molluscum%20contagiosum
MOLLUSCUM CONTAGIOSUM
Molluscum contagiosum is an infection due to poxvirus that results into discrete skin lesions with central umbilication.
Spread is by skin-to-skin contact, fomites spread and autoinoculation.
Patients with atopic dermatitis, HIV or immunodeficiency are particularly susceptible.
Incubation period may be from 2-7 weeks.
In children, it usually presents with lesions on the face, scalp, ears, trunk and extremities and crural folds while in adults, it is typically sexually transmitted and affects the groin, genital area, thighs and lower abdomen.

Pharmacotherapy

Topical Agents

Cantharidin

  • Actions: Protein phosphatase inhibitor that penetrates the epidermis & induces blistering through acantholysis
  • Effects: One study showed clearance of 90% of lesions
  • Advantages: Effective treatment
  • Disadvantages: May cause temporary burning, risk of blistering, pruritus, infection, repeated office visits are needed
    • Should not be used on the face, genital/perianal area

Cidofovir

  • Case studies has shown clearance of lesions in immunocompromised individuals & in patients suffering from recalcitrant lesions
  • May also be administered intravenously in immunocompromised patients
  • Advantages: Effective treatment
  • Disadvantages: High cost, need for extemporaneous preparation; currently only available as solution for injection

Imiquimod

  • Actions: Topical immune response modifier that produces localized immune response at the site of application
  • Effects: 75-82% of patients treated experienced clearance of lesions
  • Advantages: Effective in the majority of cases treated, well tolerated
  • Disadvantages: High cost, irritation at application site, flu-like symptoms may occur
  • Studies proving efficacy are still lacking

Iodine Tincture

  • Apply directly to lesion or apply after puncturing each papule w/ sterile needle or by curettage
  • Advantages: Reported to be safe & effective

Iodine + Salicylic Acid

  • Advantages: Reported to be effective
  • Disadvantages: May cause maceration & erosion

Podophyllotoxin

  • Effects: Small study showed 92% of patients treated experienced clearance of lesions
  • Advantages: Shown to be effective
  • Disadvantages: May cause burning, erosions, itching & erythema
    • Severe systemic effect on overdosage

Potassium Hydroxide (KOH)

  • Advantages: Reported to be effective
  • Disadvantages: Painful, may scar, hypo- & hyperpigmentation may occur
  • Studies proving efficacy are still lacking

Salicylic Acid w/ or w/o Lactic Acid

  • Advantages: Well-tolerated, easily applied
  • Disadvantages: Irritation may occur

Tretinoin

  • Advantages: Well-tolerated, easily applied
  • Disadvantages: Variable efficacy
  • Studies proving efficacy are limited

Trichloroacetic acid

  • Advantages: Causes less local irritation & systemic toxicity than other acids in its class
  • Disadvantages: Responses is often incomplete & recurrence frequently occurs

Systemic Agents

Cimetidine (Oral)

  • Actions: Stimulates delayed-type hypersensitivity
  • Effects: 1 small study showed resolution in 9 out of 13 patients treated
  • Advantages: Safe, painless, well-tolerated esp by childn, easy to administer
  • Disadvantages: Efficacy is variable & more studies are needed
    • Facial lesions often unresponsive
    • Potential of systemic side effects & drug interactions

Other Treatments

Interferon alpha

  • Alternative treatment for immunocompromised patients w/ severe, refractory MC
  • Administered subcutaneously; may also be given intralesionally
  • Influenza-like symptoms may occur

Non-Pharmacological Therapy

No Treatment

  • In immunocompetent hosts, MC is a self-limited disease, which when left untreated eventually resolves after 6 mth up to 5 yr
    • Individual lesions may resolve spontaneously w/in 2 mth & completely disappear in 6-12 mth
    • New lesions can develop w/ autoinoculation
  • Advantages: No scarring, not painful
  • Disadvantages: May transfer virus to other individuals or continue to spread to self w/ autoinoculation

Cryotherapy

  • Liquid nitrogen is applied to each lesion for a few seconds
  • Advantages: Effective treatment
  • Disadvantages: Painful, risk of blistering, risk of hyper- or hypopigmentation & scarring, multiple clinic visits may be necessary

Evisceration/Curettage

  • Mechanical removal of the core of the lesion; scalpel, edge of glass slide, etc may be used to remove umbilicated core
  • 2-4 mm curette may also be used to “flick” off the papule
  • Advantages: Effective treatment, immediate results
  • Disadvantages: Painful, risk of spread, scarring, bleeding, multiple office visits may be necessary
    • Topical anesthetic cream should be applied prior to treatment
    • May not be tolerated by small children
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