Molluscum contagiosum

Cidofovir (Fig. 2) has been formally approved for the treatment of CMV retinitis in AIDS patients, where it is administered intravenously at a dose not exceeding 5 mg/kg once weekly during the first two weeks (and every other week thereafter). Cidofovir is also used off label for the treatment of human papilloma virus (HPV) infections (i.e., cutaneous warts, anogenital warts, laryngeal and pharyngeal papilloma), polyomavirus [i.e., progressive (i.e., multifocal leukoencephalopathy (PML)], adenovirus, herpesvirus, and poxvirus (i.e., molluscum contagiosum) infections, where it can be administered intravenously (at a dose of < 5 mg/kg once weekly or every other week) or topically as a 1% gel or cream (De Clercq and Holy 2005). Especially in immunosuppressed patients (i.e., transplant recipients), local treatment of HPV-associated lesions has often yielded spectacular results (Bonatti etal.2007). 

Luttichau HR, Stine J, Boesen TP, et al. A highly selective CC chemokine receptor (CCR)8 antagonist encoded by the poxvirus molluscum contagiosum. J Exp Med 2000 191 171-80. 

Cantharidin is the active irritant isolated from cantharides. It is mainly used in the treatment of molluscum contagiosum and verruca vulgaris, particularly periungual warts. 

Imiquimod is an immune response modifier shown to be effective in the topical treatment of external genital and perianal warts (ie, condyloma acuminatum see Chapter 61). The 5% cream is applied three times weekly and washed off 6-10 hours after each application. Recurrences appear to be less common than after ablative therapies. Imiquimod is also effective against actinic keratoses, and possibly, molluscum contagiosum. Local skin reactions are the most common side effect these tend to resolve within weeks after therapy. However, pigmentary skin changes may persist. Systemic adverse effects such as fatigue and influenza-like syndrome have occasionally been reported. 

Perpetuation of masked infections with Candida albicans Conversion of scabies into the Norwegian type Widespread lesions of molluscum contagiosum Galloping impetigo... 

Krathwohl, M. D., Hromas, R., Brown, D. R., Broxmeyer, H. E., and Fife, K. H. (1997). Functional characterization of the C-C chemokine-like molecules encoded by molluscum contagiosum virus types 1 and 2. Proc. Natl Acad. Sci. USA 94, 9875-9880. 

Senkevich, T. G., Koonin, E. V., Bugert, J. J., Darai, G., and Moss, B. (1997). The genome of molluscum contagiosum vims Analysis and comparison with other poxviruses. Virology 233, 19-42. 

Other potential uses of cidofovir that are currently under investigation include treatment of the polyomavirus-associated progressive multifocal leukoencephalopathy syndrome in patients with AIDS, postexposure prophylaxis against smallpox, and topical treatment of molluscum contagiosum. Topical cidofovir is not currently available in a standardized preparation. 

Molluscum contagiosum is a relatively common viral infection of the skin that may be problematic when located near or aroimd the eyes. It is seen most often in children but may be foimd in adults, especially if immunocompromised. 

Etiology. Molluscum contagiosum is a localized self-limiting skin infection caused by a human-specific pox virus. Infection is most often due to autoinoculation or by direct contact it is rarely sexually transmitted. 

Figure 23-18 Molluscum contagiosum showing the typical dome-shaped lesions with central depression arrows). (Courtesy Dr. Mona Younes, University of Houston, College of Optometry.)...

Adenovirus Herpes simplex Varicella-zoster Molluscum contagiosum Enterovirus 70 Epstein-Barr... 

Molluscum contagiosum is a dermatologic lesion caused by a poxvirus and is responsible for causing chronic or recurrent follicular conjunctivitis in patients who have lesions of the periorbital skin or eyelids. 

Figure 25-17 Molluscum contagiosum lesion (arrow ) on lower eyelid of young child.

The management of chronic follicular conjimctivitis associated with molluscum contagiosum is removal of the dermatologic lesion to prevent further spread of virus particles into the eye. This treatment is curative, and no further intervention is required. Multiple or recurrent molluscum lesions may be associated with systemic immunosuppression and may be a sentinel lesion in patients with human immunodeficiency virus infection. 

Hengge UR, Esser S, Schultewolter T, Behrendt C, Meyer T, Stockfleth E, Goos M. Self-administered topical 5% imiquimod for the treatment of common warts and molluscum contagiosum. Br J Dermatol 2000 143(5) 1026-31. 

A 67-year-old woman with a 5-year history of rheumatoid arthritis, who had taken prednisone and methotrexate, was given infliximab (55). Her rheumatoid arthritis improved, but she developed multiple bilateral lesions of molluscum contagiosum on the upper and lower eyelids, despite normal CD4 and CDS counts. She had had similar lesions during a previous course of infliximab. Excision biopsy confirmed the diagnosis. 

A 5-year-old child had 35 g of Emla apphed under an occlusive dressing to eczematous skin in preparation for cryotherapy for molluscum contagiosum (3). Within 1 hour, the child had a generalized seizure that lasted 10 minutes. The plasma concentrations of lidocaine and prilocaine 30 minutes later were 5.5 and 2.0 pg/ml, respectively, and 6 hours later, the methemoglobin concentration was 19%. The child was given vitamin C 500 mg intravenously, and 2 days later had a methemoglobin concentration of 0.3%. 

Ronnerfalt L, Fransson J, Wahlgren CF. EMLA cream provides rapid pain relief for the curettage of molluscum contagiosum in children with atopic dermatitis without causing serious application-site reactions. Pediatr Dermatol 1998 15(4) 309-12. 

Brown SL +, Arthritis Rheum 46(12), 3151 (8 cases) Molluscum contagiosum (eyelids)... 

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