Molluscum Contagiosum: Causes, Symptoms, Treatment
Signs of Molluscum Contagiosum
Molluscum contagiosum, also known as water warts, is a common viral infection that presents as firm, dome-shaped, flesh-colored bumps on the skin, and it has traditionally affected children who are ten years and younger. However, in recent years, the disease has become increasingly common in adults, particularly younger adults, due to an increase in their sexual activity at an earlier age.
It's not considered to be a sexually transmitted disease or STD, but it is carried in the same manner. Since it is so easily spread, those who notice water-filled bumps on their skin should seek medical treatment without delay. Neither lab tests nor imaging is usually required, and the disease primarily affects only the skin, very rarely are other organs involved.
Molluscum contagiosum bumps are waxy in appearance and relatively painless, but they can be very itchy. They can eventually become sensitive or painful. Their size can range from less than 1mm to 5mm or more. Smaller molluscum bumps can be mistaken for an itchy rash, so medical attention may not be sought, which means that the disease can be spread throughout the body via self-contamination. It can also be spread to others when the host is unaware that they have molluscum contagiosum rather than a rash.
Other than the itchy rash, molluscum contagiosum is generally asymptomatic, so the rash may not be accompanied by a fever or malaise such as would happen with a bacteriological infection or another type of disease. Usually, the papules appear to have a clear fluid in the center. Sometimes, a larger papule may be a clump of lesions rather than one large individual lesion. Although a single bump can occur, the virus more often presents as a group of papules spread throughout the body. Some individuals develop eczema in the area of their lesions, but as many as 90 percent of those who have the virus don't develop eczema.
Table of Contents
Type of Virus
The CDC defines molluscum contagiosum as a benign DNA poxvirus with sub-types of viruses I, II, III, and IV. Virus I is responsible for more than 96 percent of infections and usually appears in otherwise healthy adults. Virus II primarily appears in those with human immunodeficiency virus, or HIV. Types III and IV rarely occur.
Poxviruses are the largest viruses to affect animals and are visible through the use of optical microscopy. They're very complex and not replicable through the use of lab cultures.
The disease presents in three distinct patterns, depending on the age and health of the individual:
- Healthy children
- Healthy adults
- Adults or children whose immune system is compromised
The treatment protocol and prognosis are dependent on the pattern of presentation. In children and those with compromised immune systems, the molluscum bumps are more widespread and may become more resistant to treatment. The virus doesn't become latent, and it develops virus-specific proteins that enable it to avoid detection by the immune system.
Molluscum contagiosum is usually oval or rectangular and often presents as lesions, nodules, or a rash. It's spread through direct physical contact with an infected individual or a contaminated surface. It can also be spread to other areas of the body when a lesion is damaged by scratching, shaving, or a similar type of injury. Molluscum contagiosum lesions are benign and typically disappear within six months to one year, but they have been known to persist for as long as four years. When they dissipate without intervention, there's usually no scarring.
Transmission And Fomites
Molluscum contagiosum is only transmitted through direct physical contact with a person, a surface, or an animal that has the disease. It cannot be transmitted through body fluids. Although it's considered a human disease, it can be transmitted to animals because it's part of a family of viruses that can infect both invertebrates and vertebrates, and has been found on chickens, cows, horses, and oxen as well as other animals.
Molluscum contagiosum can survive on non-skin surfaces such as toys, door handles, utensils, clothing, and so forth, so fomite transmission is possible, but direct contact with a contaminated surface is required for transmission. It can survive indefinitely without a host, whether on hard surfaces such as a countertop or on soft surfaces such as a baseball glove. Fomites are objects that are contaminated with an infectious organism and so can transmit the disease to others through secondary contact.
Those individuals who have molluscum contagiosum should disinfect hard surfaces regularly to avoid repeated transmission of the virus. Hard surfaces include clothing, doorknobs, eating utensils and dishes, toys, towels, and any surface that's not human skin. Clothing should be washed frequently and not shared with another person.
Transmission of the virus can occur with children who share a bath or in a gymnasium setting where benches and equipment are shared, including sports helmets, gloves, and mats. School swimming pools have been shown to harbor the virus, and although it is a human disease, it can be transmitted to animals if they're exposed to it. The optimal environment is warm and moist. The virus doesn't last as long in colder temperatures.
In adults, the disease is usually sexually transmitted and limited to the buttocks, lower abdomen, genitalia, and perineum, although in those individuals who have immunodeficiency syndrome, or AIDS, the virus may be more widespread throughout the body. The presence of AIDS can hinder effective therapy, and since other viral infections can mimic the appearance of molluscum contagiosum, there's the possibility of misdiagnosis. Those who have AIDS and contract molluscum contagiosum will usually have multiple lesions on their face.
Molluscum contagiosum presents asymptomatically. An individual may have the virus for up to six months yet be unaware of it. Typically, the incubation period is between 2 and 7 weeks, and the virus may initially present as a small group of lesions that aren't painful and mimic an itchy skin rash. The virus can be transferred from one area of the body to another simply by touching or scratching a lesion.
Symptoms of Molluscum Contagiosum
Since molluscum contagiosum usually presents asymptomatically, it may be present for some time in the host even though the individual may be unaware of its presence. Although individual molluscum lesions may be sensitive or be accompanied by a rash, there are generally no other symptoms such as a fever or nausea or a lack of well-being. Those who have multiple sexual partners are more inclined to develop the disease, as are those who have recently been in contact with an infected individual.
Molluscum contagiosum can appear throughout the body as a single nodule or in groups. The abdomen, arms, genital area, neck, and legs are the most common locations; molluscum bumps seldom appear on the soles of the feet or the palms of the hands. They rarely occur on the face except for those who have HIV, and then they'll usually present in groups rather than singly. HIV-positive individuals may have hundreds of molluscum bumps, and they may be enormous. The presence of HIV may make treatment more difficult since the virus is more likely to become resistant to the treatment protocols.
Molluscum lesions may soften and become red before they dissipate, and a clear fluid may drain from them. The core may appear white and waxy, and the lesions can become chronic if not treated.
Molluscum contagiosum is found throughout the world, and its proliferation may be linked, in part, to inadequate hygiene, humidity, and a warm climate. It appears to be more prevalent in whites than other races, and it affects males more often than females. It's rarely found in children who are younger than one year and is most prevalent in children who are between 1 and 5 years of age, and in young adults. In children, it's most frequently transmitted through casual contact, but in young adults, it's most often transmitted through sexual contact. Worldwide, the incidence of molluscum contagiosum seems to be increasing, as does the age span of infected individuals.
A healthcare professional can usually diagnose the presence of molluscum contagiosum by looking at the bumps. However, a tissue sample may occasionally be needed to confirm the diagnosis. This is accomplished by scraping some tissue from a bump -- which is a painless procedure -- and subjecting it to microscopic analysis.
The prognosis for resolution of molluscum contagiosum is excellent because the virus is benign and self-limiting. Resolution usually occurs within 18 months if there are no extenuating factors such as HIV or AIDS, and some individuals see resolution in as little as nine months. However, some individuals had reported that lesions persisted for up to 5 years when they didn't receive treatment for them. There may be scarring if the lesions have been scratched or abraded or treated with lasers, curettage, or cryotherapy. The presence of the lesions can produce anxiety in those who are afflicted with obvious molluscum bumps, so some individuals may require psychological treatment before the disease abates.
As many as 35 percent of individuals with molluscum contagiosum report recurrences of the disease, although the reasons for the recurrences aren't known. It may be due to reinfection or a spread of the current infection. No mortality rates are available because molluscum contagiosum is a benign dermatological disease that doesn't affect any other vital organs except the eyes. When the molluscum bumps develop on the eyelids, the individual may develop keratoconjunctivitis, which is a non-lethal ocular disease characterized by inflammation of the cornea and the conjunctiva, and the disease should be treated by a medical professional. Left untreated, corneal scarring can occur, and the individual can suffer vision loss.
Unlike many other viruses, the molluscum contagiosum virus doesn't remain in the system once the lesions are gone. Those who develop lesions after a long time without them have simply become reinfected.
How to Treat Molluscum Contagiosum?
Effective treatment regimens may require repeated sessions over an extended period, and it's important to take steps to prevent reinfection both during the treatment and between treatments. When not treated, the disease may become chronic.
Molluscum contagiosum is very common and is becoming more prevalent than ever. Good hygiene practices, such as hand washing and limiting shared clothing and towels, can help contain the disease and prevent reinfection as will avoiding the urge to scratch the lesions. Isolation of children or anyone who is infected isn't necessary, but lesions can be covered with tape or clothing to avoid damage and spread of the disease. Covering the lesions may also provide peach of mind for those who are self-conscious about their lesions. Sexual contact should be avoided because it's unclear whether condoms and the like can inhibit the spread of the disease.
Since molluscum contagiosum will eventually dissipate on its own, it isn't always treated. However, genital lesions are usually treated to eliminate the possibility of a sexually transmitted disease, or STD. Molluscum contagiosum isn't traditionally considered an STD, however. Treatment for genital lesions requires a professional, and it shouldn't be attempted at home. Some treatment options for the virus include:
- Cryotherapy, which uses liquid nitrogen to freeze the lesions
- Laser therapy
- Curettage, which is manual piercing of the lesion and then scraping the caseous material
All of these should be done by a professional in order to prevent infection, pain, and scarring. The treatments also require a local anesthetic, but the procedures are usually relatively quick. Individuals should not attempt to remove the lesions on their own since this can cause an infection or cause the disease to spread, and it will more than likely cause scarring. However, scarring can also occur when the lesions are scratched or scraped off, so physicians don't recommend removing the lesions if the individual is otherwise healthy. Additionally, removing the molluscum bumps can cause a bacterial infection, particularly in individuals who have HIV or AIDS or immune systems that are compromised in another way.
Sometimes, oral therapy is effective, particularly for small children who aren't good candidates for other types of treatments. However, oral therapy is less effective for facial lesions. Topical therapy is sometimes used, but not usually for pregnant women because of the risk of damage to the fetus.
Although the bumps will automatically disappear over time, usually within 6 to 18 months, sometimes either salicylic acid or potassium hydroxide is used to dissolve them or to lift them from the skin. If the eyes have been infected, then medication for keratoconjunctivitis may be prescribed. There are no dietary restrictions for the disease other than the individual's normal dietary restrictions due to food sensitivities and so forth.
Mortality and Morbidity
There has been no mortality rate linked to molluscum contagiosum because it's a skin disorder that primarily affects the skin and no other organ unless keratoconjunctivitis is involved. The morbidity rate is higher in those who have compromised immune systems. Their lesions are larger and more widespread, and there's a higher incidence of resistance to treatment protocols. Although most molluscum bumps abate on their own without leaving a scar, some may leave a slight indentation in the skin.
How to Prevent Molluscum Contagiosum?
The best way to avoid contracting molluscum contagiosum is through good personal hygiene. If you have come into contact with an infected person, wash your hands thoroughly and launder any clothing that may have been in contact with them. Surfaces should be disinfected thoroughly and avoid intimate contact with them as long as they have the disease.
If a child has eczema, it should be treated promptly in order to eliminate the possibility of molluscum contagiosum.
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