Patient Story
An 8-year-old girl is brought to the office because of an outbreak of bumps on her face for the past 3 months (Figure 115-1). Occasionally she scratches them, but she is otherwise asymptomatic. The mother and child are unhappy with the appearance of the molluscum contagiosum and chose to try topical imiquimod 5 percent cream. Fortunately, her health insurance covered this expensive treatment. A topical treatment was chosen to avoid the risk of hypopigmentation that can occur in dark-skinned individuals with cryotherapy.
An 11-year-old girl was also seen with molluscum on her face. The child and her mother decided to try cryotherapy as her treatment. She very bravely tolerated the treatment with liquid nitrogen in a Cryogun (Figure 115-2). The molluscum disappeared without scarring or hypopigmentation after 2 treatments.
Introduction
Epidemiology
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Molluscum contagiosum infection has been reported worldwide. An Australian seroepidemiology study found a seropositivity rate of 23 percent.1
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Up to 5 percent of children in the US have clinical evidence of molluscum contagiosum infection.2 It is a common, nonsexually transmitted condition in children (see Figures 115-1 to 115-4).
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The number of cases in US adults increased in the 1980s probably as a result of the HIV/AIDS epidemic. Since the introduction of highly active antiretroviral therapy (HAART), the number of molluscum contagiosum cases in HIV/AIDS patients has decreased substantially.3 However, the prevalence of molluscum contagiosum in patients who are HIV-positive may still be as high as 5 to 18 percent (Figure 115-5).4,5
Etiology and Pathophysiology
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Molluscum contagiosum is a benign condition that is often transmitted through close contact in children and through sexual contact in adolescents.
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It is a large DNA virus of the Poxviridae family of poxvirus. It is related to the orthopoxviruses (variola, vaccinia, smallpox, and monkeypox viruses).
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Molluscum replicates in the cytoplasm of epithelial cells. It causes a chronic localized skin infection consisting of dome-shaped pearly papules on the skin. Like most of the viruses in the poxvirus family, molluscum is spread by direct skin-to-skin contact. It can also spread by autoinoculation when scratching, touching, or treating lesions. Any single lesion is usually present for approximately 2 months, but autoinoculation often causes continuous crops of lesions.
Risk Factors
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Common childhood disease.
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Molluscum contagiosum may be more common in patients with atopic dermatitis (Figure 115-6).2
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The disease also may be spread by participation in contact sports.2
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It is also associated with immunodeficient states such as in HIV infection (Figure 115-5) and with immunosuppressive drug treatment.

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