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KembaraXtra – Medicine – Molluscum Contagiosum
Molluscum contagiosum is a generally benign viral skin disease characterized by multiple small, painless, pearly papules. The infection is confined to the skin and mucous membranes and spreads through close personal contact or autoinoculation. It occurs worldwide with an estimated incidence of 2–8% and is more prevalent in tropical regions. Coinfection is common in immunocompromised patients, with up to 5–20% of individuals with HIV affected.
The condition is caused by a double-stranded DNA poxvirus of the Molluscipox genus. In children, transmission most commonly occurs through direct skin-to-skin contact, shared objects, or exposure to contaminated water such as swimming pools or baths. In adults, infection is most often acquired through sexual contact, although autoinoculation can occur at any age. Rarely, vertical transmission during childbirth has been reported.
After an incubation period of approximately 14–50 days, patients typically present with asymptomatic lesions, though mild pruritus or tenderness may occur. An eczematous reaction surrounding the lesions is seen in up to one-quarter of cases. In immunocompetent individuals, untreated lesions usually resolve spontaneously within several months but may persist for years. On examination, lesions appear as smooth, firm, dome-shaped papules measuring 2–6 mm in diameter. They may be flesh-colored, white, translucent, or light yellow and often contain a waxy, curd-like core composed of virion-rich material. A central umbilication is a classic feature, though it may be absent in some cases. Children most often have lesions on the face, trunk, and extremities, whereas healthy adults commonly have genital or lower abdominal involvement. In patients with HIV, lesions may be larger, disseminated, persistent, and involve the face, neck, and trunk, sometimes worsening with immune reconstitution after initiation of antiretroviral therapy.
Diagnosis is primarily clinical, based on history and characteristic skin findings. Skin biopsy may be performed when the diagnosis is uncertain. Adult men presenting with molluscum contagiosum should be evaluated for possible immunocompromise. In children, the condition is rarely associated with underlying immunodeficiency and typically does not require further investigation. Laboratory testing for immunosuppression, including HIV testing, may be indicated when lesions are extensive, atypical, or unexplained. Anogenital lesions warrant evaluation for other sexually transmitted infections.
Management is directed toward destruction or removal of infected epithelial cells to reduce autoinoculation and transmission. Active treatment is not always required, as lesions are self-limited in immunocompetent hosts. Immunocompromised patients are at higher risk for prolonged disease and secondary bacterial infection and more often require intervention. Physical treatment methods such as curettage, cryotherapy, or topical destructive agents are generally the most effective options. Patients should be advised to avoid scratching, shaving over lesions, sharing towels, contact sports, and swimming pools until lesions resolve. Sexual partners should be examined when genital involvement is present. Treated patients should be re-evaluated every 2–4 weeks, as multiple treatment sessions are often required.
Hospital admission is rarely necessary and is reserved for immunocompromised patients with extensive disease complicated by severe secondary infection. Most patients can be managed safely as outpatients, with dermatology referral considered when diagnosis is uncertain or disease is refractory to initial therapy. A key clinical pitfall is unnecessary aggressive treatment in immunocompetent patients, as observation alone is often appropriate, while failure to recognize underlying immunosuppression can delay appropriate management.
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