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Molluscum contagiosum

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]

Synonyms and keywords:

Overview

Overview

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]

Overview

Molluscum contagiosum is a common disease that mostly affect children in preschool age and school aged children as well. Outbreaks of molluscum contagiosum have occurred in the different settings like swimming pools. Molluscum contagiosum may be classified according to virus sub-types based on restriction endonuclease analysis into 4 different subtypes. There is not enough evidence about correlation of molluscum contagiosum subtypes and the disease features or anatomical distribution of lesions.[1] Molluscum contagiosum is usually transmitted via direct contact with a lesion route to the human host. Following transmission, the molluscum contagiosum uses the human body cells to replicate. On gross pathology, a central umbilication, and punctiform vessels are characteristic findings of molluscum contagiosum. On electronic microscopic analysis, typical brick-shaped poxvirus particles inside the infected tissue are characteristic findings of molluscum contagiosum. he most important risk factors associated with molluscum contagiosum include: childhood age, closer contact sports[1], swimming-pool attendance [2], sexual relationship and multiple sexual partners[1], immunodeficient states[3]such as inherited immunodeficiencies, human immunodeficiency virus (HIV) infection, and following treatment with immunosuppressive drugs. [4]The hallmark of molluscum contagiosum is 2 to 5 mm in diameter lesions that spares over hands and feet. The mainstay of therapy for molluscum contagiosum is topical treatment.

Historical perspective

Molluscum contagiosum was first discovered by Bateman in 1817 in his second edition of his synopsis. In 1841 Paterson demonstrated molluscum contagiosum’s infectious nature. The viral nature of the disease was demonstrated by Juliusberg in 1905. Outbreaks of molluscum contagiosum have occurred in the different settings like swimming pools, but the exact information about outbreaks is not available due to report policy.

Classification

Molluscum contagiosum may be classified according to virus sub-types based on restriction endonuclease analysis into 4 different subtypes. There are 4 types of MCV, MCV-1 to 4, with MCV-1 being the most prevalent and MCV-2 seen usually in adults and often sexually transmitted. There is not enough evidence about correlation of molluscum contagiosum subtypes and the disease features or anatomical distribution of lesions.[1]

Pathophysiology

Molluscum contagiosum is usually transmitted via direct contact with a lesion route to the human host. Following transmission, the molluscum contagiosum uses the human body cells to replicate. On gross pathology, a central umbilication, and punctiform vessels are characteristic findings of molluscum contagiosum. On electronic microscopic analysis, typical brick-shaped poxvirus particles inside the infected tissue are characteristic findings of molluscum contagiosum.

Differentiating tonsillitis from other diseases

Molluscum contagiosum must be differentiated from other diseases that cause infection of the skin and of the mucous membranes. Skin lesions due to cryptococcosis, histoplasmosis, or Penicillium marneffei infection may resemble molluscum lesions. Other lesions that may be mistaken from molluscum contagiosum include flat warts, condyloma acuminatum, pyogenic granuloma , adnexal tumors, Langerhans cell histiocytosis , basal cell carcinoma , and amelanotic melanoma. Skin biopsy is useful for distinguishing molluscum contagiosum from other disorders.

Epidemiology and Demographics

The prevalence of molluscum contagiosum is estimated to be around 8000 cases per 100,000 annually. Worldwide, the incidence of molluscum contagiosum is 1200-1400 per 100,000 persons.[5] Molluscum contagiosum is a common disease that tends to affect children and immunocompromised. There is no racial predilection to molluscum contagiosum. There is no gender predilection to molluscum contagiosum.

Risk Factors

The most important risk factors associated with molluscum contagiosum include: childhood age, closer contact sports[1], swimming-pool attendance [2], sexual relationship and multiple sexual partners[1], immunodeficient states[3]such as inherited immunodeficiencies, human immunodeficiency virus (HIV) infection, and following treatment with immunosuppressive drugs. [4]

Screening

There is insufficient evidence to recommend routine screening for molluscum contagiosum. Molluscum Contagiosum Diagnostic Tool for Parents (MCDTP) is a new developed diagnostic test for in home diagnosis of the molluscum contagiosum in children but it is not recommended by guidelines as a routine screening test. There is no guideline recommendation for screening of molluscum contagiosum in suspected cases.[6]

Natural history, complications and prognosis

Natural History

The symptoms of molluscum contagiosum usually develop 2 to 7 weeks after exposure but may range from 1 week to 6 months, with a mean of 6 weeks. Molluscum contagiosum start with symptoms such as rash and pruritis. Molluscum contagiosum is a self-limited disease that can be resolved even without treatment. Occasionally, disease may persists for up to three to five years. [7][8][4]

Complications

Complications that can develop as a result of Molluscum contagiosum is skin scarring (which usually may happen after spontaneous resolution), chronic conjunctivitis or keratoconjunctivitis, and rarely Gianotti-Crosti like eruptions. Inflammatory reactions to molluscum contagiosum antigen has been reported.[9][10]

Prognosis

The prognosis of molluscum contagiosum is good even without treatment.

Diagnosis

Diagnostic criteria

There are no criteria for the diagnosis of molluscum contagiosum. Although the diagnosis is usually based on characteristic appearance of the lesions, diagnostic studies that can be used include histologic examination, dermoscopic examination and electron microscopy of biopsies.

History and Symptoms

The hallmark of molluscum contagiosum is 2 to 5 mm in diameter lesions that spares over hands and feet. A positive history of swimming-pool attendance[2], sexual multiple partners[1], and endemic infection are suggestive of molluscum contagiosum. The most common symptoms of molluscum contagiosum include shiny surface skin lesions, may be associated with erythema around the lesion and pruritus. Less common symptoms of molluscum contagiosum include conjunctivitis, and erythema in all the body.

Physical Examination

Patients with molluscum contagiosum usually appear good and healthy. Physical examination of patients with molluscum contagiosum is usually remarkable for skin papules that are small, shiny and firm.

Laboratory Findings

There are no diagnostic lab findings associated with molluscum contagiosum. The diagnosis of molluscum contagiosum should be made clinically. For confirmation of the diagnosis, pathological studies can be done which involve Hematoxylin and Eosin staining of the infected tissue[11] and direct visualization. it is also recommended to test for other sexually transmitted diseases in adults and for immunodeficiency related diseases.

Imaging Findings

Molluscum contagiosum can also be diagnosed with dermoscopic evaluation of infected tissue. In dermoscopic exam of infected tissue, a central umbilication with poly-lobular, white to yellow amorphous structures is visualized which is typical for diagnosis. Also a peripheral crown of radiating or punctiform vessels may be seen as well.[12]

Treatment

Medical Therapy

The mainstay of therapy for molluscum contagiosum is topical treatment. Contemporary medical therapies for molluscum contagiosum are based on topical application of caustic agents including cantharidin, podophyllotoxin, imiquimod, and potassium hydroxide. Cryotherapy is another topical therapy that involve liquid nitrogen application with a cotton-tipped swab to the lesion.

Surgery

Surgical treatments include curettage, in which molluscum contagiosum lesions are removed with a surgical knife. Also laser therapy can be effective in the treatment of molluscum contagiosum lesions.

Prevention

Primary Prevention

Effective measures for the primary prevention of molluscum contagiosum include following hygiene (cleanliness) habits, covering lesions, and not to share personal items with others.

Secondary Prevention

Secondary prevention strategies following molluscum contagiosum include early detection of lesions.

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 Dohil MA, Lin P, Lee J, Lucky AW, Paller AS, Eichenfield LF (2006). “The epidemiology of molluscum contagiosum in children”. J. Am. Acad. Dermatol. 54 (1): 47–54. doi:10.1016/j.jaad.2005.08.035. PMID 16384754.
  2. ↑ 2.0 2.1 2.2 Monteagudo B, Cabanillas M, Acevedo A, de Las Heras C, Pérez-Pérez L, Suárez-Amor O, Ginarte M (2010). “[Molluscum contagiosum: descriptive study]”. An Pediatr (Barc) (in Spanish; Castilian). 72 (2): 139–42. doi:10.1016/j.anpedi.2009.09.008. PMID 19880360.
  3. ↑ 3.0 3.1 Zhang Q, Davis JC, Lamborn IT, Freeman AF, Jing H, Favreau AJ, Matthews HF, Davis J, Turner ML, Uzel G, Holland SM, Su HC (2009). “Combined immunodeficiency associated with DOCK8 mutations”. N. Engl. J. Med. 361 (21): 2046–55. doi:10.1056/NEJMoa0905506. PMC 2965730. PMID 19776401.
  4. ↑ 4.0 4.1 4.2 Lee R, Schwartz RA (2010). “Pediatric molluscum contagiosum: reflections on the last challenging poxvirus infection, Part 1”. Cutis. 86 (5): 230–6. PMID 21214122.
  5. ↑ Olsen JR, Gallacher J, Piguet V, Francis NA (2014). “Epidemiology of molluscum contagiosum in children: a systematic review”. Fam Pract. 31 (2): 130–6. doi:10.1093/fampra/cmt075. PMID 24297468.
  6. ↑ Olsen JR, Gallacher J, Piguet V, Francis NA (2014). “Development and validation of the Molluscum Contagiosum Diagnostic Tool for Parents: diagnostic accuracy study in primary care”. Br J Gen Pract. 64 (625): e471–6. doi:10.3399/bjgp14X680941. PMC 4111339. PMID 25071059.
  7. ↑ Brown J, Janniger CK, Schwartz RA, Silverberg NB (2006). “Childhood molluscum contagiosum”. Int. J. Dermatol. 45 (2): 93–9. doi:10.1111/j.1365-4632.2006.02737.x. PMID 16445494.
  8. ↑ Butala N, Siegfried E, Weissler A (2013). “Molluscum BOTE sign: a predictor of imminent resolution”. Pediatrics. 131 (5): e1650–3. doi:10.1542/peds.2012-2933. PMID 23545377.
  9. ↑ Berger EM, Orlow SJ, Patel RR, Schaffer JV (2012). “Experience with molluscum contagiosum and associated inflammatory reactions in a pediatric dermatology practice: the bump that rashes”. Arch Dermatol. 148 (11): 1257–64. doi:10.1001/archdermatol.2012.2414. PMID 22911012.
  10. ↑ Babu TA, Arivazhahan A (2015). “Gianotti-Crosti Syndrome following immunization in an 18 months old child”. Indian Dermatol Online J. 6 (6): 413–5. doi:10.4103/2229-5178.169713. PMC 4693355. PMID 26751677.
  11. ↑ Pearce L, Brown WH (1945). “HEREDITARY ACHONDROPLASIA IN THE RABBIT : II. PATHOLOGIC ASPECTS”. J. Exp. Med. 82 (4): 261–80. PMC 2135556. PMID 19871499.
  12. ↑ Morales A, Puig S, Malvehy J, Zaballos P (2005). “Dermoscopy of molluscum contagiosum”. Arch Dermatol. 141 (12): 1644. doi:10.1001/archderm.141.12.1644. PMID 16365277.

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Historical perspective

Historical perspective

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]

Overview

Molluscum contagiosum was first described by Bateman in 1817 in the second edition of his synopsis. In 1841, Paterson demonstrated molluscum contagiosum’s infectious nature. The viral nature of the disease was demonstrated by Juliusberg in 1905.

Historical Perspective

Discovery

Molluscum contagiosum was first discovered by Bateman in 1817.[1]

Landmark Events in the Development of Treatment Strategies

  • Molluscum contagiosum was first discovered by Bateman in 1817 in his second edition of his synopsis.[1]
  • In 1841, Paterson demonstrated molluscum contagiosum infectious nature.
  • Also in 1841, Henderson-Paterson bodies (intracytoplasmic inclusion bodies, lobules containing hyalinized molluscum bodies) were described by scientists Henderson and Paterson.[2]
  • In 1905, the viral nature of the disease was demonstrated by Juliusberg.[3]
  • In 1997, Senkevich et al were the first who described molluscum contagiosum virus (MCV) genome.[4]
  • Molluscum contagiosum virus types I-IV were identified with the advance of the technology through restrictive endonuclease analysis of the genomes of isolates.[5]

References

  1. ↑ 1.0 1.1 Pickering WR, Woods RA (1972). “The uptake and incorporation of purines by wild-type Saccharomyces cerevisiae and a mutant resistant to 4-aminopyrazolo (3,4-d) pyrimidine”. Biochim. Biophys. Acta. 264 (1): 45–58. PMID 4336666.
  2. ↑ Torres A (1986). “The molluscum body. The Henderson-Paterson body with Lipschütz granules”. Am J Dermatopathol. 8 (3): 260–2. PMID 3524303.
  3. ↑ RAKE G, BLANK H (1950). “The relationship of host and virus in molluscum contagiosum”. J. Invest. Dermatol. 15 (2): 81–93. PMID 15437050.
  4. ↑ Senkevich TG, Koonin EV, Bugert JJ, Darai G, Moss B (1997). “The genome of molluscum contagiosum virus: analysis and comparison with other poxviruses”. Virology. 233 (1): 19–42. doi:10.1006/viro.1997.8607. PMID 9201214.
  5. ↑ “www.microbiologyresearch.org” (PDF).
Classification

Classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]

Overview

Molluscum contagiosum may be classified according to virus subtypes, based on the restriction endonuclease analysis into 4 different subtypes. Type 1 is the most commonly seen subtype.

Classification

  • Molluscum contagiosum may be classified according to restriction endonuclease analysis into 4 different subtypes:[1]
    • MCV-1: Highest prevalence
    • MCV-2: Often seen in adults and is sexually transmitted.
    • MCV-3
    • MCV-4
  • Molluscum contagiosum may also be classified based on the presentation of the lesions to:

References

  1. ↑ Highet AS (1992). “Molluscum contagiosum”. Arch. Dis. Child. 67 (10): 1248–9. PMC 1793928. PMID 1444521.
Pathophysiology

Pathophysiology

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]

Overview

Molluscum contagiosum is usually transmitted via direct contact with a skin lesion. Following transmission, molluscum contagiosum uses the human cell machinery to replicate. On gross pathology, a central umbilication and punctiform vessels are characteristic findings of molluscum contagiosum. On electron microscopic analysis, typical brick-shaped poxvirus particles inside the infected tissue are characteristic findings of molluscum contagiosum.

Pathogenesis

  • The human molluscum contagiosum virus (MCV) is a DNA poxvirus.
  • MCV has no animal reservoir, infecting only humans.
  • MCV replicates in cells cytoplasm. This may be related to genetic similarity in variola and vaccinia viruses more than one-half.
  • In adults, molluscum infections are often sexually transmitted and usually affect the genitals, lower abdomen, buttocks, and inner thighs. In rare cases, molluscum contagiosum infections are also found on the lips, mouth, and eyelids. It spread through direct contact or shared articles of clothing (including towels).
  • MCV can commonly cause asymptomatic cutaneous neoplasms. Children and sexually active adults as well as persistent opportunistic acquired immunodeficiency syndrome (AIDS)-associated disease are more sensitive to the virus and more in danger for cutaneous neoplasm. [1]

Genetics

  • In 1997, Senkevich et al were the first who described molluscum contagiosum virus (MCV) genome.[2]
  • MCV possesses 59 genes predicted to code for novel proteins including MHC-class I, chemokine, and glutathione peroxidase homologs not found in other poxviruses. The MCV genomic data is near complete which can allow the investigation of host defense mechanisms. These information also can provide new possibilities for the development of therapeutics for treatment and prevention of the MCV infection.[3][4]
  • Molluscum contagiosum inhibits the host inflammatory response. This unique feature seems to be related to some of the specific genes that are present in its genome.
  • Scientists have sequenced more than 190-kilobase pair genome of MCV. These genome findings have revealed that the virus potentially encodes approximately 182 proteins, 105 of which have direct counterparts in orthopoxviruses (OPV).[1] Another study suggests that MCV lacks counterparts to 83 genes of the smallpox virus, including those important in suppression of host responses to infection, nucleotide biosynthesis, and cell proliferation.[3]

Gross Pathology

In a dermoscopic exam of infected tissue the important parts include:

  • A central umbilication with polylobular, white to yellow amorphous structures
  • A peripheral crown of radiating or punctiform vessels[4]

Microscopic Pathology

Electron microscopic evaluation of tissue is not a part of routine diagnosis procedure, but if done it may show:[4]

References

  1. ↑ 1.0 1.1 Fife KH, Whitfeld M, Faust H, Goheen MP, Bryan J, Brown DR (1996). “Growth of molluscum contagiosum virus in a human foreskin xenograft model”. Virology. 226 (1): 95–101. doi:10.1006/viro.1996.0631. PMID 8941326.
  2. ↑ Senkevich TG, Koonin EV, Bugert JJ, Darai G, Moss B (1997). “The genome of molluscum contagiosum virus: analysis and comparison with other poxviruses”. Virology. 233 (1): 19–42. doi:10.1006/viro.1997.8607. PMID 9201214.
  3. ↑ 3.0 3.1 Bugert JJ, Darai G (1997). “Recent advances in molluscum contagiosum virus research”. Arch. Virol. Suppl. 13: 35–47. PMID 9413524.
  4. ↑ 4.0 4.1 4.2 Senkevich TG, Koonin EV, Bugert JJ, Darai G, Moss B (1997). “The genome of molluscum contagiosum virus: analysis and comparison with other poxviruses”. Virology. 233 (1): 19–42. doi:10.1006/viro.1997.8607. PMID 9201214.

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Causes

Causes

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]

Overview

Molluscum contagiosum is usually transmitted via direct contact with a skin lesion. Following transmission, molluscum contagiosum uses the human cell machinery to replicate. On gross pathology, a central umbilication and punctiform vessels are characteristic findings of molluscum contagiosum. On electron microscopic analysis, typical brick-shaped poxvirus particles inside the infected tissue are characteristic findings of molluscum contagiosum.

Pathogenesis

  • The human molluscum contagiosum virus (MCV) is a DNA poxvirus.
  • MCV has no animal reservoir, infecting only humans.
  • MCV replicates in cells cytoplasm. This may be related to genetic similarity in variola and vaccinia viruses more than one-half.
  • In adults, molluscum infections are often sexually transmitted and usually affect the genitals, lower abdomen, buttocks, and inner thighs. In rare cases, molluscum contagiosum infections are also found on the lips, mouth, and eyelids. It spread through direct contact or shared articles of clothing (including towels).
  • MCV can commonly cause asymptomatic cutaneous neoplasms. Children and sexually active adults as well as persistent opportunistic acquired immunodeficiency syndrome (AIDS)-associated disease are more sensitive to the virus and more in danger for cutaneous neoplasm. [1]

Genetics

  • In 1997, Senkevich et al were the first who described molluscum contagiosum virus (MCV) genome.[2]
  • MCV possesses 59 genes predicted to code for novel proteins including MHC-class I, chemokine, and glutathione peroxidase homologs not found in other poxviruses. The MCV genomic data is near complete which can allow the investigation of host defense mechanisms. These information also can provide new possibilities for the development of therapeutics for treatment and prevention of the MCV infection.[3][4]
  • Molluscum contagiosum inhibits the host inflammatory response. This unique feature seems to be related to some of the specific genes that are present in its genome.
  • Scientists have sequenced more than 190-kilobase pair genome of MCV. These genome findings have revealed that the virus potentially encodes approximately 182 proteins, 105 of which have direct counterparts in orthopoxviruses (OPV).[1] Another study suggests that MCV lacks counterparts to 83 genes of the smallpox virus, including those important in suppression of host responses to infection, nucleotide biosynthesis, and cell proliferation.[3]

Gross Pathology

In a dermoscopic exam of infected tissue the important parts include:

  • A central umbilication with polylobular, white to yellow amorphous structures
  • A peripheral crown of radiating or punctiform vessels[4]

Microscopic Pathology

Electron microscopic evaluation of tissue is not a part of routine diagnosis procedure, but if done it may show:[4]

References

  1. ↑ 1.0 1.1 Fife KH, Whitfeld M, Faust H, Goheen MP, Bryan J, Brown DR (1996). “Growth of molluscum contagiosum virus in a human foreskin xenograft model”. Virology. 226 (1): 95–101. doi:10.1006/viro.1996.0631. PMID 8941326.
  2. ↑ Senkevich TG, Koonin EV, Bugert JJ, Darai G, Moss B (1997). “The genome of molluscum contagiosum virus: analysis and comparison with other poxviruses”. Virology. 233 (1): 19–42. doi:10.1006/viro.1997.8607. PMID 9201214.
  3. ↑ 3.0 3.1 Bugert JJ, Darai G (1997). “Recent advances in molluscum contagiosum virus research”. Arch. Virol. Suppl. 13: 35–47. PMID 9413524.
  4. ↑ 4.0 4.1 4.2 Senkevich TG, Koonin EV, Bugert JJ, Darai G, Moss B (1997). “The genome of molluscum contagiosum virus: analysis and comparison with other poxviruses”. Virology. 233 (1): 19–42. doi:10.1006/viro.1997.8607. PMID 9201214.

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Differentiating Molluscum contagiosum from other Diseases

Differentiating Molluscum contagiosum from other Diseases

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2], João André Alves Silva, M.D. [3]

Overview

Molluscum contagiosum must be differentiated from other diseases that cause inflammatory or ulcertive skin , genital, or mucosal lesions including chicken pox, herpes zoster, erythema multiforme, cryptococcosis, histoplasmosis, pyogenic granuloma.

Differential Diagnosis

Different conditions that cause a round papular rash must be differentiated from molluscum contagiosum based on the appearance of the lesions such as:[1][2][3][4][5][6][7]

Disease Features Images
Molluscum contagiosum
  • Skin papules:
    • Firm
    • Dome shaped
    • Shiny
    • 2 to 5 mm diameter
    • May have central indentation or umbilication
  • Polypoid lesion: Occasionally, with a stalk-like base
  • Visibly inflamed lesions occasionally may be seen
  • Diffuse erythema: May be seen due to Gianotti-Crosti like eruptions

Cryptococcosis[8] 

Histoplasmosis
[9][10][11][12]

Penicillium marneffei[13]
Condyloma acuminatum [14]

Pyogenic granuloma[15][16][17]

Langerhans cell histiocytosis[18][19][20][21][22]

Basal cell carcinoma[23]

Amelanotic melanoma

References

  1. ↑ Hartman-Adams H, Banvard C, Juckett G (2014). “Impetigo: diagnosis and treatment”. Am Fam Physician. 90 (4): 229–35. PMID 25250996.
  2. ↑ Mehta N, Chen KK, Kroumpouzos G (2016). “Skin disease in pregnancy: The approach of the obstetric medicine physician”. Clin Dermatol. 34 (3): 320–6. doi:10.1016/j.clindermatol.2016.02.003. PMID 27265069.
  3. ↑ Moore, Zack S; Seward, Jane F; Lane, J Michael (2006). “Smallpox”. The Lancet. 367 (9508): 425–435. doi:10.1016/S0140-6736(06)68143-9. ISSN 0140-6736.
  4. ↑ Ibrahim F, Khan T, Pujalte GG (2015). “Bacterial Skin Infections”. Prim Care. 42 (4): 485–99. doi:10.1016/j.pop.2015.08.001. PMID 26612370.
  5. ↑ Ramoni S, Boneschi V, Cusini M (2016). “Syphilis as “the great imitator”: a case of impetiginoid syphiloderm”. Int J Dermatol. 55 (3): e162–3. doi:10.1111/ijd.13072. PMID 26566601.
  6. ↑ Kimura U, Yokoyama K, Hiruma M, Kano R, Takamori K, Suga Y (2015). “Tinea faciei caused by Trichophyton mentagrophytes (molecular type Arthroderma benhamiae ) mimics impetigo : a case report and literature review of cases in Japan”. Med Mycol J. 56 (1): E1–5. doi:10.3314/mmj.56.E1. PMID 25855021.
  7. ↑ CEDEF (2012). “[Item 87–Mucocutaneous bacterial infections]”. Ann Dermatol Venereol. 139 (11 Suppl): A32–9. doi:10.1016/j.annder.2012.01.002. PMID 23176858.
  8. ↑ Miyazato A (2016). “[Mechanism of Cryptococcus Meningoencephalitis]”. Med Mycol J (in Japanese). 57 (1): J27–32. doi:10.3314/mmj.57.J27. PMID 26936349.
  9. ↑ Knox KS, Hage CA (2010). “Histoplasmosis”. Proc Am Thorac Soc. 7 (3): 169–72. doi:10.1513/pats.200907-069AL. PMID 20463244.
  10. ↑ Kauffman CA (2009). “Histoplasmosis”. Clin Chest Med. 30 (2): 217–25, v. doi:10.1016/j.ccm.2009.02.002. PMID 19375629.
  11. ↑ Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL (2008). “Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008”. Critical Care Medicine. 36 (1): 296–327. doi:10.1097/01.CCM.0000298158.12101.41. PMID 18158437. Retrieved 2012-09-16. Unknown parameter |month= ignored (help)
  12. ↑ Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992 Jun;101(6):1644-55. PMID 1303622.
  13. ↑ Supparatpinyo K, Chiewchanvit S, Hirunsri P, Baosoung V, Uthammachai C, Chaimongkol B; et al. (1992). “An efficacy study of itraconazole in the treatment of Penicillium marneffei infection”. J Med Assoc Thai. 75 (12): 688–91. PMID 1339213.
  14. ↑ Cortez, Michelle Fay and Pettypiece, Shannon. “Merck Cancer Shot Cuts Genital Warts, Lesions in Men”. Bloomberg News. (Bloomberg.com) 13 Nov 2008.
  15. ↑ Freedberg, et al. (2003). Fitzpatrick’s Dermatology in General Medicine. (6th ed.). McGraw-Hill. ISBN 0-07-138076-0.
  16. ↑ Jafarzadeh H, Sanatkhani M, Mohtasham N (December 2006). “Oral pyogenic granuloma: a review” (– Scholar search). J Oral Sci. 48 (4): 167–75. doi:10.2334/josnusd.48.167. PMID 17220613. Retrieved 2009-01-04.
  17. ↑ Nthumba PM (2008). “Giant pyogenic granuloma of the thigh: a case report”. J Med Case Reports. 2 (1): 95. doi:10.1186/1752-1947-2-95. PMC 2329656. PMID 18377654.
  18. ↑ Grana N (2014). “Langerhans cell histiocytosis”. Cancer Control. 21 (4): 328–34. PMID 25310214.
  19. ↑ Harmon CM, Brown N (2015). “Langerhans Cell Histiocytosis: A Clinicopathologic Review and Molecular Pathogenetic Update”. Arch Pathol Lab Med. 139 (10): 1211–4. doi:10.5858/arpa.2015-0199-RA. PMID 26414464.
  20. ↑ DiCaprio MR, Roberts TT (2014). “Diagnosis and Management of Langerhans Cell Histiocytosis”. J Am Acad Orthop Surg. 22 (10): 643–652. doi:10.5435/JAAOS-22-10-643. PMID 25281259.
  21. ↑ Langerhans cell histiocytosis. Wikipedia (2015) https://en.wikipedia.org/wiki/Langerhans_cell_histiocytosis Accessed on February, 2 2016
  22. ↑ Langerhans cell histiocytosis. Radiopeadia (2015) http://radiopaedia.org/articles/langerhans-cell-histiocytosis Accessed on February, 3 2016
  23. ↑ Epstein EH, Shepard JA, Flotte TJ (2008). “Case records of the Massachusetts General Hospital. Case 3-2008. An 80-year-old woman with cutaneous basal-cell carcinomas and cysts of the jaws”. N Engl J Med. 358 (4): 393–401. doi:10.1056/NEJMcpc0707893. PMID 18216361. Unknown parameter |month= ignored (help)

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Epidemiology and Demographics

Epidemiology and Demographics

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]

Overview

The prevalence of molluscum contagiosum is estimated to be around 8000 cases per 100,000 annually. Molluscum contagiosum is a common disease that tends to affect children and immunocompromised adults. Among children, boys and girls are affected equally by molluscum contagiosum. In adulthood, molluscum contagiosum is more prevalent in men than women . There is no racial predilection to molluscum contagiosum.

Epidemiology and Demographics

Prevalence

  • Worldwide, the prevalence of molluscum contagiosum in children aged 0-16 year ranges from 5000 to 11500 per 100,000 persons with an average prevalence of 8000 per 100,000 persons.[1]

Incidence

  • Worldwide, the incidence of molluscum contagiosum is 1200-1400 per 100,000 persons per year.[1]
  • Outbreaks of molluscum contagiosum have occurred in different settings like swimming pools, but the exact information about outbreaks is not available due to the subclinical manifestations leading to under reporting.

Case Fatality Rate

Age

  • The prevalence of molluscum contagiosum decreases with age.[4][1][5]
  • Incidence first peaks in preschool/school-aged children, with the greatest incidence being in those aged 1-4 years.[6]
  • If diagnosed in adults, molluscum contagiosum will most commonly be seen in the 18 to 20 year age group.[7]

Gender

  • Among children, boys and girls are affected equally by molluscum contagiosum.
  • In adulthood, molluscum contagiosum is more prevalent in men than in women .
  • The male to female ratio is approximately 3 to 1 [8]. A high proportion of the studied subjects were HIV-positive adults.[9][10]

Race

  • There is no racial predilection to molluscum contagiosum.[11]

Geographic Distribution

  • There are no geographic predispositions to molluscum contagiosum.

References

  1. ↑ 1.0 1.1 1.2 Olsen JR, Gallacher J, Piguet V, Francis NA (2014). “Epidemiology of molluscum contagiosum in children: a systematic review”. Fam Pract. 31 (2): 130–6. doi:10.1093/fampra/cmt075. PMID 24297468.
  2. ↑ Calista D, Boschini A, Landi G (1999). “Resolution of disseminated molluscum contagiosum with Highly Active Anti-Retroviral Therapy (HAART) in patients with AIDS”. Eur J Dermatol. 9 (3): 211–3. PMID 10210787.
  3. ↑ Koopman RJ, van Merriënboer FC, Vreden SG, Dolmans WM (1992). “Molluscum contagiosum; a marker for advanced HIV infection”. Br. J. Dermatol. 126 (5): 528–9. PMID 1610701.
  4. ↑ Leung AK, Barankin B, Hon KL (2017). “Molluscum contagiosum: an update”. Recent Pat Inflamm Allergy Drug Discov. doi:10.2174/1872213X11666170518114456. PMID 28521677.
  5. ↑ Dohil MA, Lin P, Lee J, Lucky AW, Paller AS, Eichenfield LF (2006). “The epidemiology of molluscum contagiosum in children”. J. Am. Acad. Dermatol. 54 (1): 47–54. doi:10.1016/j.jaad.2005.08.035. PMID 16384754.
  6. ↑ Kalasannavar SB, Sawalgimath MP (2013). “Molluscum contagiosum: A novel Ayurvedic approach”. Anc Sci Life. 33 (1): 49–51. doi:10.4103/0257-7941.134606. PMC 4140023. PMID 25161331.
  7. ↑ Laxmisha C, Thappa DM, Jaisankar TJ (2003). “Clinical profile of molluscum contagiosum in children versus adults”. Dermatol. Online J. 9 (5): 1. PMID 14996374.
  8. ↑ “Sexually transmitted diseases. Extract from the annual report of the Chief Medical Officer of the Department of Health and Social Security of the year 1980”. Br J Vener Dis. 59 (2): 134–7. 1983. PMC 1046157. PMID 6687557.
  9. ↑ Overfield TM, Brody JA (1966). “An epidemiologic study of molluscum contagiosum in Anchorage, Alaska”. J. Pediatr. 69 (4): 640–2. PMID 5921341.
  10. ↑ Gottlieb SL, Myskowski PL (1994). “Molluscum contagiosum”. Int. J. Dermatol. 33 (7): 453–61. PMID 7928025.
  11. ↑ Konya J, Thompson CH (1999). “Molluscum contagiosum virus: antibody responses in persons with clinical lesions and seroepidemiology in a representative Australian population”. J. Infect. Dis. 179 (3): 701–4. doi:10.1086/314620. PMID 9952381.

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Risk Factors

Risk Factors

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]

Overview

The prevalence of molluscum contagiosum is estimated to be around 8000 cases per 100,000 annually. Molluscum contagiosum is a common disease that tends to affect children and immunocompromised adults. Among children, boys and girls are affected equally by molluscum contagiosum. In adulthood, molluscum contagiosum is more prevalent in men than women . There is no racial predilection to molluscum contagiosum.

Epidemiology and Demographics

Prevalence

  • Worldwide, the prevalence of molluscum contagiosum in children aged 0-16 year ranges from 5000 to 11500 per 100,000 persons with an average prevalence of 8000 per 100,000 persons.[1]

Incidence

  • Worldwide, the incidence of molluscum contagiosum is 1200-1400 per 100,000 persons per year.[1]
  • Outbreaks of molluscum contagiosum have occurred in different settings like swimming pools, but the exact information about outbreaks is not available due to the subclinical manifestations leading to under reporting.

Case Fatality Rate

Age

  • The prevalence of molluscum contagiosum decreases with age.[4][1][5]
  • Incidence first peaks in preschool/school-aged children, with the greatest incidence being in those aged 1-4 years.[6]
  • If diagnosed in adults, molluscum contagiosum will most commonly be seen in the 18 to 20 year age group.[7]

Gender

  • Among children, boys and girls are affected equally by molluscum contagiosum.
  • In adulthood, molluscum contagiosum is more prevalent in men than in women .
  • The male to female ratio is approximately 3 to 1 [8]. A high proportion of the studied subjects were HIV-positive adults.[9][10]

Race

  • There is no racial predilection to molluscum contagiosum.[11]

Geographic Distribution

  • There are no geographic predispositions to molluscum contagiosum.

References

  1. ↑ 1.0 1.1 1.2 Olsen JR, Gallacher J, Piguet V, Francis NA (2014). “Epidemiology of molluscum contagiosum in children: a systematic review”. Fam Pract. 31 (2): 130–6. doi:10.1093/fampra/cmt075. PMID 24297468.
  2. ↑ Calista D, Boschini A, Landi G (1999). “Resolution of disseminated molluscum contagiosum with Highly Active Anti-Retroviral Therapy (HAART) in patients with AIDS”. Eur J Dermatol. 9 (3): 211–3. PMID 10210787.
  3. ↑ Koopman RJ, van Merriënboer FC, Vreden SG, Dolmans WM (1992). “Molluscum contagiosum; a marker for advanced HIV infection”. Br. J. Dermatol. 126 (5): 528–9. PMID 1610701.
  4. ↑ Leung AK, Barankin B, Hon KL (2017). “Molluscum contagiosum: an update”. Recent Pat Inflamm Allergy Drug Discov. doi:10.2174/1872213X11666170518114456. PMID 28521677.
  5. ↑ Dohil MA, Lin P, Lee J, Lucky AW, Paller AS, Eichenfield LF (2006). “The epidemiology of molluscum contagiosum in children”. J. Am. Acad. Dermatol. 54 (1): 47–54. doi:10.1016/j.jaad.2005.08.035. PMID 16384754.
  6. ↑ Kalasannavar SB, Sawalgimath MP (2013). “Molluscum contagiosum: A novel Ayurvedic approach”. Anc Sci Life. 33 (1): 49–51. doi:10.4103/0257-7941.134606. PMC 4140023. PMID 25161331.
  7. ↑ Laxmisha C, Thappa DM, Jaisankar TJ (2003). “Clinical profile of molluscum contagiosum in children versus adults”. Dermatol. Online J. 9 (5): 1. PMID 14996374.
  8. ↑ “Sexually transmitted diseases. Extract from the annual report of the Chief Medical Officer of the Department of Health and Social Security of the year 1980”. Br J Vener Dis. 59 (2): 134–7. 1983. PMC 1046157. PMID 6687557.
  9. ↑ Overfield TM, Brody JA (1966). “An epidemiologic study of molluscum contagiosum in Anchorage, Alaska”. J. Pediatr. 69 (4): 640–2. PMID 5921341.
  10. ↑ Gottlieb SL, Myskowski PL (1994). “Molluscum contagiosum”. Int. J. Dermatol. 33 (7): 453–61. PMID 7928025.
  11. ↑ Konya J, Thompson CH (1999). “Molluscum contagiosum virus: antibody responses in persons with clinical lesions and seroepidemiology in a representative Australian population”. J. Infect. Dis. 179 (3): 701–4. doi:10.1086/314620. PMID 9952381.

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Screening

Screening

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]

Overview

According to the United States Preventive Services Task Force (USPSTF), screening of the general population for molluscum contagiosum is not recommended.

Screening

According to the United States Preventive Services Task Force (USPSTF), screening of the general population for molluscum contagiosum is not recommended. The Molluscum Contagiosum Diagnostic Tool for Parents (MCDTP) is a newly developed diagnostic test for in home diagnosis of the molluscum contagiosum in children but it is not recommended by guidelines as a routine screening test.[1]

References

  1. ↑ Olsen JR, Gallacher J, Piguet V, Francis NA (2014). “Development and validation of the Molluscum Contagiosum Diagnostic Tool for Parents: diagnostic accuracy study in primary care”. Br J Gen Pract. 64 (625): e471–6. doi:10.3399/bjgp14X680941. PMC 4111339. PMID 25071059.
Natural History, Complications and Prognosis

Natural History, Complications and Prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]

Overview

If left untreated, most of the patients with molluscum contagiosum may resolve the lesions spontaneously. Common complications of molluscum contagiosum include scarring, conjunctivitis, inflammatory reaction to molluscum contagiosum anigen and rarely Gianotti-Crosti like eruptions. Prognosis is generally good.

Natural History

  • The symptoms of molluscum contagiosum usually develop 2 to 7 weeks after exposure but may range from 1 week to 6 months, with a mean of 6 weeks.
  • Molluscum contagiosum initially presents with rash and pruritis.
  • Molluscum contagiosum is a self limited disease that usually resolves without treatment.
  • Occasionally, the disease may persist for three to five years. [1][2][3]
  • In rare cases of eye involvement are left untreated, chronic conjunctivitis or keratoconjunctivitis may progress to visual disturbance.

Complications

Complications that can develop as a result of molluscum contagiosum is skin scarring (which usually may happen after spontaneous resolution), chronic conjunctivitis or keratoconjunctivitis, and rarely Gianotti-Crosti like eruptions. Inflammatory reactions to molluscum contagiosum antigen, including the previously underrecognized GCLR, has been reported.

Prognosis

The prognosis of molluscum contagiosum is good even without treatment. Sometimes, molluscum contagiosum will result in scarring. The presence of atopic dermatitis is associated with a particularly poor prognosis and higher chance of scar development among patients with molluscum contagiosum.

References

  1. ↑ Brown J, Janniger CK, Schwartz RA, Silverberg NB (2006). “Childhood molluscum contagiosum”. Int. J. Dermatol. 45 (2): 93–9. doi:10.1111/j.1365-4632.2006.02737.x. PMID 16445494.
  2. ↑ Butala N, Siegfried E, Weissler A (2013). “Molluscum BOTE sign: a predictor of imminent resolution”. Pediatrics. 131 (5): e1650–3. doi:10.1542/peds.2012-2933. PMID 23545377.
  3. ↑ Lee R, Schwartz RA (2010). “Pediatric molluscum contagiosum: reflections on the last challenging poxvirus infection, Part 1”. Cutis. 86 (5): 230–6. PMID 21214122.
  4. ↑ Berger EM, Orlow SJ, Patel RR, Schaffer JV (2012). “Experience with molluscum contagiosum and associated inflammatory reactions in a pediatric dermatology practice: the bump that rashes”. Arch Dermatol. 148 (11): 1257–64. doi:10.1001/archdermatol.2012.2414. PMID 22911012.
  5. ↑ Babu TA, Arivazhahan A (2015). “Gianotti-Crosti Syndrome following immunization in an 18 months old child”. Indian Dermatol Online J. 6 (6): 413–5. doi:10.4103/2229-5178.169713. PMC 4693355. PMID 26751677.
Diagnosis

Diagnosis

Diagnostic Criteria | History and Symptoms | Physical Examination | Laboratory Findings | X-ray | Ultrasound | CT | MRI | Other Imaging Studies| Other Diagnostic Studies

Treatment

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case Studies

Case #1

Related Chapters
  • Acrochordons (also called skin tags — similar in appearance and grow in similar areas)
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