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Molluscum Contagiosum
Definition
Molluscum contagiosum is a very common and often profuse viral lesion of the skin in children.
Definition of molluscus contagiosum
Molluscum contagiosum is a viral infection of the epidermis caused by Molluscum Contagiosum Virus (MCV), a virus belonging to the Poxvirus family (which includes smallpox virus), characterized by the presence of multiple small pearly skin elevations , flesh-colored, hard and umbilicated (they have a small hole at the top), mainly found on the face, the folds of the limbs and armpits as well as the anogenital area.
Is it contagious?
As the name suggests, molluscum contagiosum is contagious. It is transmitted between children by direct contact during games or baths, or indirect (loan of underwear, towels, etc.) and by handling in the same patient.
Causes
Molluscum contagiosum is caused by viral infection of the surface layer of the skin by Molluscum Contagiosum Virus (MCV), which has become the most common pathogenic poxvirus in humans and of which we currently know four classified genotypes of CVD- 1 to MCV-4. MCV-1 is most commonly implicated in children, while MCV-2 is more common in adults.
The incubation time of Molluscum Contagiosum Virus is of the order of 2 to 7 weeks.
The diagnosis of molluscus contagiosum
The diagnosis is often obvious to the doctor, dermatologist or pediatrician. These are small, flesh-colored or pearly-colored skin lesions, found in a child in the folds or face.
Who is most affected?
Children are by far the most affected by molluscum contagiosum. Molluscum contagiosum infection is more common in hot and humid climates and in populations living in poor hygienic conditions, but it can be observed in all social strata.
Profuse lesions can develop especially in children with atopic dermatitis.
In adults, molluscum contagiosum is rarer and is most often seen in the genital area through sexual contagion. It can also be transmitted by shaving (loan of a razor), by waxing during hair removal at the beautician, by poorly sterilized tattoo instruments …
The occurrence of molluscum contagiosum in adults is common in patients with HIV infection. The occurrence of molluscum contagiosum has been reported in HIV + patients before the onset of human immunodeficiency syndrome (AIDS), so the occurrence of molluscum contagiosum may be the first warning sign of HIV infection. and it may happen that the doctor requests an HIV serology in an adult with these lesions.
Likewise, molluscum has been described in patients with other sources of immunosuppression (chemotherapy, corticosteroid therapy, lympho-proliferative diseases)
Evolution et complications possible
The natural evolution of molluscum contagiosum is spontaneous regression, most often after an inflammatory phase.
However, the contagiousness of the lesion means that there are often several dozen lesions, each evolving on its own account. Thus, even if the natural course is regression in a few weeks or months, during this period of time, we often see many other lesions appear.
Some can be localized on delicate areas to be treated (eyelid, nose, foreskin, etc.).
The other classic complications are pain, itching, inflammatory reactions on the molluscum and secondary bacterial infections.
Symptoms of the disease
Molluscum contagiosum lesions are classically small round skin elevations 1 to 10 mm in diameter, pearly flesh-colored, firm and umbilicated, located on the face, limbs (especially in the folds of the elbows, knees and armpits. ) and the anogenital region. The lesions are often multiple (several dozen).
Risk factors
The risk factors are in children, atopy, life in tropical regions and age between 2 and 4 years.
In adults, the risk factors are sexuality, HIV infection and immunosuppression, razor loans, salon waxing and tattooing.
Prevention
We can fight against the risk factors in children which are atopy and in adults, HIV infection and immunosuppression, the loan of razor, waxing in a salon and tattooing without rules. strict hygiene
The use of bath products and towels specific to each person in a family is generally recommended.
The opinion of Ludovic Rousseau, dermatologist The treatment of molluscum contagiosum is debated among dermatologists: if it seems lawful to propose abstention given the spontaneous regression of the lesions, it is often difficult to hold this speech in front of the parents who came precisely to see them disappear. quickly these little balls which colonize their child’s skin. In addition, we often fear the multiplication of lesions, especially in younger children and locations that are difficult to treat (face, genitals, etc.). Gentle treatments are therefore often offered as a first-line treatment, and in the event of failure, ablative treatments are most often carried out after applying an anesthetic cream to the lesions one hour before the procedure. |
Treatments
As molluscum contagiosum tends to regress spontaneously, many doctors are waiting and prefer to wait for their hypothetical disappearance, especially when there are few, rather than attempting sometimes painful treatments. The treatment is mainly implemented to control contagion by handling lesions and contagiousness to those around them, but also to limit the risk of complications (irritation, inflammation and superinfection). Likewise, patients are often very demanding of treatment and are generally not ready to wait for the hypothetical spontaneous disappearance of their lesions.
cryotherapy
This treatment involves applying liquid nitrogen to lesions of molluscum contagiosum, which destroys skin tissue by forming ice crystals inside and outside the cells.
This technique is painful, causing a bubble on each molluscum contagiosum with the risk of scars and pigmentary disorders or even scars. It is therefore often little appreciated by children … and parents.
Expression of the contents of molluscum contagiosum
This consists of incising the molluscum contagiosum (most often after applying an anesthetic cream) and emptying the white embedding of the molluscum contagiosum, manually or by means of forceps.
Curettage
This technique consists of removing the molluscum contagiosum using a curette under local anesthesia by cream (or general if there are numerous lesions of molluscum contagiosum in children).
Potassium hydroxide
Potassium hydroxide is a substance that penetrates deep into the skin and dissolves keratin there. It can be used at home until you get redness. It is marketed under the trade names Poxkare *, Molutrex *, Molusderm * …
Laser
The CO2 laser and especially the pulsed dye laser can be used in adults and children: the first destroys, which causes more risk of scarring, while the second coagulates the vessels of molluscum contagiosum, causing bruising and scabs a little painful.
Complementary Approach: Tea Tree Essential Oil
The World Health Organization recognizes the topical use of Tea Tree essential oil to relieve symptoms of various common skin conditions.
Apply the essential oil by skin application, 1 drop of oil diluted with a vegetable oil to apply it punctually on each lesion (jojoba oil for example), only in children over 7 years old and adults
Caution: Due to the possibility of allergic reactions, it is advisable to first test a small area of the skin before applying the essential oil to the entire area to be treated.