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There are two schools of thought on the management of molluscum contagiosum. Some physicians prefer conservative treatment, allowing the immune system to run its course and clear off the virus over time. On the other hand, one may opt for a more proactive approach to medically treating the infection. 

In this article, we explore the reasons for considering treating molluscum contagiosum.

molluscum contagiosum singapore
To treat or not to treat adult molluscum contagiosum?

What is molluscum contagiosum?

Molluscum contagiosum is a benign viral skin infection caused by the poxvirus [1]. The infection causes small, discrete, firm, white skin bumps known as Mollusca, with a classical characteristic of a dimple or pit in the centre. Molluscum lesions can occur on any part of the body, including the face, neck, body, arms, legs, or even the genital region.

What are the odds that Molluscum contagiosum can recover on its own?

Medical literature shows that 70% of molluscum contagiosum infections take months (up to 6-18 months) to resolve spontaneously [2]. However, in some patients, new molluscum lesions can continue to appear intermittently for 3-4 years. Less commonly, medical reports suggest the infection can even last up to 5 years.

How can a person acquire molluscum contagiosum?

One can acquire the viral infection through skin-to-skin contact, sexual contact, and fomite transfer through wet towels, pools, bathtubs, spa rooms, gym floor surfaces, etc [3]. Practising good hand hygiene is imperative in reducing the transfer of infection to self and others.

molluscum contagiosum spread
Molluscum contagiosum is a viral infection that can spread through fomite transfer.

Is molluscum contagiosum an STD?

While molluscum contagiosum can be acquired through skin contact with contaminated surfaces/fomites, it is considered an STD when one contracts it from sexual partners. Typically, an STD-related molluscum contagiosum infection involves the genital areas or the oral region due to skin-to-skin transmission during physical intercourse [4].

How can I confirm the rash that I have is molluscum contagiosum?

If you are unsure whether your symptoms are due to molluscum contagiosum, you can contact your trusted physician for further evaluation. The lesions are characterised by round, discrete, waxy, pale dots with a central umbilication (indentation). 

In cases where the diagnosis is unclear, your doctor may further evaluate the lesion with a dermatoscope or surgically remove a small skin sample (biopsy) to confirm the diagnosis.

Why Should I Consider Treating Molluscum Contagiosum?

The Mollusca that remains on the skin has a high risk of being passed on via skin-to-skin contact to people around us and self-inoculate to other parts of our body such as the hands, eyes, face, neck, and genital region.

As sexual activities involve physical intimacy and friction, the viral infection can easily be passed on between sexual couples. Untreated molluscum over the genital region increases a person’s risk of acquiring other types of STDs.

Incessant scratching can be a nuisance and an embarrassment in our daily life. The itch can even affect sleep and daily productivity. Although not life-threatening, molluscum can be uncomfortable and significantly reduce our well-being.

itchy molluscum contagiosum
One of the symptoms of molluscum contagiosum on the genitals is itching.

One of the common complications from persisting molluscum lesions is secondary bacterial infection. This is particularly important in patients with a compromised immune system [5], such as HIV patients. Concurrent bacterial and molluscum infections can further complicate health and hamper recovery. In these situations, it is imperative to get molluscum (the primary problem) treated.

This is particularly true in the case of inflammatory skin conditions such as eczema, where molluscum can cause a flare-up of existing eczema [6]. Persistent molluscum infection also makes the treatment of eczema more recalcitrant.

Although uncommon, when molluscum infection occurs in a pregnant woman, there is a possibility of vertical transmission of the disease from the mother via the uterus/birth canal to the baby. 

Molluscum lesions covering the skin surface, particularly exposed areas such as the face, arms, legs, and hands, can be disfiguring and cause social embarrassment. Even having them over the genital regions can be socially awkward and embarrassing between couples.

Scratching, picking, and inappropriate scooping of the molluscum lesions can lead to scarring of the skin. Spontaneous scarring from molluscum infection is also possible due to chronic inflammation of the skin infection [7]. Skin scarring is irreversible.

When is it medically necessary to treat Molluscum Contagiosum?

It is medically indicated to consider treating molluscum contagiosum if:

eczema molluscum contagiosum
Seek medical intervention if you suffer from eczema and molluscum contagiosum.

What are my treatment options for Molluscum Contagiosum? Are treatments safe?

Medical treatment of molluscum infection involves the following:

Effective physical removal treatments are offered safely in outpatient settings.

As molluscum contagiosum infection may continue to resurface due to underlying immune system inadequacy to combat the virus, physical removal treatment may be required in repeated sessions to eradicate the infection.

It is not advised to self-attempt to pick or remove the skin lesions as this can increase the risk of scarring and further self-inoculation of the virus to the surrounding skin.

Why should I also consider screening for other STDs if I have Molluscum Contagiosum?

When a person has genital molluscum contagiosum, this is an indication of an increased risk of other sexually transmissible infections.  Other STD testing, including HIV testing, should be offered to prevent further complications develop from STDs and to protect loved ones from contracting STDs.

Can I be immune towards Molluscum Contagiosum?

A person who has had molluscum contagiosum and has been treated before is not immunised or protected against future infections. Even with successful clearance of molluscum infection, you are still at risk of developing a new molluscum infection if exposed to a new source of the virus. There is currently no vaccination against molluscum contagiosum.

How long will I be contagious with Molloscum Contagiosum?

As long as you have the molluscum bumps, you can spread them to others.

Crucial take-home messages:

If you are concerned about acquiring molluscum contagiosum infection or exposure to other forms of STDs, you are encouraged to reach out to your trusted physician and take proactive steps to protect yourself and the people around you.

References

  1. Baxby, D. (1996). Medical Microbiology. 4th edition. Texas: University of Texas Medical Branch at Galveston.
  2. Rodrigo Meza-Romero, C. N.-D. (2019). Molluscum contagiosum: an update and review of new perspectives in etiology, diagnosis, and treatment. Clinical, Cosmetic, and Investigational Dermatology, doi: 10.2147/CCID.S187224.
  3. CDC. (11 May, 2015). Centers for Disease Control and Prevention. Retrieved from Molluscum Contagiosum: https://www.cdc.gov/poxvirus/molluscum-contagiosum/transmission.html#:~:text=Fomites%20are%20inanimate%20objects%20that,%2C%20pool%20equipment%2C%20and%20toys.
  4. L Zichichi, M. M. (2012). The challenges of a neglected STI: Molluscum contagiosum. G Ital Dermatol Venereol, 447-453.
  5. Elena Netchiporouk, B. A. (2012). Recognizing and managing eczematous id reactions to molluscum contagiosum virus in children. Pediatrics, doi: 10.1542/peds.2011-1054.
  6. Richard Weller, C. J. (1999). Scarring in molluscum contagiosum: comparison of physical expression and phenol ablation. BMJ, doi: 10.1136/bmj.319.7224.1540.

The liver is an organ that never stops working, yet most of the time, we pay minimal attention and care to it. The liver plays numerous pivotal roles ranging from aiding digestion, protein and enzyme production, and detoxifying the body. 

Even with a minor liver injury, insult, or stress, the liver continues to stay resilient and functions without symptoms. It is only when the liver is more than 2/3 damaged that symptoms start to show. Hence, taking care of the liver is paramount. In this article, we discuss a common reversible cause of liver damage—fatty liver disease.

Why is our liver so important to us? What is the function of the liver?

The liver is located just below the lungs and over the right upper part of the abdomen –the region is also known as the right hypochondrium. It plays a vital role in:

liver
The liver is absolutely vital to our survival, it is responsible for “detoxing” our body of impurities.

What is fatty liver disease?

Fatty liver disease, also known as steatosis of the liver, is a medical condition that occurs due to the accumulation of fat in the liver. There are two types of fatty liver disease, these are:

There is a strong association of NAFLD with metabolic conditions such as obesity, hypertension, diabetes, and dyslipidaemia. Some medical journals suggest fatty liver is the hepatic manifestation of metabolic syndrome.

What are the 4 stages of non-alcoholic fatty liver disease?

Non-alcoholic fatty liver disease occurs in approximately 40% of Singaporeans and comprises four different stages, these are: 

liver damage stages
The first three stages of fatty liver disease are reversible, however, once it reaches stage four, fatty liver disease is irreversible and can only be cured with a liver transplant.

How do I know if I have fatty liver disease?

Patients with a fatty liver are usually asymptomatic. However, if you notice the following symptoms, it could be a sign that your fatty liver disease has progressed: 

If you notice the above symptoms, make an appointment with your doctor immediately.

What causes fatty liver disease in non-alcoholics?

Non-alcoholic fatty liver disease is associated with the build-up of excess fats in the liver. This occurs when more calories are consumed than the body can use, the excess calories are converted to fats and stored in the liver. When the amount of fats in the liver is more than 5% of the liver’s weight, then fatty liver disease occurs. 

There is also a strong association between non-alcoholic fatty liver disease and non-alcoholic steatohepatitis with metabolic syndrome.

This means that individuals are more predisposed to fatty liver disease if they have:

As most patients are asymptomatic, routine health screening or a medical checkup is encouraged to screen for metabolic syndrome and NAFLD. You are encouraged to discuss with your doctor on your possible risk factors and what can be done to reduce your risk of developing fatty liver disease.

Patient doctor
Speak to your doctor on how you can reduce your risk of developing fatty liver disease.

What are the risk factors of developing NAFLD?

Medical conditions that increase an individual’s risk for developing NAFLD include:

How common is fatty liver disease in Singapore?

With the rise of metabolic syndrome, obesity, and diabetes, the cases of NAFLD are rising exponentially as well. Currently NAFLD is becoming the most common cause of liver disease in the world. A study conducted in 2022 found that the prevalence of NAFLD is estimated to be 32.4%, with numbers expected to grow. 

In Singapore, the prevalence can be as high as 40%. Interestingly, not only can NAFLD be seen in obese people, but also in 20% of non-obese Asians. 

Why should I screen for fatty liver/NAFLD?

As NAFLD can progress into irreversible complications such as cirrhosis (severe scarring of the liver), regular routine screening is important in the prevention of fatty liver disease.  

Once an individual has developed liver cirrhosis, further complications may occur such as a buildup of abdominal fluid (ascites), oesophageal vein swelling and rupture (varices), liver encephalopathy (with change of mental state, confusion, drowsiness), increased risk of liver cancer (hepatocellular carcinoma), and end stage liver failure.

Hence, it is very important to detect and treat NAFLD when it is still in its early, reversible stages. Thankfully, the progression of the condition is generally slow, and most NAFLD patients are stable and can be managed in primary care. Do speak to your doctor to screen for NAFLD.

blood test
A liver function test is conducted to check for fatty liver disease.

How is fatty liver/NAFLD diagnosed?

Fatty liver can go undiagnosed for years as it usually does not cause pain or other symptoms. One usually picks up fatty liver findings during routine blood tests.

If your results are concerning to your doctor, he/she may arrange an ultrasound of the liver. In severe cases, your doctor may refer you to a gastroenterologist who will then advise for a liver fibroscan or biopsy for further evaluation of the extent or severity of your fatty liver disease.

When should I screen for fatty liver/ NAFLD in Singapore?

You should consider screening for fatty liver/NAFLD if you have any of the following conditions: 

What should I expect when I see my doctor for fatty liver/NAFLD?

Your doctor will usually take your medical history and examine you physically— covering blood pressure, weight, height, waistline measurement, etc. Depending on how you fare, your cardiovascular organs and liver may also be screened.

Subsequently, blood tests which cover the general screening, and a liver function test are conducted to screen for metabolic syndrome and fatty liver disease. Depending on your individual risk factors, you may also be required to have imaging (e.g., ultrasound, CT scan, MRI) taken of your liver. You can discuss your concerns with your doctor regarding NAFLD and decide on any suitable tests for further evaluation.

What should I do if I have fatty liver/NAFLD?

NAFLD is a reversible condition if managed early, below are some steps you can take to reverse or prevent fatty liver disease. 

Medications: medication may be prescribed for the concurrent management of diabetes, cholesterol, or blood pressure problems. Medications may also be prescribed to individuals with recalcitrant visceral fat/chronic elevated BMI in order to facilitate weight loss.

healthy food
A healthy lifestyle that comprises exercise and good food goes a long way in your liver health and overall general well-being.

A major component of health screening involves cancer screening. Cancer remains a leading cause of morbidity and mortality in Singapore, accounting for 29.7% of deaths in 2015 according to the National Registry of Disease Office of Singapore.

The thought of screening for cancer can be distressing. One may even argue that by identifying cancer, it will be life-changing, life-defining, even death-sentenced without a cure to the problem. On the flipped side, even without curative treatment to the disease, early detection promises a better disease prognosis and a better quality of life with current modern medicine in comparison to cancer cases that are detected at late stages.

In certain cancers, early screening can in fact be life-saving. This is where health screening comes in place. Screening has been shown to be effective in early detection of colon cancer, breast cancers and cervical cancer. This article is written in the hope to give certain guidance and recommendation to people on choosing cancer screening packages.

Should I undergo Cancer Screening?

You should consider if you are

Lady-having-a-health-screening-consultation-with-doctor

Every reason to screen for colon cancer, breast cancer and cervical cancer!

Colon cancer

You are recommended for a colonoscopy for everyone at the age of 50 and every 10 years thereafter. Your doctor may advise you for an earlier colonoscopy procedure if you have symptoms or family risk factors of colon cancer.

Colonoscopy, though not completely risk-free, is not overtly scary. Colonoscopy is a planned procedure arranged between you and your endoscopist. Prior to the procedure, you are advised to drink a medicine liquid 1 to 2 days prior procedure to clear out your bowels. You will be given sedation throughout the procedure to ease your discomfort. The procedure itself takes about 15 to 30 minutes, allowing your doctor to visualize your colon intestinal walls, and take sample biopsies or remove small polyps during the procedure.

Breast cancer

You are recommended for a yearly mammogram at the age of 40 until the age of 50, then every 2 years repeating mammogram until the age of 69. Although Ultrasound breasts are not routinely performed, it may be recommended by your doctor if clinically indicated. In high risks individuals, your doctor may recommend you to do MRI breasts.

Many people find mammogram is a painful test. Mammogram though is not the most comfortable test, is useful in identifying cancerous areas of the breasts. Breast cancer is one of the cancers with a good survival rate if detect and managed early.

Cervical Cancer

You are recommended cervical cancer screening from the age of 25 onwards if you have ever had sexual contact. You are recommended for pap smear test at least once every 3 years. You are also advised for HPV test every 5 years if you are sexually active and over the age of 30.

While pap smear and HPV tests can be uncomfortable, early treatment is curative. Early treatment of cervical cancer is particularly important to women during their reproduction years for future conceive and childbearing.

What cancer symptoms or warning signs I should be aware of?

While cancer is most often asymptomatic, you should speak to your doctor if you experience

Afterword

Health screening is not completely without risks. False-positive results can cause anxiety and require further tests that involve further risks and cost. In false negative tests, it may give a person a false sense of security.

Speak to your doctor before deciding any tests for cancer screening- don’t leave cancer to chance.

Health screening allows screening for potential health conditions, striving at prevention and early management of asymptomatic health diseases, including Metabolic Syndrome.

Metabolic Syndrome also is known as Syndrome X, is made up of risk factors that if left unattended can potentially lead to chronic conditions such as cardiovascular diseases and cerebrovascular diseases. Metabolic Syndrome is a silent killer that is often not addressed until a major disastrous event such as a heart attack or stroke strikes with debilitating irreversible complications including death.

What exactly is Metabolic Syndrome?

You have Metabolic Syndrome if you have 3 or more characteristics below:

What are the risks factors of Metabolic Syndrome?

What are the signs and symptoms of Metabolic Syndrome?

As mentioned, it is an insidious condition that most people present without any symptoms. Some may show an obvious physical appearance of obesity with a large waistline and ‘pear-shaped’ body.

Signs and symptoms of Metabolic Syndrome

Why should I screen for Metabolic Syndrome?

Metabolic Syndrome has 2 components- the fixed factors and flexible factors. The fixed factors are how we are genetically born and programmed with such as our race, age and family medical conditions that we are unable to change. Having said that, it is not all doomed, and we should not leave our health to fate. Flexible factors include one’s cholesterol, blood pressure, glucose level, body weight and personal lifestyle. We can make a major difference in the outcome by managing these flexible factors.

Health screening for Metabolic Syndrome involves screening for personal and family risks factors. This involves doctors review, both histories taking and physical examinations, batteries of blood tests investigations, blood pressure measurement, weight and height measurement, body fat percentage measurement and baseline ECG. In certain high-risk groups, your doctor may advise you further investigations or specialist input.

Screening for Metabolic Syndrome is aimed at managing the flexible factors of a person, reducing the chance of developing catastrophic conditions such as heart attack and stroke. By understanding one’s risks factors and health situation, your doctor can further advise you on both non-pharmacological (with lifestyle and dietary modification) and pharmacological (if required) changes.

Take charge of your health today, screen for Metabolic Syndrome!

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