eMedicine Specialties > Infectious Diseases > Skin and Soft-Tissue Infections

Molluscum Contagiosum: Follow-up

Author: Ashish C Bhatia, MD, FAAD, Assistant Professor of Clinical Dermatology, Department of Dermatology, Northwestern University, Feinberg School of Medicine; Director of Clinical Research, Department of Dermatology and Dermatologic Surgery, River North Dermatology and Dermatologic Surgery, DuPage Medical Group
Coauthor(s): Tracy Campbell, MD, Staff Physician, Department of Dermatology, Rush Medical Center; Seth Forman, MD, Private Practice, Tampa, Florida; David Rowe, MD, Pathologist, Laboratory Medicine, Martha Jefferson Hospital; Robert Orenstein, DO, Associate Professor, Department of Medicine, Medical College of Virginia, Virginia Commonwealth University; Medical Director, Infectious Disease Clinic, Medical College of Virginia Hospitals; Julia R Nunley, MD, Professor, Program Director, Dermatology Residency, Department of Dermatology, Virginia Commonwealth University Medical Center
Contributor Information and Disclosures

Updated: Apr 1, 2008

Follow-up

Further Outpatient Care

  • Repeat examination is recommended 2-4 weeks after treatment.
  • Re-treatment often is necessary.
  • Consider combination therapy in patients whose lesions respond poorly.

Deterrence/Prevention

  • Discontinue all topical immune suppressants (eg, tacrolimus).

Complications

  • Autoinoculation may result from trauma, such as shaving, as well as manipulation of lesions by the patient.
  • Cellulitis is an unusual complication of molluscum contagiosum in patients who are HIV infected.15 Secondary infection with Staphylococcus aureus has resulted in abscess formation, whereas Pseudomonas aeruginosa can cause necrotizing cellulitis.

Prognosis

  • Spontaneous resolution generally occurs by 18 months in immunocompetent individuals; however, lesions have been reported to persist for as long as 5 years.
  • The duration of infection is uncertain in populations with HIV infection and in populations that are otherwise immunocompromised (eg, patients who have undergone renal transplant) because molluscum contagiosum may not be self-limiting in these cases.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Histological or microscopic confirmation of molluscum contagiosum is indicated in immunocompromised patients because several life-threatening opportunistic infections may clinically mimic molluscum contagiosum.

Special Concerns

  • Therapeutic approach in children
    • Choose conservative therapy first because this is a self-limiting condition, and aggressive treatment risks scarring. Use caution when treating facial lesions.
    • When intervention is necessary, prior application of eutectic lidocaine/prilocaine cream (eutectic mixture of local anesthetics [EMLA]) as a local anesthetic before curettage or cryotherapy may be helpful.6
    • Studies suggest that cimetidine may hasten resolution of molluscum contagiosum in children, although the FDA has not approved this therapy.
  • Therapeutic approach in patients who are infected with HIV
    • Confirm molluscum contagiosum histologically based on biopsy or squash preparation to exclude the diagnoses of cutaneous cryptococcosis, aspergillosis, or histoplasmosis.
    • Restoration of immune competence using HAART therapy may allow spontaneous resolution of cutaneous molluscum contagiosum. If this cannot be accomplished or if lesions do not improve with restoration of the CD4 cell count, surgical and/or medical therapies may be used.
    • The combination of an aggressive surgical approach with use of 1 or more topical agents is usually necessary in severely immunosuppressed individuals.
    • Intralesional IFN-alfa has been reported to be effective in patients who are infected with HIV, although this is not FDA approved.
    • The use of topical imiquimod cream therapy has been described for the treatment of chronic molluscum contagiosum in a patient with advanced HIV disease; however, this is not FDA approved.7
    • Although no controlled studies exist, radiation therapy has been used to treat molluscum contagiosum in individuals infected with HIV.
 


More on Molluscum Contagiosum

Overview: Molluscum Contagiosum
Differential Diagnoses & Workup: Molluscum Contagiosum
Treatment & Medication: Molluscum Contagiosum
Follow-up: Molluscum Contagiosum
Multimedia: Molluscum Contagiosum
References
[ CLOSE WINDOW ]

References

  1. Ackerman AB, Tanski EV. Pseudoleukemia cutis: report of a case in association with molluscum contagiosum. Cancer. Aug 1977;40(2):813-7. [Medline].

  2. Ahn BK, Kim BD, Lee SJ, Lee SH. Molluscum contagiosum infection during the treatment of vitiligo with tacrolimus ointment. J Am Acad Dermatol. Mar 2005;52(3 Pt 1):532-3. [Medline].

  3. Birthistle K, Carrington D. Molluscum contagiosum virus. J Infect. Jan 1997;34(1):21-8. [Medline].

  4. Blattner RJ. Molluscum contagiosum: eruptive infection in atopic dermatitis. J Pediatr. Jun 1967;70(6):997-9. [Medline].

  5. Brown ST, Nalley JF, Kraus SJ. Molluscum contagiosum. Sex Transm Dis. Jul-Sep 1981;8(3):227-34. [Medline].

  6. Buckley MM, Benfield P. Eutectic lidocaine/prilocaine cream. A review of the topical anaesthetic/analgesic efficacy of a eutectic mixture of local anaesthetics (EMLA). Drugs. Jul 1993;46(1):126-51. [Medline].

  7. Buckley R, Smith K. Topical imiquimod therapy for chronic giant molluscum contagiosum in a patient with advanced human immunodeficiency virus 1 disease. Arch Dermatol. Oct 1999;135(10):1167-9. [Medline].

  8. Bugert JJ, Darai G. Recent advances in molluscum contagiosum virus research. Arch Virol Suppl. 1997;13:35-47. [Medline].

  9. Buntin DM, Roser T, Lesher JL Jr, Plotnick H, Brademas ME, Berger TG. Sexually transmitted diseases: viruses and ectoparasites. Committee on Sexually Transmitted Diseases of the American Academy of Dermatology. J Am Acad Dermatol. Sep 1991;25(3):527-34. [Medline].

  10. Burke BE, Baillie JE, Olson RD. Essential oil of Australian lemon myrtle (Backhousia citriodora) in the treatment of molluscum contagiosum in children. Biomed Pharmacother. May 2004;58(4):245-7. [Medline].

  11. Charles NC, Friedberg DN. Epibulbar molluscum contagiosum in acquired immune deficiency syndrome. Case report and review of the literature. Ophthalmology. Jul 1992;99(7):1123-6. [Medline].

  12. Dohil MA, Lin P, Lee J, Lucky AW, Paller AS, Eichenfield LF. The epidemiology of molluscum contagiosum in children. J Am Acad Dermatol. Jan 2006;54:47-54. [Medline].

  13. Dourmashkin R, Bernhard W. A study with the electron microscope of the skin tumor of molluscum contagiosum. J Ultrastructure Research. 1959;3:11-38.

  14. Fery-Blanco C, Pelletier F, Humbert P, Aubin F. Disseminated molluscum contagiosum during topical treatment of atopic dermatitis with tacrolimus: efficacy of cidofovir. Ann Dermatol Venereol. May 2007;134:457-9. [Medline].

  15. Freeman CL, Moriarty AT. Molluscum contagiosum presenting as cellulitis in an AIDS patient: cytologic and ultrastructural features. Diagn Cytopathol. Jun 1995;12(4):345-9. [Medline].

  16. Gold MH, Boring MM, Bridges TM, Bradshaw VL. The successful use of ALA-PDT in the treatment of recalcitrant molluscum contagiosum. J Drugs Dermatol. Mar-Apr 2004;3(2):187-90. [Medline].

  17. Gottlieb SL, Myskowski PL. Molluscum contagiosum. Int J Dermatol. Jul 1994;33(7):453-61. [Medline].

  18. Hanna D, Hatami A, Powell J, Marcoux D, Maari C, Savard P, et al. A prospective randomized trial comparing the efficacy and adverse effects of four recognized treatments of molluscum contagiosum in children. Pediatr Dermatol. Nov-Dec 2006;23:574-9. [Medline].

  19. Horn CK, Scott GR, Benton EC. Resolution of severe molluscum contagiosum on effective antiretroviral therapy. Br J Dermatol. Apr 1998;138(4):715-7. [Medline].

  20. Lewis EJ, Lam M, Crutchfield CE. An update on molluscum contagiosum. Cutis. Jul 1997;60(1):29-34. [Medline].

  21. Mansur AT, Goktay F, Gunduz S, Serdar ZA. Multiple giant molluscum contagiosum in a renal transplant recipient. Transpl Infect Dis. Sep 2004;6(3):120-3. [Medline].

  22. Margolis S. Genital warts and molluscum contagiosum. Urol Clin North Am. Feb 1984;11(1):163-70. [Medline].

  23. Martin DH, Mroczkowski TF. Dermatologic manifestations of sexually transmitted diseases other than HIV. Infect Dis Clin North Am. Sep 1994;8(3):533-82. [Medline].

  24. Medical Economics Company. Intron A for Injection (Schering). PDR: Physicians' Desk Reference. 2001;[Full Text].

  25. Michel JL. Treatment of molluscum contagiosum with 585 nm collagen remodeling pulsed dye laser. Eur J Dermatol. Mar-Apr 2004;14(2):103-6. [Medline].

  26. Naert F, Lachapelle JM. Multiple lesions of molluscum contagiosum with metaplastic ossification. Am J Dermatopathol. Jun 1989;11(3):238-41. [Medline].

  27. Nageswaran A, Kinghorn GR. Sexually transmitted diseases in children: herpes simplex virus infection, cytomegalovirus infection, hepatitis B virus infection and molluscum contagiosum. Genitourin Med. Aug 1993;69(4):303-11. [Medline].

  28. Ordoukhanian E, Lane AT. Warts and molluscum contagiosum: beware of treatments worse than the disease. Postgrad Med. Feb 1997;101(2):223-6, 229-32, 235. [Medline].

  29. Pereira B, Fernandes C, Nachiambo E, Catarino MC, Rodrigues A, Cardoso J. Exuberant molluscum contagiosum as a manifestation of the immune reconstitution inflammatory syndrome. Dermatol Online J. 2007;13(2):6. [Medline].

  30. Postlethwaite R. Molluscum contagiosum. Arch Environ Health. Sep 1970;21(3):432-52. [Medline].

  31. Praetorius-Clausen F. Rare oral viral disorders (molluscum contagiosum, localized keratoacanthoma, verrucae, condyloma acuminatum, and focal epithelial hyperplasia). Oral Surg Oral Med Oral Pathol. Oct 1972;34(4):604-18. [Medline].

  32. Reed RJ, Parkinson RP. The histogenesis of molluscum contagiosum. Am J Surg Pathol. Jun 1977;1(2):161-6. [Medline].

  33. Ross GL, Orchard DC. Combination topical treatment of molluscum contagiosum with cantharidin and imiquimod 5% in children: a case series of 16 patients. Australas J Dermatol. May 2004;45(2):100-2. [Medline].

  34. Smith KJ, Yeager J, Skelton H. Molluscum contagiosum: its clinical, histopathologic, and immunohistochemical spectrum. Int J Dermatol. Sep 1999;38(9):664-72. [Medline].

  35. Sulica RL, Kelly J, Berberian BJ, Glaun R. Cutaneous cryptococcosis with molluscum contagiosum coinfection in a patient with acquired immunodeficiency syndrome. Cutis. Feb 1994;53(2):88-90. [Medline].

  36. Sutton JS, Burnett JW. Ultrastructural changes in dermal and epidermal cells of skin infected with Molluscum contagiosum virus. J Ultrastruct Res. Feb 1969;26(3):177-96. [Medline].

  37. Syed TA, Lundin S, Ahmad M. Topical 0.3% and 0.5% podophyllotoxin cream for self-treatment of molluscum contagiosum in males. A placebo-controlled, double-blind study. Dermatology. 1994;189(1):65-8. [Medline].

  38. Theos AU, Cummins R, Silverberg NB, Paller AS. Effectiveness of imiquimod cream 5% for treating childhood molluscum contagiosum in a double-blind, randomized pilot trial. Cutis. Aug 2004;74(2):134-8, 141-2. [Medline].

  39. Watanabe T, Tamaki K. Cidofovir diphosphate inhibits molluscum contagiosum virus DNA polymerase activity. J Invest Dermatol. Nov 15 2007;[Medline].

  40. Whitaker SB, Wiegand SE, Budnick SD. Intraoral molluscum contagiosum. Oral Surg Oral Med Oral Pathol. Sep 1991;72(3):334-6. [Medline].

  41. White CJ, Robey WH. Molluscum Contagiosum. J Med Res. 1902;7:255-77.

  42. Wilson LM, Reid CM. Molluscum contagiosum in atopic dermatitis treated with 0.1% tacrolimus ointment. Australas J Dermatol. Aug 2004;45(3):184-5. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

molluscum contagiosum, MC, molluscum contagiosum virus disease, MCV disease, opportunistic infection, sexually transmitted disease, STD, Henderson-Paterson body, Orthopoxvirus genus, renal transplantation, tacrolimus, topical immune suppressants, molluscum body

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Ashish C Bhatia, MD, FAAD, Assistant Professor of Clinical Dermatology, Department of Dermatology, Northwestern University, Feinberg School of Medicine; Director of Clinical Research, Department of Dermatology and Dermatologic Surgery, River North Dermatology and Dermatologic Surgery, DuPage Medical Group
Ashish C Bhatia, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American Medical Association, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, and Connective Tissue Oncology Society
Disclosure: Nothing to disclose.

Coauthor(s)

Tracy Campbell, MD, Staff Physician, Department of Dermatology, Rush Medical Center
Tracy Campbell, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Chicago Dermatological Society, and Women's Dermatologic Society
Disclosure: Nothing to disclose.

Seth Forman, MD, Private Practice, Tampa, Florida
Seth Forman, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Abbott Laboratories Honoraria Speaking and teaching

David Rowe, MD, Pathologist, Laboratory Medicine, Martha Jefferson Hospital
David Rowe, MD is a member of the following medical societies: United States and Canadian Academy of Pathology
Disclosure: Nothing to disclose.

Robert Orenstein, DO, Associate Professor, Department of Medicine, Medical College of Virginia, Virginia Commonwealth University; Medical Director, Infectious Disease Clinic, Medical College of Virginia Hospitals
Robert Orenstein, DO is a member of the following medical societies: Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Julia R Nunley, MD, Professor, Program Director, Dermatology Residency, Department of Dermatology, Virginia Commonwealth University Medical Center
Julia R Nunley, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Society of Nephrology, International Society of Nephrology, Medical Dermatology Society, Medical Society of Virginia, National Kidney Foundation, Phi Beta Kappa, and Women's Dermatologic Society
Disclosure: Johnson and Johnson stock holder dividends; Amgen stock holder dividends; Forest Lab, Inc stock holder dividends; Galaxo Smith Klein stock holder dividends; Covidien stock holder dividends; Novartis Grant/research funds Consulting; Biolex  sub-investigator

Medical Editor

Daniel R Lucey, MD, MPH, Chief, Fellowship Program Director, Department of Internal Medicine, Division of Infectious Diseases, Washington Hospital Center; Professor, Department of Internal Medicine, Uniformed Services University of the Health Sciences
Daniel R Lucey, MD, MPH is a member of the following medical societies: Alpha Omega Alpha and American College of Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

John W King, MD, Professor of Medicine, Chief, Section of Infectious Diseases, Director, Viral Therapeutics Clinics for Hepatitis, Louisiana State University Health Sciences Center; Consultant in Infectious Diseases, Overton Brooks Veterans Affairs Medical Center
John W King, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Association of Subspecialty Professors, Infectious Diseases Society of America, and Sigma Xi
Disclosure: emedicine $50.00 author of chapter

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.