Molluscum contagiosum - an overview

Molluscum contagiosum, a common viral cutaneous infection in childhood, is caused by a poxvirus of the molluscipox genus. Molluscum contagiosum occurs worldwide, but is more common in areas with tropical and humid climates. Elementary school-aged children are more commonly affected. The virus is transmitted by close physical contact, autoinoculation, and fomites (e.g., bath sponges, towels), especially if the skin is wet. Typically, molluscum contagiosum presents as discrete, smooth, flesh-colored, dome-shaped papules with central umbilication from which a plug of cheesy material can be expressed. Lesions are usually 1 to 5 mm in diameter and the number is usually less than 20. They often appear in clusters or in a linear pattern. The lesions are often asymptomatic. No single intervention has been convincingly effective in the treatment of molluscum contagiosum. Some authors suggest benign neglect of the lesions and to await spontaneous resolution. Most authors suggest active treatment of lesions for cosmetic reasons or concerns of transmission and autoinoculation. Active treatments may be mechanical (e.g. curettage, cryotherapy with liquid nitrogen, pulsed dye laser therapy, carbon dioxide laser therapy), chemical (e.g. cantharidin, tretinoin, podophyllotoxin, trichloroacetic acid, potassium hydroxide, lactic acid, glycolic acid, salicylic acid), immune-modulating (e.g. imiquimod, cimetidine) and antiviral (cidofovir). The choice of the treatment method should depend on the physician's comfort level with the various treatment options, the patient's age, the number and severity of lesions, and the preference of the child/parents.