To manage the expectations that arguably have already penetrated the community to the point where it might be hard to convince people otherwise that doing this or that is not necessarily beneficial to their condition or to anyone else who might have the same condition soon, it might be more critical to primary tackle the issue of misinformation first then proceed to the delivery of the appropriate treatment and diagnostic guidelines that everyone could use to manage perhaps the conditions that they may or may not have. In doing so, we would have to establish outlines and comprehensive information hubs that will help describe the specifics of a particular condition to the public – one that this very outline aims to do for everyone who might need help regarding the manifestations that they are currently experiencing.
Without further ado, and with the background of this outline’s goal laid out for everyone to understand and comprehend, let us examine the condition known as molluscum contagiosum.
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Molluscum contagiosum is one of the many viral infections that may infect the skin – causing the production of specific physical manifestations that are often used as the distinctive diagnostic factor for such a condition. While it is not necessarily rare especially considering its prevalence rate among children, it is commonly unheard of as most people would often disregard it as a benign wart or growth within the skin, without knowing that they are already infected and may as well infect the people that they might come into contact with.
As previously discussed, molluscum contagiosum is a viral infection that resides within the skin of the patient, causing the development of wart-like lesions that are often white, pink, or flesh-colored that can be further described as very small, a little shiny, and smooth to the touch, The lesions itself are the cause for its transmission from one individual to another through contact – making the condition extremely contagious when it comes to people who are exposed to as many people as possible either through their hobby or through their work. There is no way just yet to know where these lesions will appear, but the most common areas where they might be found include the palms of your hands, soles of your feet, your torso, or even within your private region.
Molluscum contagiosum is caused by a virus with the same name, Molluscum contagiosum or M. contagiosum. The condition itself is generally harmless except perhaps for the heightened transmission upon contact with the infectious lesions. However, if the situation is not managed correctly, there are still some complications that some individuals might see, albeit the complications themselves are not as dangerous either when compared to other conditions that might have similar presentations.
Due to the relatively poor recognition of the condition itself, there are no exact statistics to show how prevalent M. contagiosum infections are within the community. Considering that the disease itself may be resolved without the need for a full-scale treatment or workup, many become complacent that they have only acquired warts and often do not bother to report the condition or have their physician look at it in the clinic. However, based on the data that we have on the prevalence of molluscum contagiosum among children, no matter how limited or skewed the values are due to the inconsistencies and missing data, we can estimate that the condition happens more in children than in adults – showing that 9 out of 10 molluscum contagiosum infections have been diagnosed among kids. It is not exactly a record of the condition’s prevalence within the community, but it does give us an idea of where the infection is more frequently noted, helping us prepare for the condition when we have a child to take care of.
Do note that while most infections are seen in children, it is still possible for an adult to contract the disease, particularly if they have a weakened immune system either because of their physiology or because of another medical condition that they have concurrently.
To further understand how the infection behaves within the population, it might be more efficient to first look at the subgroups at risk for contracting or developing the condition at least once in their lifetime. While this is not necessarily saying that you will automatically get the condition just because you are at risk, it is essential in giving you an idea as to whether you should start protecting yourself from such a preventable condition.
The primary risk factor that can be considered for molluscum contagiosum infections is having your immune system compromised. As we have previously mentioned, molluscum contagiosum is a viral infection, meaning that the main component of our body’s physiology that will first come into contact with the pathogenic microorganism is our immune system. In its normal state, the immune system can ward off this infection, particularly in adults who already have a properly composed and well-developed defense against such trivial conditions.
However, there are certain instances wherein the immune system of a particular individual is weakened to the point where it can no longer fight against these invading pathogens – resulting in successful colonization and the subsequent development of symptoms. There are not many immunocompromised individuals as this usually happens when there is an external stimulus that has led to this, except perhaps when a patient has an autoimmune disease where either their immune system is naturally damaged or dysfunctional, such as in the case of “bubble babies” or individuals born without a functioning immune system.
The majority of the immunocompromised subgroup is mainly composed of patients with an underlying condition such as HIV/AIDS and individuals who have recently gone through some medical operation or process wherein their immune system is medically-weakened to either bring down any inflammation or allow the body to accept an organ transplant of some sort. This is not an extensive list per se of all the immunocompromised individuals in the community, but this encapsulates the general idea of what an immunocompromised person is. If you are within this subgroup, make sure that you are as far away from an infected person as possible, or you employ preventive measures to avoid its transmission to you.
One risk factor that you can consider somewhat quirky is the increased susceptibility of individuals with a case of atopic dermatitis. If you are not familiar with the condition, atopic dermatitis is a disease wherein the person develops scaly and itchy rashes that can be seen all over their body. It can be considered as a condition that primarily shows up when the person is stressed or if their immune system is compromised – showing that it has some overlap with the previous risk factor that has been discussed.
Many would inevitably wonder why this is considered a risk factor for the condition when it does not necessarily directly affect the patient's immune system. Many do not know in a case like this that atopic dermatitis and its itchy presentations would often result in the development of micro-wounds in the patient's skin. The skin serves as the primary barrier between the systemic circulation of the patient and the external regions of the body – making it crucial in ensuring that we are not constantly exposed to harmful pathogens that could be in every corner. In the case of people with atopic dermatitis, though, the scaling and the breaks in the skin caused by scratching can be utilized by M. contagiosum to infect the body of the person, no matter how fortified their immune system might be.
When contact happens between someone with an active infection and someone with an atopic dermatitis flare-up, there is a high chance that there will be a transmission of the disease as it is much easier for the virus to take root and produce its manifestations once it can penetrate the external barrier of the body or the skin. The same reasoning can be said for those with an active infection and atopic dermatitis case – making them more contagious when someone comes into contact with their open skin.
While tropical climates are not necessarily a direct cause of the virus’ transmission, the humid and warm climate is often equated to crowded living conditions where there is not much space to move around, and skin-to-skin contact is usually inevitable. As previously discussed, molluscum contagiosum is transmitted through direct contact between an infected individual and someone who is either at risk or can be infected by the infection once the virus comes into contact with them. When you are living in such crowded locations, there is a higher chance that you will come into contact with someone who has the condition – making you, in a sense, at a higher risk for the infection by simply being within the premises of a high-risk area.
As we have previously laid out earlier, children are at a much higher risk of contracting the condition than adults due to several factors that often are out of our control or are inherently seen among children of all ages. You first have to understand that since children are young, their immune system is still continuously developing. Considering that molluscum contagiosum is a viral infection that is primarily deterred by the body’s immune system once the virus enters your system, it is hard for children to ward off the disease by using their underdeveloped immunity – making them more susceptible to active infection in cases where they are exposed to someone who has the condition.
Another thing that makes children even more at risk for developing this disease is that they are constantly touching things and people, even in public. While many would say that this is cute at times, and we might even agree with you on that because they are, the constant contact even with individuals who may or may not have an active infection already puts them at risk of contracting the condition. Add that to the fact that children would likewise play constantly with other children who may have the condition, and you have the perfect trifecta as to why you can see a higher prevalence of the disease in children than in adults.
While its entire mechanism is not entirely different from how children and people living in humid and cramped places are at a higher risk for the infection, we perhaps had to give more emphasis on people participating in sports as we believe that this is where many would often forget that they might contract an infection from their opponents. Contact sports are extremely common around the globe for their intensity and the drive of many athletes to win against the opponent they are facing. In most instances, many would forget about anything else and only look at the competition as it is – a tournament, a game, nothing more, nothing less. What makes this more dangerous is that there is inevitable contact between two players in such events, and as we previously mentioned, the virus itself is transmitted through direct contact. If you are an athlete and are participating in such circumstances, make sure that your immune system is strong and healthy enough to fight off any possible infections that you might contract. Proper hygiene, such as taking a shower or washing your hands regularly after a session, may also go a long way in ensuring that transmission is minimized.
Considering that molluscum contagiosum is commonly self-limiting or can be resolved without any pharmacological management strategies whatsoever, it is essential for most people, particularly healthy ones or those who are otherwise not affected by any significant risk factor, to let their body address their condition. If your immune system is strong enough to fight off the infection, like how the body resolves colds through its natural defenses, you would be fine even if you do nothing to resolve your condition.
In cases where you are concerned due to your compromised immune system, you may opt for multiple options commonly utilized in practice. In many clinics, one that is used is the physical removal of lesions through cryotherapy, curettage, or laser therapy. These three techniques may cause pain as it essentially removes a part of your overgrown skin along the process, but it does the job effectively when done correctly. However, please note that you shouldn't remove the lesions on your own as you will be risking the spread of your infectious fluids, or worse, the wound resulting from the removed lesions may be infected by another condition.
In any other case, you may also opt for an oral medication therapy or topical therapy wherein you will be either given an oral medicine or topical ointment that you can use to help the lesions settle down without or with minimal scarring in the end.
Molluscum contagiosum is not a sexually transmitted condition per se, as its mechanism does not revolve around the sexual contact between a carrier and a potentially new host for the virus. The disease is transferred from one person to another through contact, no matter the means used for the two surfaces to touch. Considering this, though, since molluscum contagiosum may also manifest its infectious lesions within the genital area of the patient, there is also the possibility that you will be able to transmit the virus during sexual intercourse – leading many people to believe that the condition is solely sexually transmitted and confusing it with other conditions such as benign papules that are often seen around the male genitalia.
In a sense, while molluscum contagiosum is not a sexually transmitted disease or infection by name in the strictest sense, it can still be transmitted sexually in the sense that it does likewise involve contact between an infected lesion and a healthy tissue – resulting in transmission.
Although we have previously said that molluscum contagiosum is generally a benign and self-limiting condition for as long as the patient’s immune system can fight off the infection within the patient’s body, the disease itself may still have a few complications that are relatively rare and are often not a result of an untreated condition. These complications are more of a result of an unfortunate instance wherein the odds were just not in favor of the patient – resulting in unlikely scenarios that you might still want to be aware of just in case.
Considering that your body will be developing lesions throughout the virus's infective phase, the infection's aftermath would often see wounds and scarring as the affected areas dry off and expose the overgrown area within. This is typically preventable with the help of some topical medications that would help shrink the lesions while likewise minimizing the presence of scars.
Relative to the previous point, the wounds caused by the removal of lesions or when the lesions disappear can likewise be utilized by other pathogenic microorganisms to infect the susceptible patient – like how molluscum contagiosum begins its pathogenesis. When this happens, the wounds may become infected with an entirely different bacteria – requiring another set of medications and consultations to address the underlying infestation adequately.
As previously mentioned, molluscum contagiosum may produce lesions in any part of the patient’s body. There is no way of knowing where these lesions will appear throughout the infection. As such, you might also want to be wary of lesions within the eyelids, as these protruding areas may cause damage to your eyes if the lesions are close enough to the opening. If you have observed that the appearance of lesions has migrated towards your eyes, contact your doctor immediately to know what steps you need to take to avoid any damage to your eyes.
If you would like you or your child to be protected against this condition, or if you would like to protect others against your active infection, there are several things that you can do to minimize the risk of contracting the condition.
Molluscum contagiosum is a viral skin infection primarily caused by a pathogenic microorganism of the same name, Molluscum contagiosum or M. contagiosum. The causative agent is classified under the poxvirus classification, and its direct transmission is performed either through direct contact or contact with fomites left by an infected individual. If you are not familiar with the terminology, fomites are non-living objects that can host microorganisms for a brief period – resulting in transmission even if the original host is no longer in the vicinity. This may include linens, sheets, blankets, towels, bath sponges, toys, or any other surface that could come into contact with the infectious lesions of an affected patient.
The virus is transmitted when the active lesion is touched by other healthy tissues – resulting in its transmission to the other individual. When this happens, M. contagiosum remains within the top layer of the skin or epidermis, signifying that it cannot be transmitted through any other means apart from direct contact.
The distinctive lesions for molluscum contagiosum infections may appear in any part of the body, even within the genitalia – explaining why most adult infections are commonly due to sexual contact with another infected individual. However, this does not result in the classification of the condition as an STD as its transmission through sexual means is purely circumstantial with the appearance of lesions in the genitalia.
In most cases, the virus’ incubation period may take between 2 to 7 weeks, but there are instances wherein the virus will not present with any symptoms for up to 6 months.
In instances where the virus has become active and symptomatic, the primary manifestation that all would observe is the appearance of a small group of painless lesions that can be described as the following:
While molluscum contagiosum would often not require a stringent therapy as it is relatively self-limiting among healthy individuals, in certain instances wherein the immune system might need some help, or if the lesions have appeared in sensitive areas such as in the eyelids or the genitalia, a proper diagnosis might be necessary for physicians to be able to recommend the appropriate therapy for the patient’s condition.
This is essentially a procedure where an exudate or discharge from the lesions is collected and viewed under the microscope.
It is a procedure used to detect the presence of M. contagiosum within the lesions – confirming the presence of an infection.
This is essentially a confirmatory test for inconclusive diagnoses as it shows the histological characteristics of the lesion.
This is commonly employed as its cost is minimal, and it can determine the condition due to the distinct features of molluscum contagiosum lesions.
Although molluscum contagiosum does not necessarily require a proper treatment regimen to ensure that the condition resolves, there are still some therapies that can be used to aid the body’s healing process and ensure that further transmission will be minimal.
This is commonly employed using cryotherapy, curettage, or laser therapy to remove the lesions themselves – leaving minimal scars but an initial wound that might be subject to secondary infections.
Oral medication is often used among pediatric patients as it is less painful and can be safely administered by the parents. The most common medication used is oral cimetidine, but it does not resolve facial lesions well compared to lesions found anywhere else in the body.
0.5% podophyllotoxin cream is usually recommended for men, but it is contraindicated against pregnant women due to a possible systemic absorption and subsequent fetal toxicity due to the drug. The cream itself is applied to each lesion manually as the effect of the medication is widely localized.
In cases where the patient has a weakened or compromised immune system, it is much more effective to target instead the restoration of their resistance instead of addressing the symptoms, as this would have a much better long-term outlook when it is the body’s immune system that will be limiting the proliferation of the virus.
The rule of thumb is that if the lesions have completely healed, you are no longer contagious.
Is it recommended for sexual partners to likewise be informed if I have an active molluscum contagiosum?
Yes. Since physical contact during sexual intercourse happens, it is possible that contact with the infectious lesions itself could have occurred – making them exposed to the condition already.
There is conflicting information regarding the issue of immunity following an active infection. However, to be on the safer side, it might be wise to assume that you might still get the disease if you become exposed to the virus again.
Unlike some STDs such as herpes which remain dormant in the body following an outbreak, molluscum contagiosum is completely flushed from the body once treated – making it impossible to have a recurrent infection unless you are exposed to the virus again.
Some studies suggest that some adults develop immunity due to a previous infection from their childhood, but to be on the safer side, wear protective equipment like gloves when applying a topical treatment to your child’s lesions.
Clinical, Cosmetic, and Investigational Dermatology
Written by Mark Riegel, MD
No. The virus has to run its course.
Viral. The infection is caused by the molluscum contagiosum virus - a member of the poxvirus family.
Removal. Sometimes no treatment is given. Other times the bumps are removed (scraping, laser, freezing).
6 to 12 months. Untreated symptoms can disappear in 6-12 months.
No. Sexual activity should be avoided until all symptoms have resolved.
Yes. People can be re-infected with the virus repeatedly.
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