Molluscum contagiosum is a viral disease with following characteristics: Benign viral infection Caused by a pox virus Double stranded DNA virus Spread by direct contact, bath towels, tattoo instruments, beauty parlour implements, swimming pools in children In adults, most commonly an STD, males>females Incubation period – 2-7 weeks but can be as long as 26 weeks More common and severe in patients with A.D. More common in certain geographic areas with warm climates (Fiji, Congo, Papua New Guinea)

1. Common dermatologic disorders
Molluscum contagiosum
Dr.FaramarzDidar
CosmeticFacialUKLimited
www.cosmeticfacial.co.uk

2. Molluscum contagiosum (MC) is a viral infection of the skin or
occasionally of the mucous membranes.
It is caused by a DNA poxvirus called the molluscum contagiosum virus .
MCV has no animal reservoir, infecting only humans.
There are four types of MCV, MCV-1 to -4; MCV-1 is the most prevalent
and MCV-2 is seen usually in adults and often sexually transmitted.
This common viral disease has a higher incidence in children, sexually
active adults, and those who are immunodeficient.
MC can affect any area of the skin but is most common on the trunk of
the body, arms, and legs.
The virus commonly spreads through skin-to-skin contact.
 This includes sexual contact or touching or scratching the bumps and
then touching the skin.
The virus can spread from one part of the body to another or to other
people.
Molluscum contagiosum is contagious until the bumps are gone (which,
if untreated, may last up to 6 months or longer).
average incubation period between 2 and 7 weeks.
Diagnosis is made on the clinical appearance; the virus cannot routinely
be cultured.
Molluscum contagiosum lesions are flesh-colored, dome-shaped, and
pearly in appearance. They are often 1–5 millimeters in diameter, with a
dimpled center.
They are generally not painful, but they may itch or become irritated.
Picking or scratching the bumps may lead to further infection or
scarring. They may occasionally be complicated by secondary bacterial
infections.

3. 1. Histologically, molluscum contagiosum is characterized by molluscume
bodies in the epidermis above the stratum basale, which consist of
large cells with:
– abundant granular eosinophilic cytoplasm (accumulated virons),
– a small peripheral nucleus.
2. The viral infection is limited to a localized area on the topmost layer of
the epidermis.
3. In a process called autoinoculation, the virus may spread to
neighboring skin areas

4. CLINICAL APPEARANCE
 Characteristic lesions
 Smooth, umbilicated, symmetrical papules, usually 1-20mm in diameter
 Can be white, flesh coloured, translucent, yellow, pink or red.
 Central umbilication sits atop a white, waxy curd-like core.
 Solitary or in groups
 In children mostly found in chest, arms, trunk, legs and face
 In adults, usually in genitalia, lower abdomen or buttocks
 Self limiting disease – spontanous resolution within 18months – longer in
immunocompromised
 Infection can recur after initial clearance in 1/3 patients

6. treatment
• Cochrane database 2012 – “no single itervention has been shown to be
convincingly effective in treating molluscum contagiosum”
• Reasons to treat
– Alleviating discomfort
– Cosmetic reasons
– Social stigma associated with visible lesions
– Limiting spread to other areas and other people
– Preventing scarring and secondary infection
– Preventing trauma and bleeding of lesions
• Benign neglect
• Direct lesional trauma
– Caustic agents
– cryotherapy
– Lasers
– curettage
• Antiviral therapy
– Ritonavir, cidofovir
• Immune response stimulation
– Imiquimod cream,intralesional interferon alfa

7. Treatment: General rules
Individual molluscum lesions may go away on their own ,lasting generally from 6 to 8 weeks, to 2 or 3 months.
via autoinoculation, the disease may propagate and so an outbreak generally lasts longer with mean durations variously
reported as 8 months, to about 18 months, and with a range of durations from 6 months to 5 years.
Treatment is often unnecessary[ depending on the location and number of lesions,
treatments causing the skin on or near the lesions to rupture may spread the infection further.
treating bumps located in the genital area to prevent them from spreading.
The virus lives only in the skin and once the growths are gone, the virus is gone and cannot be spread to others.
Types of Treatment:
Cryotherapy
 Cryotherapy involves killing infected cells by "freezing" them with a pressurized liquid spray, usually liquid
nitrogen or nitrous oxide.
Astringents
 Astringent chemicals applied to the surface of molluscum lesions to destroy successive layers of the skin include
potassium hydrochloride, and cantharidin.
Benzoyl peroxide
 In a small randomized controlled trial twice daily application of 10% benzoyl peroxide cream for 4 weeks was
found to be more effective than tretinoin 0.05% cream; after 6 weeks 92% of the benzoyl peroxide group were
lesion-free, compared with 45% of the tretinoin group (p = 0.02)
Over-the-counter substances
 For mild cases, over-the-counter wart medicines, such as salicylic acid may or may not[ shorten infection duration.
Daily topical application of tretinoin cream ("Retin-A 0.025%") may also trigger resolution.These treatments
require several months for the infection to clear, and are often associated with intense inflammation and possibly
discomfort.
Surgical treatment
 Surgical treatments include cryosurgery, in which liquid nitrogen is used to freeze and destroy lesions, as
well as scraping them off with a curette.

8. Laser
1) Pulsed dye laser therapy for molluscum
contagiosum may be the treatment of choice
for multiple lesions in a cooperative patient
(Dermatologic Surgery, 1998).
2) The use of pulsed dye laser for the treatment
of MC has been documented with excellent
results.
3) The therapy was well tolerated, without scars
or pigment anomalies.
4) The lesions resolved without scarring at 2
weeks.
5) Studies show 96%–99% of the lesions resolved
with one treatment.
6) The pulsed dye laser is quick and efficient, but
its expense makes it less cost effective than
other options.

9. RELEVANCE TO NSFA
 Prospective, non-randomised pilot study
 Binder et al, 2008, Journal of the German Society of Dermatology
 Using the flash-lamp pumped pulse dye laser 585nm wavelength
 19 children
 All patients tolerated laser well
 84.3% needed only one laser treatment to produce full remission
 10.5% further session necessary
 One patient treated 3 times to achieve remission
Similar study with 32 patients achieved strikingly similar success rates
– retrospective looking back over 5 years –
(Klinda et al, Medical Laser application 2011)

10. References:
1. Hanson D, Diven DG (March 2003). "Molluscum contagiosum". Dermatol. Online J. 9 (2): 2. PMID 12639455.
http://dermatology.cdlib.org/92/reviews/molluscum/diven.html.
2. "Frequently Asked Questions: For Everyone. CDC Molluscum Contagiosum". United States Centers for Disease Control
and Prevention. http://www.cdc.gov/ncidod/dvrd/molluscum/faq/everyone.htm#whogets. Retrieved 2008-06-29.
3. Pamphlets: Molluscum Contagiosum". American Academy of Dermatology. 2006.
http://www.aad.org/public/publications/pamphlets/viral_mollscum.html. Retrieved 2008-11-30.
4. Weller R, O'Callaghan CJ, MacSween RM, White MI (1999). "Scarring in molluscum contagiosum: comparison of
physical expression and phenol ablation". BMJ 319 (7224): 1540. PMC 28297. PMID 10591712.
http://www.bmj.com/cgi/content/full/319/7224/1540.
5. Molluscum Contagiosum at eMedicine
6. MedlinePlus Encyclopedia Molluscum Contagiosum
7. Tyring SK (2003). "Molluscum contagiosum: the importance of early diagnosis and treatment". Am. J. Obstet. Gynecol.
189 (3 Suppl): S12–6. DOI:10.1067/S0002-9378(03)00793-2. PMID 14532898.
8. "Molluscum Contagiosum - Treatment Overview". WebMD. January 12, 2007. http://www.webmd.com/skin-problems-
and-treatments/tc/molluscum-contagiosum-treatment-overview. Retrieved 2007-10-21
9. Papa C, Berger R (1976). "Venereal herpes-like molluscum contagiosum: treatment with tretinoin". Cutis 18 (4): 537–
40. PMID 1037097.
10. Credo, BV; Dyment, PG (1996). "Molluscum Contagiosum". Adolesc Med 7 (1): 57–62. PMID 10359957.
11. Hanna D, Hatami A, Powell J, et al. (2006). "A prospective randomized trial comparing the efficacy and adverse effects
of four recognized treatments of molluscum contagiosum in children". Pediatric dermatology 23 (6): 574–9.
DOI:10.1111/j.1525-1470.2006.00313.x. PMID 17156002.
12. Hammes S, Greve B, Raulin C (2001). "Molluscum contagiosum: Treatment with pulsed dye laser" (in German). Der
Hautarzt; Zeitschrift für Dermatologie, Venerologie, und verwandte Gebiete 52 (1): 38–42. PMID 11220237.
13. Hughes P (February 1998). "Treatment of molluscum contagiosum with the 585-nm pulsed dye laser". Dermatol Surg
24 (2): 229–30. DOI:10.1016/S1076-0512(97)00178-7. PMID 9491117.