You are on page 1of 31

Monday, March 3 2014

MOLLUSCUM
CONTAGIOSUM
Nurul Holisa Hadi (09-777-001)
Rahma Nilasari (09-777-033)

Supervisor: dr. Sukma Anjayani, M.Kes, Sp. KK

DEFINITION

Molluscum contagiosum is a
disease virus infection of the skin
caused by the molluscum
contagiosum virus and
characterized by papules miliarlentikuler that there are
indentations on its surface and
contains a mass containing
molluscum bodies.

ETIOLOGY

Virus Taxonomy:
Ordo: Poxyviridae
Family: Chornopoxvirinae
Genus: Molluscipox virus
Species: Molluscum contagiosum virus (MCV)

http://viralzone.expasy.org/all_by_species/174.html

Double stranded DNA.


Virion MCV was found with envelope structure

and have the linear genome structure.


Shape like brick with size 320 x 250 x 200 nm.
Four main subtypes of MCV: MCV I, MCV II, MCV

III, and MCV IV.


MCV I is the type moss commonly found.
All the type showed the same symptoms.

EPIDEMIOLOGY

Molluscum Contagiosum Virus (MCV) can be

found worldwide with higher distribution in


the tropical areas
The disease is more prevalent in children with
the lesions involving the face, trunk and
extremities
In adults the lesions are most often found
near the genital region

PATHOGENESIS

The incubation period is 2-7 weeks. The process

of viral replication occurs in the cytoplasm.


First

phase

the

virus

will

go

into

glycosaminoglycans (GAGs) are found on the


surface of target cells or through extracellular
matrix components. This triggered membrane
fusion core that causes the release of the virus
into the host cell cytoplasm.

Furthermore

happen

transcription

by

RNA

polymerase which will result in the expression of


viral genes after 30 minutes post-infection.
Marks the end of the initial phase is not covert
viral core and the viral genome is completely
detached in the cytoplasm.

Second

phase

occurs

approximately

100

minutes post-infection and begins with the


expression

of

genes

intermediates

in

the

cytoplasm which then trigger the replication of


genomic DNA.
Final phase : occurred within 140 minutes to 48

hours post-infection. This phase is characterized


by the structure of viral proteins produced
complete.

There are many MCV genes that may contribuse

to an impaired immune response to this virus,


including
(1) a homolog of a major histocompatibility class 1

heavy chain, which may interfere with antigen


presentation;
(2) a

chemokine

homolog

that

may

inhibit

inflammation;
(3) a

glutathione peroxidase homolog that may

DIAGNOSIS

1. Anamnesis

- transmission may occur via direct skin or


mucous membran contact
- via indirect contact, example: bath towels
and swimming pools

10

2. Clinical manifestation

Ahmed AM, Madkan VK, Mendeza N, Tyning Sk, Lowy DR. Viral disease: General
consideration.
Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, eds. Fitzpatrick
dermatology in
general medicine. 7th ed. USA: Mc graw hill; 2008.

Papul

dome-shaped,

discret,

size

miliar

to

lenticular, and have a central umbilication/dell with


a waxy surface on the central part, flesh colored
(fiesh), but lession can also be pink to gray.

3. Special Tests

- Giemsa Stain

Ahmed AM, Madkan VK, Mendeza N, Tyning Sk, Lowy DR. Viral disease: General
consideration.
Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, eds. Fitzpatrick
dermatology in
general medicine. 7th ed. USA: Mc graw hill; 2008.

Shows intracytoplasmic molluscum inclusion


bodies

Histopatology

Cup shaped nodul

Molluscum Bodies

Rao K, Priya NS, Umadevi HS, Smitha T. Molluscum Contagiosum. J Oral


Maxillofac Pathol
2013;17(1)

THERAPY

It is important to discuss the risks and benefits

of individual therapies with families before


embarking on treatment for this essentially
benign condition, which will generally resolve
without complication in the immunocompetent
individual.

14

Cantharidin 0,7 % - 0,9 % liquid (induced

vesiculation at the epidermal juntion)


Curretage
Cryotherapy

15

Other topical therapeutic modalities include

retinoid creams, imiquoid cream, slicylic acid,


cidofovir, and siver nitrate paste and tape
stripping.
Oral

cemetidine has also been used with

success. Cimetidine is a histamine H2 receptor


antagonist

which

stimulates

delayed-type

hypersensitivity reactions. The dose is 40 mg /


kg / day in two divided doses.

16

COMPLICATION

Chronic conjunctivitis and punctate keratitis

may develop in patients with eyelide lesions


Secondary

bacterial

infection

can

occur,

particularly if patients scratch their lesions

17

DIFFERENTIAL
DIAGNOSIS

a. Verrucae Vulgaris

Common warts are due mainly to HPV. Verrucae vulgaris


may occur any where on the skin. Firm papules with a
rough, horny surface, they range in size from less than 1
mm to over 1 cm in diameter and by confluence can
form large masses.

Sterling JC. Virus infection. Burns T, Breathnach S, Cox N, Griffiths C, eds. Roks textbook of dermatology.
8th ed. USA: Wiley Blackwell; 2010.

b. Pyogenic granuloma

Pyogenic granuloma is a relatively common


vascular benign lesion of the skin and mucosa,
it can affect any part of the body and usually
present as a solitary lesion. The characteristic
feature is rapid growth and profuse bleeding
with little or no trauma

Solitary pinkish brown pyogenic granuloma


Naqash MM, Salati SA. Facial pyogenic granuloma. Journal of symtops and signs 2013;2(2)

c. Cutaneous cryptococcosis

Cutaneous cryptococcosis is a cryptococcus


neoformans infection . In HIV/AIDS
cryptococcal skin involvment should be
suspected when papulonodular necrotizing
skin lesions with central umbilication, like
molluscum contagiosum

Baker DJ. Reboli AC. Cutaneous Cryptococcosis. NEJM 1997;998

d. Basal cell Carsinoma

Approximately 80% occur on the head and neck.


Flat lesions, pale areas are small, the color is
pink or red, translucent, shiny and waxy, and
there is a bleed area with minor injuries. The
lesion grows slowly, is not painful and not itchy.

Wong CSM, Strange RC, Lear JT. Basal cell carcinoma. BMJ 2003

PROGNOSIS

This disease can be cured without treatment,

but requires quite a long time (months to


years.) So that adequate treatment is needed
to cure the disease faster.

23

THANK YOU VERY


MUCH...

24

25

REFERENCES

1. Ahmed AM, Madkan VK, Mendeza N, Tyning Sk,


Lowy DR. Viral disease: General consideration. Wolff
K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS,
Leffell DJ, eds. Fitzpatrick dermatology in general
medicine. 7th ed. USA: Mc graw hill; 2008.p.1911-3
2.Berman K. Molluscum contangiosum. Atlanta J
Dermathol 2013;
3.Hanson D, Diven DG. Molluscum contangosum.
Dermatol online J; 2003:9(2):2

26

4.Chen

X,

Anstey

AV,

Bugert

JJ.

Molluscum

contangiosum viral infection. Lancet Infect Dis


2013;1:877-88
5.Phelps A, Murphy M, Elaba Z, Hoss D. Molluscum
contagiosum in benign epithelial cystic lesionreport of 2 cases with different pathogenesis. Am
J Dermathophatol 2010;32:7
6.Hanson D, Diven DG. Molluscum contagiosum.
Dermatol online J 2007;9(2):2

27

7.Rao

K,

Priya

NS,

Umadevi

HS,

Smitha

T.

Molluscum Contagiosum. J Oral Maxillofac Pathol


2013;17(1):146-147
8.James WD, Berger TG, Elston DM. Andrews
disease of the skin clinical dermatology. 10th ed.
USA: Saunders Elsevier; 2006.p.317-19, 394-6,
403-4
9.Sterling JC. Virus infection. Burns T, Breathnach
S, Cox N, Griffiths C, eds. Roks textbook of
dermatology.

th

ed.

USA:

Wiley

28
Blackwell;

10.Naqash
granuloma.

MM,

Salati

Journal

of

SA.

Facial

symtops

pyogenic
and

signs

2013;2(2):114-6
11.Bunker CB, Gotch F. HIV in the skin. Burns T,
Breathnach S, Cox N, Griffiths C, eds. Roks
textbook of dermatology. 8th ed. USA: Wiley
Blackwell; 2010.p.35.33
12.Baker DJ. Reboli AC. Cutaneous Cryptococcosis.
NEJM 1997;998
13.Wong CSM, Strange RC, Lear JT.

29
Basal cell

30

31