent to the laboratory for further workup for causes of immunosuppression.
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
        • transmitted via physical contact with other children
      • 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
      • immunocompromise
  • Etiology
    • molluscum contagiosum virus
      • an enveloped DNA poxvirus 
  • Pathogenesis
    • the molluscum contagiosum 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
      • may be associated with other sexually transmitted infections
    • in adult
      • 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
    • indications
      • confirmation of diagnosis if clinical diagnosis is uncertain
  • Histology
    • central umbilication
    • molluscum bodies
      • Henderson-Patterson bodies
      • large cells with granular eosinophilic cytoplasm, containing accumulated virions
  • 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
  • Procedural
    • 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
Comlications
  • Secondary bacterial infection

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(M2.DM.13.4) A 9-year-old girl is brought to the pediatrician by her mother who is concerned about a new rash. Her daughter is otherwise feeling well, is up to date on vaccinations, and has not traveled recently. The family lives in an old apartment building. She is currently excelling in school and has many friends. Physical exam is notable for the finding in Figure A. Which of the following is the most likely diagnosis?

QID: 104215
FIGURES:
1

Human herpesvirus 6

14%

(3/21)

2

Human herpesvirus 8

0%

(0/21)

3

Paramyxovirus

14%

(3/21)

4

Parvovirus

62%

(13/21)

5

Poxvirus

10%

(2/21)

M 6 E

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