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276 Indian Medical Gazette — JULY 2013

Review

Molluscum Contagiosum — An Update


Silpi Basak, Professor & Head,
Monali N. Rajurkar, Tutor
— Department of Microbiology, Jawaharlal Nehru Medical College, Wardha (M.S.), India.

Abstract can spread by direct contact or autoinfection, fomites or


sexual contact 4. The fomites include towel, clothing and
Molluscum contagiosum, a viral disease, can cause
toys etc. Incubation period for MCV is 2-8 weeks5 and
popular lesion on skin of face, arm, trunk and ano-genital may be prolonged to 6 months and even to about 18
region. Multiple lesions can be observed in months6.
immunocompromised hosts. Though the lesions resolves
within 2-6 months, in HIV positive patients it may take In immunocompromised individuals i.e. patients with
more time. The mode of transmission, newer diagnostic AIDS, corticosteroid therapy, antimalignant therapy, rapidly
and therapeutic options have been discussed in this article. worsening course of disease can be observed. The lesion
can grow very large or 100 papules may appear and cellulitis
Introduction may be an unusual complication in HIV positive patients.

Molluscum contagiosum is a papular or nodular lesion Signs & Symptoms


on the skin and occasionally of mucous membrane caused
Lesions begin as small (2-5mm) painless firm papules
by virus belonging to family Poxviridae and is classified as which gradually become raised, pearly flesh coloured nodule
the sole member of genus Molluscipoxvirus and species alongwith umbilicated center which is the hallmark of the
Molluscum contagiosum virus (MCV). There are four types disease1. The lesions are not usually painful but they may
of Molluscum contagiosum virus, MCV I to IV. MCV-I is itch or irritation may be there. Scratching the papule may
most prevalent and MCV-II is usually seen in adults and lead to secondary bacterial infection. By autoinoculation,
probably sexually transmitted. In HIV positive patients virus may spread to surrounding skin. Scratching or picking
MCV–II causes most of the infections (60%)1. may also spread the virus. The papules occur in lines where
person has scratched and usually in skin of trunk or
History anogenital region. The lesion has a central core composed
of plug of white, cheesy & waxy material1. The lesions
Bateman first described molluscum lesion in 1817.
may turn into benign tumour.
Paterson demonstrated the infectious nature of the disease
in 1841. Juliusberg in 1905 proved that it’s viral aetiology. Laboratory Diagnosis
MCV infection commonly occurs in children (1-10 yrs Humans are the only susceptible host and the virus
old) 2, sexually active adults and immunocompromised cannot be grown in egg, tissue culture or animals. Antibody
individual 3. In children, the lesions are seen in face, neck, titres are not helpful. Diagnosis is mostly done clinically.
armpits, arms and hands & sole, mucous membrane i.e. Pseudocystic and giant molluscum contagiosum lesios are
lips, tongue and buccal mucosa. In adults, the lesions are more difficult to diagnose clinically. The viral infection is
common in genital, abdomen and inner part of thigh. MCV limited to a localized area on epidermis.

Address for correspondence: Dr Silpi Basak, Professor and Head, Department of Microbiology, Jawaharlal Nehru Medical College,
Wardha (M.S.) – 442 004, India. E-mail : drsilpibasak@gmail.com
Indian Medical Gazette — JULY 2013 277

Diagnosis is confirmed by excisional biopsy and in 2011 have described that after incision with a 19 gauge
examination under low power microscope shows ovoid, needle, a comedone extractor is used to express the cheesy
smooth walled homogeneous cytoplasmic masses which core. The cheesy core is squashed or pressed between 2
mainly consists of mature, immature and incomplete virion glass microscopic slides. The smears are stained with 5-7
alongwith cellular debris. These are called as molluscum drops of Giemsa stain and observed under microscope to
bodies 20-30µm in size, which displace the nuclei to the see the Henderson –Paterson bodies. Other staining
periphery of the cell. In molluscum bodies, large numbers techniques e.g. Wright, 10% KOH, Gram and Papanicolaou
of virus particles are embedded in protein matrix. have been described 11, 12, 13, 14.
Molluscum bodies are the inclusion bodies of Molluscum
contagiosum virus. Wright’s Giemsa strain, Haematoxylin Prevention
& eosin staining can be done. The section shows acanthoma The patient is advised not to scratch or pick at the
with downward proliferation of rete ridges. As the bumps, not to share the towels, wash cloths and other
molluscum bodies reach the level of granular cell layers, personal items, not to share the skin that has lesion, in ano-
their staining reaction changes from eosinophilic to genital lesions not to have sex.
basophilic. In the horny cell layer, molluscum bodies are
basophilic and called as Henderson-Patterson bodies1. The Treatment
stratum corneum in the centre of the lesion disintegrate
and release the molluscum bodies and there is formation of Many treatment modalities have been described but exact
central crater. Usually, no inflammatory reaction is seen in treatment option depends upon patient’s age, immune status,
the dermis. Inflammatory reaction is seen when the lesion site of lesion etc.
is ruptured, and the contents of the lesion is discharged i. Cryosurgery – The bumps are frozen with liquid
into the dermis. Spontaneously involuting lesion shows a nitrogen.
mononuclear infiltrate surrounding the lesion, which also
infiltrate between infected epidermal cells. Actually histologic ii. Curettage – The bumps can be scraped of the skin
section stained with hematoxyline and eosin shows a cup by using a curatte.
shaped indentation of epidermis into dermis.
iii. Laser surgery – Laser can be used to destroy the
Molluscum lesions usually resolve within 6-9 months bumps.
but may persist for 2 years. MCV do not remain latent in
iv. Electrodessication – It is more effective in
the body like Herpes virus, when the lesion resolve from
immunocompromised hosts.
the skin, it will not appear on their own7. But there is no
permanent immunity to MCV and the individual can again v. Topical agents – Various acids e.g. Trichloro acetic
be infected on exposure to an infected person. acid or blistering solution can be used to destroy
the bumps. Astringents like potassium
In immunocompetent host the differential diagnosis of
hydrochloride, cantharidium can be used. Similarly,
molluscum lesions include varicella, lichen planus, Darier’s
essential oils e.g. Australian lemon myortie and tae
disease, histiocytoma, basal cell epithelioma,
tree oil with organically bound iodine can be used.
keratoacanthoma, verruca vulgaris, condyloma accuminata,
10% Benzyl peroxide, Imiquimod, Retinoid can also
warts, dermatitis herpetiformis etc8, 9. Warts lack the central
be used over the bumps. In extensive lesions
umblication and usually occur on palm and soles. Herpes
antiviral drugs i.e. Cidofovir is used.
lesions are vesicle, tender and have a rapid onset and shorter
clinical course.
Prognosis
Polymerase chain reaction (PCR) can also be done for Molluscum lesions clears up within 2 years. The lesions
diagnosis. Lydia et al have described the technique of are contagious as long as the skin growths are present.
Squash preparation using Giemsa stain for inoffice diagnosis Advantage of the treatment is to hasten the resolution of
of molluscum lesion10. In Squash preparation, the cellular virus. Low CD4 cell counts have been linked to widespread
exudates can be observed under microscope. Lydia et al. facial mollusca and therefore have become a marker for
278 Indian Medical Gazette — JULY 2013

severe HIV disease 15. Therefore, therapies have been recipient. Transpl Infect Dis. 6:120-123, 2004.
targeted for boosting the immune system in these patients16.
10. Eleftheriou L.I., Kerr S.C., Stratman E.J. —
References Diagnosis of atypical MolluscumContagiosum: The
utility of a Squash Preparation, Clinical Medicine and
1. Bhatia A.C., Crowe M.A. — Molluscum Contagiosum. Research. 9(1):50-51, 2011.
http://www.emedicine.medscape.com/article. 5 Jan
2012. 11. Bauer J.H., Miller O.F., Peckham S.J. — Medical
Pearl: confirming the diagnosis of molluscum
2. Frequently Asked Questions: For everyone. CDC contagiosum using 10% potassium hydroxide. J Am
Molluscum Contagiosum.United States Centers for Acad Dermatol. 56:S104-105, 2007.
Disease Control and Prevention. http://www.cdc.gov/
ncidod/dvrd/molluscum/faq/everyone.html#whogets, 12. American Academy of Pediatrics. Summaries of
2008. Infectious Diseases. In: Pickering LK, Baker CJ,
Kimberlin DW, Long SS, eds. Red Book: 2009 Report
3. Hanson D., Diven D.G. — Molluscum Contagiosum of the Committee on Infectious Diseases. 28th ed.
Dermatol online J. 9(2):2PMID12639455. http:// Elk Grove Village, IL:American Academy of Pediatrics;
dermatology.edlib.org/92/reviews/molluscum/ 466, 2009.
diven.html, 2003.
13. Penneys N.S., Matsuo S., Mogollon R. — The
4. Viruses and human diseases II ed. James Strauss, identification of molluscum infection of
Ellen G Strauss Ap Elesevir. immunohistochemical means. J Cutan Pathol.13:97-
101, 1986.
5. “Pamphlets: Molluscum Contagiosum”. American
Academy of Dermatology. http://www.aad.org/public/ 14. Thompson C.H., Biggs I.M., DeZwart-Steffe R.T.
publications/pamphlets/viral_mollscum.html. 2006. — Detection of molluscum contagiosum virus DNA
by in-situ hybridization. Pathology. 22:181-186, 1990.
6. MedlinePlus Encyclopedia Molluscum Contagiosum.
15. Reynaud-Mendel B., Janier M., Gerbaka J., et al. —
7. Thomas P. — Habif 2nd ed. Ch. Skin disease: Dermatologic findings in HIV-1-infected patients: a
Diagnosis and Treatment. prospective study with emphasis on CC4+ cell count.
Dermatology. 192:325-328, 1996.
8. Silverberg N.B. — Pediatric molluscum contagiosum:
optimal treatment strategies. Pediatr Drugs. 5:505- 16. Hicks C.B., Myers S.A., Giner J. — Resolution of
512, 2003. intractable molluscum contagiosum in a human
immunodeficiency virus infected patient after
9. Mansur A.T., Goktay F., Gunduz S., et al. — Multiple institution of anti-retroviral therapy with ritonavir.
giant molluscum contagiosum in a renal transplant Clin.Infect.Dis. 24:1023-1025, 1997.

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