Molluscum contagiosum

Published on 05/05/2015 by admin

Filed under Internal Medicine

Last modified 22/04/2025

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196 Molluscum contagiosum

Instruction

Look at these skin lesions.

Salient features

History

• Ask the patient whether there are similar lesions elsewhere (particularly genitals).

Examination

• Multiple rounded, dome-shaped, waxy papules that are 2–5 mm in diameter and contain central umbilication with a caseous plug (Fig. 196.1)

• The common sites are face, hands, lower abdomen and genitals.

image

Fig. 196.1 Molluscum contagiosum. Multiple raised nodules, with areas of confluent lesions.

(With permission from Rakel 2007.)

Proceed as follows:

• Tell the examiner that you would like to investigate for an underlying HIV infection.

Diagnosis

This patient has molluscum contagiosum (lesion), which is of viral aetiology; you would like to rule out an underlying HIV infection as the lesions are extensive and widely distributed on the face, neck and other parts of the body.

Questions

How do these lesions spread from one part of the body to another?

Probably by autoinoculation.

How is the infection spread from one patient to another?

By direct contact.

What is the histology of these lesions?

Microscopically they show cup-like verrucous epidermal hyperplasia. Large inclusion bodies called ‘molluscum bodies’ are present in the cells of the stratum corneum and granulosum. These bodies are also seen in the curd-like material that can be expressed from the central umbilication. Numerous virions are present within the molluscum bodies.

What is the aetiology of these lesions?

It is caused by a pox virus that is characteristically brick shaped and has a central dumb-bell-shaped DNA core.

How are these lesions treated?

• Curettage or cryotherapy (applications of liquid nitrogen to freeze the lesions)

• Physical expression by squeezing

• Phenol ablation (causes more scarring than squeezing; BMJ 1999;319:1540)

• Light electrosurgery with a needle

• Imiquimod cream (50%) applied three times per week eradicates about 50% of anogenital warts (Arch Dermatol 1998;134:25–30). Imiquimod is an immune-enhancing agent with antiviral and anti-tumour effects

• Anecdotal reports suggest that topical cidofovir may be useful in severe molluscum contagiousm particularly in immunodeficient individuals (Lancet 1999;353:2042).

Note: In children these lesions tend to resolve spontaneously.

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