Molluscum contagiosum: the sooner the diagnosis, the better

Molluscum contagiosum is a common skin infection caused by the molluscum contagiosum virus, which belongs to the poxvirus family. It is transmitted by direct physical contact, or indirect contact through touching contaminated objects such as towels, bathrobes or gym equipment.

What does molluscum contagiosum look like?

The first lesion that appears is a smooth papule that measures about two to six millimeters in diameter and that has an indent in the center. From this first lesion, other smaller papules arise nearby.
They do not usually cause itching or other symptoms, which is often the reason why diagnosis can be delayed.

The importance of early diagnosis

Molluscum contagiosum can rapidly spread, sometimes causing the eruption of hundreds of papules which make treatment much more complex. Early recognition of the first papules is of great importance both for treating the individual and reducing the spread of infection.

How to identify molluscum contagiosum

The papules caused by molluscum contagiosum are flesh-colored, shiny bumps that spread rapidly to increase in number. The fact that these papules spread should be the first warning sign that there is an infection at play.

How is molluscum contagiosum spread?

As the name suggests, molluscum contagiosum is a highly infectious virus. In children, it can spread through direct contact during play, something that often happens in infants at daycare.
In adults, sexual intercourse is often the first route of contagion.

Who is affected by molluscum contagiosum?

There are two distinct categories of those affected: children and adults. In children, molluscum contagiosum are mainly distributed on the face, trunk and limbs, and less frequently in the genital area. In adults, the papules are almost exclusively localized in the genital area.

How long does molluscum contagiosum last?

Molluscum contagiosum usually regresses spontaneously after a specific state of immunity is established. Unfortunately, however, the papules can persist, spread and be contagious to others for as long as two to three years. For this reason, treatment and removal of the lesions is recommended.

Treatment for molluscum contagiosum

The most appropriate treatment varies depending on whether the individual is a child or adult, and the number of lesions present.
In children, if the number of papules is in the range of three to four, removal with curettage may be considered. If numbers of papules are higher than this range, it is extremely unlikely a child will be able to tolerate their removal without general anesthesia.
In such cases, the papules can be destroyed using an acid-based solution, the most common of which is 30% salicylic acid in elastic collodion which is also used to treat warts (see website). As an alternative, 70% trichloroacetic acid can also be used, however DermaClub prefers the former. The formula for salicylic acid in elastic collodion is as follows:

• Salicylic acid 3g
• Elastic collodion 5g
• Ethyl alcohol 1g
• Ethyl ether 1g

The final formula should be a thick, transparent fluid and should be prepared by a pharmacist in a glass bottle with an integrated-spatula cap. To avoid the product from drying out, it should be refrigerated.
Apply a small dot of the formula on the lesion and leave to dry, at which point a white adherent film will form.
Repeat once or twice a week until the papule(s) disappears. In adults, direct intervention with curettage removal is preferred over acid treatments, particularly in the genital area which is particularly sensitive.
Removing papules with thermal energy (diathermocoagulation, laser therapy or liquid nitrogen) is not recommended as it can cause scarring and recurrence.

Conclusion

Although molluscum contagiosum regresses spontaneously within two to three years, it is important to diagnose and treat early in order to improve outcomes and limit contagion.