Modified curettage technique for molluscum contagiosum

Molluscum contagiosum is a frequently occurring, virally induced cutaneous condition that affects infants, children, and adults. Although historically considered a self-limiting entity, many patients experience prolonged infections, often resistant to varied therapeutic interventions. Topical treatments achieve complete clearance in only a limited number of patients. Because of the associated pain, affected children are characteristically uncompliant to commonly used destructive modalities. We describe a modification of the traditional curettage technique to remove lesions of molluscum contagiosum, which has proven to be effective and well tolerated by a significant number of patients in our practice.     

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.     

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.     

Self-administered topical 5% imiquimod for the treatment of common warts and molluscum contagiosum

BACKGROUND: Despite numerous therapeutic options the treatment of common warts and molluscum contagiosum remains unsatisfactory for both patients and physicians. Imiquimod, a novel topical immune response modifier, has been successfully used for the treatment of external anogenital warts. OBJECTIVES: We aimed to evaluate the safety, tolerance and efficacy of imiquimod for the treatment of common cutaneous warts and mollusca that were resistant to previous therapeutic interventions. METHODS: Imiquimod 5% cream was self-applied by the patients to the warts or mollusca once daily for 5 days per week and left in place overnight. Assessment for response and the occurrence of side-effects was performed every 4 weeks until clinical cure or up to a maximum of 16 weeks. RESULTS: Twenty-eight of 50 (56%) patients with warts achieved a total clearance (n = 15; 30%) or a > 50% reduction in wart size (n = 13; 26%) after a mean treatment period of 9.2 weeks. Twelve of 15 (80%) patients with mollusca achieved a total clearance (n = 8; 53%) or a > 50% reduction in molluscum size (n = 4; 27%). There was no difference in response with regard to gender, human immunodeficiency virus serostatus or atopic predisposition. CONCLUSIONS: Patient-applied 5% imiquimod cream holds promise as an effective treatment of common warts and mollusca in a difficult-to-treat patient population.     

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.     

Molluscum contagiosum arising in a melanocytic congenital nevus

Molluscum contagiosum within a congenital melanocytic nevus has rarely been reported. We report a 6‐year‐old child with molluscum contagiosum infection arising within an intermediate melanocytic congenital nevus of the thigh, associated with itching and occasional bleeding. Dermoscopy lead to the correct diagnosis, but histologic confirmation with shave biopsy was performed to reassure the parents and allow mechanical removal of the lesions using curettage.     

An immunohistochemical study of abnormal keratinocyte differentiation in molluscum contagiosum

To investigate abnormalities in the keratinization process in lesional epidermis of molluscum contagiosum, production of filaggrin, loricrin, Ted-H-1 antigen, involucrin, cystatin A and CD95 ligand (CD95L) was investigated using specific antibodies. Anti-filaggrin monoclonal antibody (MoAb) did not react with keratohyalin granules (KHG), but with the substance around virus particles in the stratum corneum. KHG reacted with anti-loricrin polyclonal antibody (PoAb) and anti-Ted-H-1 MoAb. Anti-involucrin PoAb and anti-cystatin A PoAb reacted with materials in the cytoplasm of the middle stratum spinosum to the stratum granulosum. CD95L was expressed in the cell membrane region of the living cell layers in lesional epidermis. These observations suggest that the keratinization process may be altered in molluscum contagiosum.     

An immunohistochemical study of abnormal keratinocyte proliferation in molluscum contagiosum

BACKGROUND: Molluscum contagiosum is a common cutaneous tumour that is characterized by usually spontaneous involution and self-limited spreading in immunocompetent individuals. OBJECTIVE: We aimed to investigate the apoptosis and the expression of cell-cycle proteins in molluscum contagiosum lesions. METHODS: The terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labelling (TUNEL)-based apoptotic index and the expression of the cell-cycle proteins Ki-67, p53, p21WAF and Bcl-2 were investigated in molluscum contagiosum lesions obtained from the trunk of 20 immunocompetent patients and in normal skin samples from the trunk of six healthy volunteers. RESULTS: Whereas molluscum contagiosum lesions displayed a TUNEL-based apoptotic index similar to that of normal skin, they exhibited an increased Ki-67 index, which was confined to the basal and first suprabasal layers (P < 0.001). Compared with normal non-sun-exposed skin, molluscum contagiosum lesions also exhibited increased p53 staining in basal cells (P < 0.01), increased p21WAF in suprabasal cells (P < 0.001) and loss of Bcl-2 expression. CONCLUSIONS: These results indicate that molluscum contagiosum lesions exhibit an increased proliferation rate of keratinocytes, which is likely to be partially counteracted by accumulation of p53.     

Plantar molluscum contagiosum: a case report of molluscum contagiosum occurring on the sole of the foot and a review of the world literature

Molluscum contagiosum (MC) is a skin infection caused by the double-stranded DNA virus of the family Poxviridae that typically presents as flesh-colored asymptomatic umbilicated papules. Plantar MC is uncommon. We describe a 23-year-old man who presented with multiple plantar MC. We also summarize the epidemiologic features of the 34 previously reported patients with plantar MC and discuss the clinical characteristics, differential diagnosis, and treatment of plantar MC. The patients were immunocompetent and the median age at diagnosis was 21 years. Although the plantar MC were asymptomatic in some individuals, a common presenting symptom was pain while walking. Patients had 1 lesion (23/35), 2 lesions (5/35), 3 lesions (4/35), or more than 5 lesions (3/35). Giant MC (>or=1 cm in diameter) was observed in more than 75% (a minimum of 27/35) of patients. At the initial patient evaluation, plantar verruca often was suspected; subsequently, light and/or electron microscopy of the plantar lesion confirmed the diagnosis of plantar MC. Removal or destruction of the lesion resulted in definitive treatment of the plantar MC.     

Cutaneous cryptococcosis resembling molluscum contagiosum: a first manifestation of AIDS

A 30-year-old homosexual man developed multiple skin umbilicated lesions resembling molluscum contagiosum. Initially the lesions were on his face but they rapidly spread. Histopathology and mycologic cultures of a skin biopsy revealed cryptococcus neoformans which was also identified in cerebrospinal fluid and in bronchoalveolar washings. The patient had fever, weight loss, generalized lymph node enlargement, depletion of the T helper subpopulation and positive HIV-1 serology. During treatment with flucytosine and amphotericin B, the skin lesions regressed in 3 months (cryptococcus neoformans disappeared in the cerebrospinal fluid and skin within one and five weeks, respectively). Our case demonstrates that molluscum contagiosum-like skin manifestations may be caused by cryptococcal infections. So it is necessary to perform skin biopsy in HIV seropositive patients with skin lesions resembling molluscum contagiosum, to diagnose mycotic infections, and especially cryptococcosis. Cutaneous cryptococcosis was, in this case, the first symptom of AIDS.     

Ken and Katie caterpillar: helpful props for treatment of molluscum contagiosum

A hand-made prop that aids in the efficient treatment of molluscum contagiosum with curettage or cantharidin is described. Small bandages or pieces of tape are affixed to a tongue depressor prior to the procedure so that they may be placed quickly over the treated molluscum. This improves time management and helps to reduce patient anxiety.     

Vascular network tightly enclosing lesions of molluscum contagiosum: Basket‐like capillaries of molluscum

Immunohistochemical studies of one typical and two atypical cases of molluscum contagiosum with anti‐CD34 monoclonal antibodies showed a tightly enclosing fine vasculature around the lesional masses of the disease. The thin interstitial septa between the lobules of the molluscum lesions also contained abundant endothelium. An electron microscopic study of a pinched‐off lesion of common molluscum contagiosum demonstrated that the tightly enclosing blood vessels lacked muscle layers, suggesting that they were capillaries, being a distance of several hundred nanometers from the basal cells of the molluscum mass. A 3D constructed image of the vasculature confirmed a network of the vessels. These tightly enclosing vascular networks around the lesions of molluscum contagiosum support the rapid growth of this disease.     

Therapeutic hotline: An alternative adjuvant treatment after ear keloid excision using a custom-made methyl methacrylate stent

The efficacy of most pressure devices developed for treatment of ear keloids is limited by the insufficient control of the applied pressure, sometimes causing pain and repeated bleeding with a subsequently increased risk of infections and cosmetic problems. The present study aims to describe the efficacy of the custom-made methyl methacrylate stent in patients that were surgically treated for ear keloids and afterward underwent pressure therapy. The recurrence rate of the ear keloids was evaluated after at least 12 months. Adjuvant treatment with the methyl methacrylate stent resulted in an 83% success rate in our experience with 23 patients that completed the intended therapeutic duration of 18 months. No cases of severe complications were seen during or after the treatment. Furthermore, all the items of the Patient and Observer Scar Assessment Scale resulted in a statistically significant improvement of the scar (p < 0.05). Postoperative pressure therapy with the custom-made methyl methacrylate stent seems efficacious, safe, and is usable for keloids of both the helix and the earlobe.