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 family of Poxviruses (including the 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), sitting mainly on the face, the folds of the limbs and armpits and the ano-genital region.
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 …) and by manuportage in the same patient.
Causes of Molluscum Contagiosum
Molluscum contagiosum is caused by Molluscum Contagiosum Virus (MCV) viral infection of the superficial layer of the skin, which has become the most common pathogenic poxvirus in humans and is currently known to have four classified genotypes of MCV. 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, the dermatologist or the pediatrician . These are small flesh-colored or pearly skin lesions that sit in a child’s folds or face.
Who is the 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 poorly-saned populations, but 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 commonly seen in the genital area through sexual contact. It can also be transmitted by shaving (ready with a razor), by wax during hair removal at the beautician, by badly sterilized tattoo instruments …
The occurrence of molluscum contagiosum in adults is common in patients with HIV . The occurrence of molluscum contagiosum has been reported in HIV + patients before the onset of human immunodeficiency syndrome (AIDS), so the occurrence of a molluscum contagiosum may be the first sign of HIV infection. and it may happen that the doctor requests HIV serology from an adult with these lesions.
Similarly, molluscum has been described in patients with other sources of immunodepression (chemotherapy, corticosteroids, lympho-proliferative diseases).
Evolution and possible complications
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 behalf. Thus, even if the natural evolution is the regression in a few weeks or months, during this period of time, many other lesions often appear.
Some can be located on delicate areas to treat (eyelid, nose, foreskin …).
Other classic complications are pain, itching, inflammatory reactions on molluscum and bacterial superinfections.
SYMPTOMS of Molluscum Contagiosum
The lesions of molluscum contagiosum are classically small round skin elevations of 1 to 10 mm in diameter, flesh-colored pearly, firm and umbilicated, sitting on the face, the limbs (especially in the folds of the elbows, knees and armpits ) and the ano-genital area. Lesions are often multiple (several tens).
Risk factors for Molluscum Contagiosum
Risk factors are in children, atopy, life in the tropics and age between 2 and 4 years.
In adults, the risk factors are sexuality, HIV infection and immunosuppression, razor loan, institute waxing and tattooing.
Risk factors in children such as atopy and in adults, HIV infection and immunodepression, razor lending, institute waxing and tattooing without 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 in dermatologists: if it seems lawful to propose abstention given the spontaneous regression of lesions, it is often difficult to hold this speech in front of the parents who came just to see disappear quickly those little balls that colonize their child’s skin. Moreover, it is often feared the multiplication of lesions especially in the youngest children and difficult to treat localization (face, genitals …).
Gentle treatments are therefore often offered as first-line treatment, and in the event of failure, the ablative treatments are usually performed after application of anesthetic cream to the lesions one hour before the procedure.
Treatments of Molluscum Contagiosum
As molluscum contagiosum tends to regress spontaneously, many doctors are waiting and prefer to wait for their hypothetical disappearance, especially when they are small, rather than trying sometimes painful treatments. The treatment is essentially established to control contagion by manuportage lesions and contagiousness vis-à-vis the entourage, but also to limit the risk of complications (irritation, inflammation and superinfection). Similarly, patients are often very demanding of treatments and are generally not ready to wait for the hypothetical spontaneous disappearance of their lesions.
This treatment consists in applying liquid nitrogen to the lesions of molluscum contagiosum, which causes the destruction of the cutaneous tissues by formation of ice crystals inside and outside the cells.
This technique is painful, causing a bubble on each molluscum contagiosum with risk of scar and pigment disorders or even scar. It is therefore often not appreciated by children … and parents.
Expression of the content of molluscum contagiosum
This consists in incising the molluscum contagiosum (most often after having applied an anesthetic cream) and emptying the white drowning molluscum contagiosum, manually or by means of pliers.
This technique consists in removing by means of a curette the molluscum contagiosum under local anesthesia by cream (or general if there are numerous lesions of molluscum contagiosum in the child).
Potassium hydroxide is a substance that penetrates the depth of the skin and dissolves the keratin. It can be used at home until it becomes red. It is marketed under the trade names Poxkare , Molutrex , Molusderm …
The CO2 laser and especially the pulsed dye laser can be used in adults and children: the first destroyed, which causes more risk of scarring, while the second coagulates the vessels of molluscum contagiosum, causing bruising and crusts a little painful.
Complementary approach: Tea Tree Essential Oil
The World Health Organization recognizes the topical use of the essential oil of T ea Tree to relieve the symptoms of various common skin conditions.
Apply the essential oil in dermal 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: in Because of the possibility of allergic reactions, it is advisable to first test on a small area of the skin before applying the essential oil on the entire area to be treated.