Molluscum contagiosum

Last Updated: 2020-11-19

Author(s): -

Bateman 1817.

Dell warts.

A self-limiting, very common disease caused by the epidermotropic, highly contagious poxvirus, which occurs primarily in children, atopic and immunodeficiency patients.

Especially occurring between 3-10 years.

  • Incubation period: 2-7 weeks, occasionally up to 6 months.
  • Transmission occurs via skin contact or dusts. The possibility of autoinculation is also described.

Whitish, centrally dented, broad-base papules. The content of the papules is highly contagious. The molluscs often sit on eczema. If irritated, the molluscs can also trigger a local eczema, or even a generalized Gianotti-Crosti-like syndrome.

Clinic 

Squeeze out with tweezers empty hard white granule 

Possible biopsy.

Especially trunk, extremities.

Basophile virusinfizierte Epidermiszellen (Molluscum-Körperchen), epitheliale Hyperplasie.

  • High spontaneous healing rates.
  • Prevent scratching! If necessary, put on gloves while sleeping.
  • If there are only a few molluscs, a wait-and-see attitude is possible.

 

  • Curettage, previously application of EMLA® plaster.

 

  • Cryotherapy (CAVE: hypopigmentation), previously local anaesthesia with EMLA® patch 

 

  • Tretinoin (Airol® Cream 0.05% or Lotio 0.05% 1-2x daily)
  • off-label-use 
  • Application: 1-2x daily, if necessary 1x daily or every 2nd day for sensitive skin. Use for at least 6-14 weeks.
  • CI: acute dermatitis, rosacea, pregnancy, lactation.

 

  • Podophyllin/Podophyllotoxin 
  • Condyline® Lin: Apply 2x daily for 3 consecutive days. Repeat if necessary.
  • off-label-use:
  • Application: Apply 2x daily for 3 consecutive days, protect surrounding skin. Repeat if necessary.
  • CI: < 12 years, open wounds, women of childbearing age, contraception recommended up to 30 days after therapy, pregnancy, lactation.
  • Immunomodulators 

 

  • Imiquimod 
  • Aldara® 5 times a week for several weeks, max. 16 weeks.
  • off-label use 
  • Application: 5x/ week over several weeks, maximum 16 weeks.
  • Before the removal of the wart surface necessary.
  • Side effects: Reddening, itching, burning, erosion of the skin. Inform the patient about this before starting the therapy!

 

  • Apply KOH-Lsg. (InfectoDell® ) 2x daily to molluscs.
  • Available in Germany. Order via international pharmacy.
  • CI: < 2 years, for immunosuppression, no ocular application or application to mucous membranes or open wounds, horny conditions incl. corns, verrucae vulgares and tendency to scar atrophy/keloids. Exacerbated neurodermatitis.
  • Side effects (highly corrosive): redness, itching, reverse. Hypo- or hyperpigmentation, rarely scarring.

 

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  4.  Hengge UR, Cusini M. Topical immunomodulators for the treatment of external genital warts, cutaneous warts and molluscum contagiosum. Br J Dermatol 2003;149:15-9. 
  5.  Hengge UR, Esser S, Schultewolter T, et al. Self-administered topical 5% imiquimod for the treatment of common warts and molluscum contagiosum. British Journal of Dermatology 2000;143:1026-31. 
  6.  Skinner RB, Ray S, Talanin NY. Treatment of Molluscum Contagiosum with Topical 5% Imiquimod Cream. Pediatric Dermatology 2000;17:420-. 
  7.  Smith KJ, Col, Usa MC, et al. Molluscum contagiosum: its clinical, histopathologic, and immunohistochemical spectrum. International Journal of Dermatology 1999;38:664-72. 
  8.  Smith WA, Siegel D, Lyon VB, Holland KE. Psoriasiform eruption and oral ulcerations as adverse effects of topical 5% imiquimod treatment in children: a report of four cases. Pediatr Dermatol 2013;30:e157-60. 
  9.  van der Wouden JC, van der Sande R, van Suijlekom-Smit LWA, Berger M, Butler CC, Koning S. Interventions for cutaneous molluscum contagiosum.  Protocols: Wiley-Blackwell; 2009.