Professional Documents
Culture Documents
Case One
Susie
Bacteria
Fungus
Parasite
Virus
10
Bacteria
Fungus
Parasite
Virus
11
A herpes virus
A pox virus
Human immunodeficiency virus
Human papillomavirus
Varicella-zoster virus
12
A herpes virus
A pox virus
Human immunodeficiency virus
Human papillomavirus
Varicella-zoster virus
13
Molluscum Contagiosum
Molluscum contagiosum (MC) is a benign,
usually asymptomatic viral infection of the skin
with no systemic manifestations
Usually is characterized by 2 to 20 discrete, 5mm-diameter, flesh-colored to translucent,
dome-shaped papules, some with central
umbilication
Lesions commonly occur on the trunk, face, and
extremities but are rarely generalized
14
15
Cantharidin
Cryotherapy
Curettage
No treatment because it may resolve on its
own
e. All of the above are options
16
17
18
19
Blisters
Color change
Pain
Scarring
All of the above
20
Blisters
Color change
Pain
Scarring
All of the above
21
Treatment Principles
There is no consensus on the management of MC in
children and adolescents
Therapy may be warranted to:
22
Treatment Options
First-line treatments include:
Cantharidin a vesicant that causes
blistering on the applied area (not painful
when applied, but can be uncomfortable
when blisters occur)
Curettage scraping to remove
Cryotherapy liquid nitrogen therapy
23
Treatment Options
Treatment considerations
24
25
26
Molluscum Transmission
Spread via skin-to-skin contact, fomite exposure, and
autoinoculation
Associated with public water exposures (pools, bath
houses, hot tubs)
Wrestlers are particularly at risk because of prolonged
skin contact and friction
MC should not prevent a child from attending child care
or school or from swimming in public pools
To prevent transmission, lesions not covered by clothing
should be covered by a watertight bandage. The
bandage should be changed daily or when soiled.
27
28
29
30
Henderson-Paterson Bodies
Henderson-Patterson
Bodies, aka Molluscum
bodies
Intracytoplasmic inclusion
bodies, containing poxvirus
particles, seen in
keratinocytes
31
32
33
b.
c.
Susie has been scratching, and the molluscum are now secondarily
infected. (This can occur, but inflammation is often just the host response.
Furuncle-like appearance may indicate infection)
Susies eczema has flared around the molluscum. (Molluscum can make
eczema worse, but this inflammation is not eczematous)
These are new lesions of Eczema herpeticum that resemble molluscum.
(E.herpeticum will present with monomorphous, clear fluid-filled vesicles and
erosions)
d.
e.
34
Molluscum Contagiosum
Development of tenderness, crusting, and erythema of
molluscum leads many physicians to suspect secondary
bacterial infection.
These signs, however, represent the host response that
heralds resolution of the viral infection.
Butala et al coined the term BOTE sign, for
Beginning Of The End.
Treatment with antibiotics is usually not necessary.
If one lesion has expanding erythema, consider a bacterial
culture and treatment with antibiotics based on culture results.
35
Case Two
Kyle
36
37
38
Scabies
Irritant contact dermatitis
Molluscum contagiosum
Nummular eczema
Psoriasis
39
40
41
42
Referral Information
Refer a patient with MC to a dermatologist if:
Recalcitrant/prolonged cases
Diffuse involvement
Extensive facial involvement
Significant discomfort
Coexisting severe dermatitis
Immunocompromised
43
44
45
46
Molluscum Contagiosum in
Immunosuppressed Patients
Adults with chronic MC outside the genital area should
be evaluated for immunosuppression
Patients with untreated HIV often have lesions
concentrated on the face or genitalia. Oral and genital
mucosa may be involved
Giant lesions can occur
HAART leads to clearance but
may have lag time before
improvement is seen
47
48
Acknowledgements
This module was developed by the American Academy of
Dermatology Medical Student Core Curriculum Workgroup
from 2008-2012.
Primary authors: Susan K. Ailor, MD, FAAD; Kari L. Martin,
MD.
Peer reviewers: Timothy G. Berger, MD, FAAD; Brandon D.
Newell, MD; Maria C. Garzon, MD, FAAD; Heather BrandlingBennett, MD, FAAD; Christine Lauren, MD, FAAD
Revisions and editing: Sarah D. Cipriano, MD, MPH; Meghan
Mullen Dickman, Matthew Dizon, Erin Mathes, MD.
Last revised August 2013.
49
References
Berger EM, Orlow SJ, Patel RR, Schaffer JV. Experience with molluscum
contagiosum and associated inflammatory reactions in a pediatric dermatology
practice: the bump that rashes. Arch Dermatol. 2012 Nov;148(11):1257-64
James WD, Berger TG, Elston DM. Chapter 19. Viral Diseases (chapter). Andrews
Diseases of the Skin Clinical Dermatology. 10th ed. Philadelphia, Pa: Saunders
Elsevier; 2006: 394-397.
Katz KA, Swetman GL. Imiquimod, Molluscum, and the Need for a Better Best
Pharmaceuticals for Children Act. Pediatrics. 132(1): 1-3. 2013.
Silverberg NB. Warts and molluscum in children. Adv Dermatol. 20:23-73. 2004.
van der Wouden JC, et al. Interventions for cutaneous molluscum contagiosum.
Cochrane Rev. Vol 2. 2010.
50
51