Definition

Molluscum contagiosum is a skin infection caused by poxvirus. This infection causes the formation of small, solid, round, dome-shaped papules, with a dimple in the middle (delle) and painless. These lesions vary in size, from the size of a pin to the size of a corn kernel. If the papule is pressed, a white object will come out of the lesion. These white objects are called molluscum bodies.

Molluscum contagiosum can be transmitted from direct contact with the skin of infected individuals or indirect contact through contaminated objects.

Molluscum contagiosum is more common in children. In adults, molluscum contagiosum is often experienced by people with decreased immune functions, such as HIV/AIDS or diabetes patients. Adults with healthy immune systems can develop molluscum contagiosum after having sexual contact with an infected person.

If not treated, the lesion will disappear within 6 months to 2 years.

Causes

Poxvirus is a DNA virus that can spread through direct skin contact. This virus infects the outermost tissue of the skin (epidermis) and will divide within these cells. The interval between first exposure to the virus and the appearance of symptoms (incubation period) is around 2-8 weeks.

This virus most often spreads in the following ways:

• Direct skin-to-skin contact with molluscum contagiosum patients
• Contact with items used by molluscum contagiosum patients, such as towels, bed sheets, or clothing
• Swimming in a pool or warm bath contaminated with the virus
• Having sexual contacts with someone infected with molluscum contagiosum
• Scratching or popping the lesion can make the infection spread to the surrounding skin

Risk factor

Molluscum contagiosum occurs quite often, especially in children aged 1-10 years.

Other groups that have a high risk of experiencing molluscum contagiosum are:

• People with decreased immune functions, such as HIV/AIDS patients or cancer patients undergoing chemotherapy. The appearance of molluscum contagiosum in this population can be different compared to healthy populations – The lesion is more severe and more difficult to treat
• Having atopic dermatitis. Atopic dermatitis causes the skin barrier to weaken and become more easily infected by viruses
• Live in a warm, humid, and densely populated environment

Symptoms

Symptoms that appear if you have molluscum contagiosum are:

• Ukuran bintil sekitar 1-5 mm serta bertangkai. Beberapa bintil dapat berukuran lebih besar (sekitar 10-15 mm)
• Gatal pada bagian yang berbintil
• Bintil dapat timbul pada alat kelamin, bagian bawah perut, dan paha dalam pada infeksi menular seksual (IMS)
• The appearance of a round, dome-shaped papules with a dimple in the middle
• Skin-colored papules that arised
• The lesions usually appear on the face, trunk or torso, arms and legs
• The size of the papule is around 1-5 mm and has a stem. Some papules can be larger (around 10-15 mm)
• Itching on the papule area
• Papules can appear on the genitals, lower abdomen and inner thighs if the cause is sexually transmitted infections (STIs).

Diagnosis

Doctors diagnose molluscum contagiosum based on the appearance of the skin. The appearance of molluscum contagiosum is quite typical, namely skin-colored papules with dimple or indentation at the top.

If further examination is needed, the doctor can ask for these:

• Giemsa stain procedure. This examination uses molluscum bodies (the white mass inside the papule). The doctor will look for inclusion bodies, which are viruses hiding inside cells
• Histopathological examination. This examination uses skin tissue samples taken from scrapings or biopsies in infected areas. The doctor will look for the poxvirus in the epidermal tissue
• PCR test to search for virus particles

Management

Molluscum contagiosum can heal on its own without treatment within 6 months to 2 years. Once the lesion is gone, you can no longer spread the virus to other people. If you have had molluscum contagiosum, you can become infected again (reinfected). Further measures to treat molluscum contagiosum are generally not recommended, because:

• Infection can heal on its own
• The infection does not cause any symptoms other than skin lesions
• The infection does not interfere with daily activities, such as working, swimming and exercising
• Treatment generally can cause pain and scars

Treatment is generally recommended for older children or adults with severe symptoms, have a compromised immune system, and the symptoms have interfered with daily activities.

If your doctor recommends further treatment, the treatments could consist of procedures and medications. The procedures aimed to remove the molluscum bodies. This is done using a comedone extractor, syringe, or cryotherapy. After the procedure, your doctor will prescribe topical antibiotics. This procedure can cause pain so your doctor will perform local anesthesia first.

Apart from treatments, medicines that could help the healing process include:

• Medications that can cause local irritation of the lesion, such as benzoyl peroxide
• Medications that cause the skin to blister so that the lesion can be lifted and removed more easily, such as cantharidin

Recommended treatment may also be a combination of procedures and medications.

Your doctor will refer you to a specialist if you have:

• Lesion in the eye area accompanied by red or painful eyes
• Other comorbid diseases, such as HIV, with severe symptoms
• Having an immune deficiency due to other things, such as chemotherapy

Complications

Molluscum contagiosum rarely causes further complications, but in some cases it can cause the following conditions:

• The lesion is further infected with bacteria and requires antibiotics
• Skin irritation and inflammation over a long period of time could leave scars. After the lesion disappears, it could cause hypopigmentation. This often happens especially after treatment
• Vision problems. Eye infections can occur, especially if the lesion is around the eyelid. This infection can include conjunctivitis and keratitis. Symptoms include watery, red eyes and light sensitivity 
• Cellulitis is a complication that often occurs in people who have conditions that cause immune deficiency, such as HIV/AIDS. Secondary infection by bacteria can cause an abscess

Prevention

To prevent the transmission of viruses, you can do the these things:

• Wash your hands. Keep your hands clean by washing your hands with soap.
• Don't touch the lesion. Touching and scratching the lesion can spread the virus to healthy areas of the skin or to objects you touch.
• Avoid sharing personal items with other people. These personal items include clothes, towels, combs, etc.
• Avoid sexual contact. If you have molluscum contagiosum lesions around your lower abdomen or genital area, avoid sexual intercourse until they heal.
• Cover the lesion when going outside. Cover the papules and lesions areas when you are around other people to avoid direct skin contact. If you are not meeting other people, you can let the skin uncovered to speed up healing process.
• Use a condom when having sexual intercourse

When to see a doctor?

If you suspect you or your child has molluscum contagiosum, immediately go to the nearest healthcare facility. Avoid scratching, squeezing, and coming into direct contact with the lesions. If you experience symptoms of complications from molluscum contagiosum such as red, watery eyes, or infection around the lesions, immediately consult a doctor for further examination and treatment.