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Molluscum Contagiosum

To Treat or Not To Treat?
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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?

  • Molluscum Contagiosum is highly contagious

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.

  • Molluscum Contagiosum is sexually transmissible

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.

  • Molluscum Contagiosum is associated with itch that can affect our quality of life

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.
  • Molluscum Contagiosum increases the risk of bacterial infection

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.

  • Molluscum Contagiosum can aggravate underlying existing inflammatory skin conditions

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.

  • Molluscum Contagiosum can be passed on to the baby

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 Contagiosum can be aesthetically unpleasant

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.

  • Molluscum Contagiosum infection has a risk of scarring

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:

  • You have molluscum over your genital area
  • You have an underlying medical condition with a weaker immune system, such as HIV patients, and have a molluscum infection
  • You have underlying chronic skin inflammatory conditions such as atopic dermatitis (eczema)
  • You are troubled by the molluscum lesions
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:

  • Topical treatment: this involves the use of acid and other chemicals to clear the skin infections.
  • Cryotherapy: cryotherapy involves a repeated cycle of cold-freezing from liquid nitrogen and room-temperature thawing to destroy the Molluscum lesions.
  • Electrocautery procedure: electrocautery uses electric current and heat to destroy the skin lesions.

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:

  • Molluscum contagiosum is a benign skin infection; it may take time to resolve on its own.
  • One is highly infectious if molluscum contagiosum skin lesion(s) is present.
  • Molluscum contagiosum is considered an STD if it is acquired through sexual contact and found over the genital region.
  • STD screening should be considered in sexually transmitted molluscum contagiosum.
  • There are effective treatment options for Molluscum contagiosum.

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.

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