Therapy of external anogenital warts and molluscum contagiosum: a literature review

ABSTRACT:  Anogenital warts and mollusca contagiosum are virally induced, benign skin tumors for which there is no single preferable therapy. Treatments include physical and chemical destruction, surgical removal, and biological response modifiers to enhance the natural immune response. The choice of therapy is an art, and depends upon patient preference, finances, number of lesions, and lesional morphology. However, the therapy of these lesions can sometimes be very painful and expensive, and therapy should not be worse than the disease.     

Treatment modalities for molluscum contagiosum

ABSTRACT: Molluscum contagiosum (MC) is caused by a poxvirus which produces cutaneous lesions which appear as small, firm, umbilicated papules. In general, there are three clinical presentations of MC: the childhood variety due to casual contact; the sexually transmitted variety in adults; and the aggressive form seen in patients infected with the human immunodeficiency virus (HIV). Removal of MC lesions is usually straightforward in the first two presentations and can include mechanical removal with a blade or curette, cryosurgery, podophyllin or podophyllotoxin, cantharidin, various acids or retinoids. In the HIV seropositive patient such treatments are usually inadequate due to the very large number of lesions and the rapid recurrence after mechanical removal. Combination therapy has been more successful in such cases especially if treatment includes such experimental antiviral/immunomodulatory agents as imiquimod or cidofovir.     

Curettage treatment for molluscum contagiosum: a follow-up survey study

Background Although curettage is commonly used to treat molluscum contagiosum, prospective studies on its effectiveness are lacking. Objectives To evaluate prospectively the efficacy of curettage in the treatment of molluscum contagiosum and to identify the risk factors associated with treatment failure. Methods A systematic 2‐month follow‐up survey study was carried out on 73 patients treated by curettage for molluscum contagiosum. Results Treatment of molluscum contagiosum by curettage was associated with a high risk of treatment failure at week 4 (42/64, 66%) and at week 8 (25/55, 45%). Risk factors for treatment failure at week 4 and 8 were the number of lesions at day 0 (P < 0·001), the number of involved anatomical sites (P < 0·001) and concomitant atopic dermatitis (P = 0·038 and P < 0·001, at weeks 4 and 8, respectively). Conclusions The main risk factor for treatment failure is lesion number, underlining the importance of the early detection of the lesions or, alternatively, emphasizing the need for therapeutic options other than curettage in patients with numerous lesions.     

传染性软疣样皮损表现的播散性隐球菌病2例

报告2例播散性隐球菌病。除系统累及表现外，皮损为传染性软疣样丘疹，组织液、血液及脑脊液检查找到隐球菌，皮损和淋巴结组织病理学检查见孢子。提示当发热性疾病伴传染性软疣样皮损时，应警惕隐球菌感染。避免误诊和延误诊断的关键是提高对本病的认识和对可疑病例做真菌检查。     

成人头皮传染性软疣1例

报告成人头皮传染性软疣1例.患者女,38岁.头皮丘疹、结节3个月.皮肤科检查:发际线正中近额处可见一花生米大小的肤色结节,质中,界清,顶端有一小凹陷,周围散在数个粟粒大小半球形丘疹,表面蜡样光泽.皮损组织病理检查可见软疣小体.皮肤镜检查:中央黄白色无定型结构,边缘围绕点状血管.诊断:传染性软疣.治疗:予刮匙刮除全部疣体...     

26例误诊传染性软疣皮肤镜分析

回顾性分析2019年8月至2020年1月我院门诊首诊误诊但皮肤镜下可见典型传染性软疣(MC)特征的26例患者的临床资料。26例患者中首诊被误诊为痒疹5例、湿疹4例、毛囊炎3例、皮肤肿瘤3例、粟丘疹3例,疖2例、黄色肉芽肿1例、疣1例、瘢痕1例、疥疮结节1例、角化棘皮瘤1例、未诊断1例,皮肤镜下均可见MC的特异性结构,即病灶中央黄白色结构和周围皇冠状血管,中央黄白色结构呈四叶草形10例、多叶形7例、圆形5例及非特异形1例,四叶草形+多叶形1例、四叶草形+圆形1例、圆形+多叶形1例。     

Successful treatment of molluscum contagiosum with intralesional immunotherapy by measles,mumps, and rubella vaccine: a report of two cases

Molluscum contagiosum (MC) is a common viral infection of the skin and mucous membrane that often affects young children. Generally, physical removal by surgical curettage is commonly used for the treatment of MC, but the pain during the treatment is a major problem. Thus immunotherapy using various antigens has been introduced recently. Here we present two cases of MC that improved with measles, mumps, and rubella (MMR) vaccine intralesional injection. On the ground of our knowledge, they were the first cases of successful MMR intralesional injection in this disease entity.     

Handheld reflectance confocal microscopy for the diagnosis of molluscum contagiosum: Histopathology and dermoscopy correlation

Handheld reflectance confocal microscopy may represent an adjunctive, fast, non‐invasive tool for the diagnosis of molluscum contagiosum, revealing microscopic details closely related to histopathology, as demonstrated by this study evaluating 19 molluscum lesions in 11 patients. It permits the rapid examination of one or multiple skin lesions in real time and it is perfectly suitable for children.     

传染性软疣58例临床及病理分析

目的：分析传染性软疣（Molluscum Contagiosum,MC）的临床病理特点.方法：收集58例MC患者的临床和病理资料进行综合分析.结果：MC发病男女比例约2.9∶1,多无自觉症状.皮疹成人多位于下腹部、股内侧和外生殖器部位,而儿童多在面、躯干和四肢.虽然MC为常见皮肤病,本组中发现其临床误诊率为46.6%.组织病理特征为小叶状、内生性生长的结节,角质形成细胞胞质中存在包涵体,即软疣小体,可继发感染或并发表皮囊肿等.结论：MC继发感染或并发表皮囊肿等其他皮肤损害时,临床表现多不典型,组织病理可确诊.     

传染性软疣伴发表皮囊肿1例

报告1例传染性软疣伴发表皮囊肿。患者男，71岁。鼻尖部出现一黄豆大红色丘疹4个月，无自觉症状。皮损组织病理检查显示真皮内见一囊肿，囊壁细胞内见嗜酸性圆形或椭圆形病毒包涵体，囊腔内的角质物网眼内亦见病毒包涵体。组织病理诊断为传染性软疣发表皮囊肿。     

Topical cidofovir for severe cutaneous human papillomavirus and molluscum contagiosum infections in patients with HIV/AIDS. A pilot study

BACKGROUND: Cidofovir is a nucleoside analogue of deoxycytidine with a strong activity against several DNA viruses, including herpes, pox and human papilloma virus (HPV). MATERIAL AND METHODS: Fourteen acquired immunodeficiency syndrome patients, 10 with extensive HPV lesions and four with molluscum contagiosum (MC) infections, unresponsive to conventional therapies, were treated with a cream containing cidofovir 1%. All the subjects had been on treatment with highly active antiretroviral therapy for almost 1 year before starting the cream. Measured end-points of therapy were efficacy, tolerability, side-effects and freedom from recurrence. RESULTS: Thirteen of the 14 patients (92.8%) completed the therapy, one dropped out. These 13 eventually cleared their MC or warts, over varying periods of time. In nine, the lesions regressed 2 weeks from the end of the first cycle of therapy. Three patients needed two cycles and the last three consecutive courses of topical therapy before the cutaneous lesions healed. No recurrence was observed in nine patients over an average follow-up period of 24.1 months (range 12-30 months). Four patients had isolated relapses, which were successfully treated with simple curettage. SIDE-EFFECTS: All the patients experienced side-effects where they applied the cream. Inflammation, erosion and a burning sensation were the most frequent. Postinflammatory hyperpigmentation was observed in six cases, while two developed a transient alopecia on the beard area. No systemic side-effects or alteration of laboratory data were noted. CONCLUSION: Cidofovir appears to offer an effective therapeutic alternative option for lesions that are unresponsive to conventional methods. Appropriate clinical trials are required, however, to confirm the true efficacy and safety of topical cidofovir.     

传染性软疣皮肤镜和共聚焦显微镜的图像特征

目的： 确定皮肤镜和反射式共聚焦显微镜(RCM)下传染性软疣的图像特征。方法： 选取临床确诊的传染性软疣患者,每例选1处或多处皮损行皮肤镜及RCM检查,记录并统计各项图像特征。结果： 共20例传染性软疣患者85处皮损进行了监测,皮肤镜显示85处皮损中71处可见黄白色高亮结构;RCM显示85处皮损显示细胞形态较大的软疣小体,其周围为挤压致密的表皮细胞。结论： 传染性软疣在皮肤镜和RCM下的图像均具有特征性,都可作为传染性软疣的辅助诊断技术。     

Successful treatment of recalcitrant molluscum contagiosum in a stem cell transplant patient with Candida immunotherapy

Solid organ and stem cell transplant recipients have an increased risk of developing cutaneous infections, which often are refractory to conventional treatment (Euvrard et al., Journal of the American Academy of Dermatology, 2001, 44, 932–939). Molluscum contagiosum, a common self‐limited disease primarily affecting children, can be more severe and unresponsive to therapy in transplant patients (Gardner & Ormond, Clinical and Experimental Dermatology, 2006, 31, 452–453). Candida immunotherapy has been widely used for the treatment of warts, and recently its application has been expanded to include treatment of symptomatic molluscum in pediatric patients (Enns & Evans, Pediatric Dermatology, 2011, 28, 254–258; Maronn et al., Pediatric Dermatology, 2008, 25, 189–192). However, to our knowledge there have been no reports in the literature of its utility in the setting of adult transplant or immunocompromised patients. Herein, we report a case of successful treatment of refractory molluscum contagiosum in a stem cell transplant patient with Candida immunotherapy.     

Topical cidofovir for the treatment of recalcitrant viral warts and molluscum contagiosum in Jacobsen syndrome

Jacobsen syndrome is caused by a terminal deletion on the long arm of chromosome 11 and can be associated with immunodeficiency. Patients with Jacobsen syndrome can be predisposed to cutaneous viral infections that are difficult to treat. We report successful use of topical 1% cidofovir as treatment of recalcitrant verruca vulgaris in one patient and molluscum contagiosum in another patient with Jacobsen syndrome. Topical cidofovir appears to be a good treatment option in this cohort and should be considered early for treatment-resistant cutaneous viral infections.     

HIV感染合并泛发性顽固性传染性软疣1例

报道1例HIV感染者合并泛发性、顽固性传染性软疣。患者女,25岁,因躯干、外生殖器、双大腿内侧皮疹2个月就诊。患者4个月前确诊HIV感染,经高效抗逆转录病毒治疗(HAART)2个月。皮肤科检查：右侧乳晕、右肋间、腹部、耻骨部、大阴唇、小阴唇、肛周、双大腿内侧大量丘疹、结节,以及部分斑丘疹、脓疱、糜烂、痂。乳晕、外生殖器处皮损组织病理均提示：细胞胞浆内均可见嗜酸性病毒包涵体,软疣小体形成,可见一些嗜碱性透明角质颗粒,真皮浅层少量慢性炎细胞浸润。皮损随着HAART逐渐增多、增大。诊断：HIV感染合并泛发性、顽固性传染性软疣。治疗：予以微波治疗联合咪喹莫特乳膏外用,同时对患者进行心理干预等综合治疗。3个月后随访,皮损已基本消退,取得满意疗效。     

Imiquimod cream 5% for recalcitrant cutaneous warts in immunosuppressed individuals

BACKGROUND: Viral warts may cause significant morbidity in individuals unable to mount an adequate T-helper 1 cell-mediated immune response to human papillomavirus. Imiquimod is a potent inducer of antiviral cytokine activity which has shown significant efficacy in the treatment of genital warts. Similar efficacy in cutaneous warts is not yet established. OBJECTIVES: To assess the response of persistent cutaneous warts to 5% imiquimod cream in immunosuppressed individuals. METHODS: Fifteen immunosuppressed patients with warts on the hands and/or feet present for more than 18 months, which had failed to respond to a minimum of 12 weeks of topical salicylic acid and four cycles of cryotherapy, were recruited. Imiquimod 5% cream was applied in an open label, right vs. left comparison study for 24 weeks (three times weekly for 8 weeks, daily for 8 weeks, then daily with occlusion for 8 weeks). RESULTS: Twelve (80%) patients completed the study protocol. Benefit was seen in five patients [36% in the intent-to-treat analysis (14 patients)], including more than 30% clearance of warts in three patients and reduction in overall size of warts in two further cases. Local skin reactions occurred in four (29%) patients and were usually mild. A transient rise in creatinine (11-29% above baseline) was measured in three renal transplant recipients, but we did not consider that this was related to imiquimod exposure. CONCLUSIONS: This is the first controlled study to assess therapeutic efficacy of topical 5% imiquimod cream in persistent warts associated with immunosuppression. It provides preliminary evidence that topical imiquimod may benefit a subgroup of immunosuppressed patients with recalcitrant cutaneous warts.