What is Molluscum Contagiosum (Water Warts)?
Molluscum contagiosum, often referred to as water warts, is a harmless skin condition. The skin bumps associated with molluscum contagiosum are referred to as mollusca. Normally, these bumps look like small, rounded, and pinkish-purple domes. See image for reference.
What Causes Molluscum Contagiosum (Water Warts)?
Molluscum contagiosum is a skin condition caused by a type of double-stranded DNA virus known as the molluscum contagiosum virus (MCV). There are four known subtypes of this virus. MCV-1, which is responsible for 98% of all cases, is most commonly seen in children. Meanwhile, MCV-2 primarily causes skin lesions in people living with HIV. The other subtypes, MCV-3 and MCV-4, are mainly found in Asia and Australia. As of now, there’s no way to grow cultures from the molluscum contagiosum virus.
This skin condition spreads through direct contact with the skin, such as touching someone else’s skin or through sexual contact. It can also spread indirectly, for example, by sharing towels, underwear, toys, razors, and tattoo supplies. Sometimes, if a person with molluscum contagiosum tries to scrape off their skin lesions, they might accidentally spread the virus to other parts of their body. There’s also a possibility that it might spread in swimming pools and other wet environments, though more research is needed to solidify this. Molluscum contagiosum can also be passed from pregnant mothers to their babies, either during pregnancy or childbirth. In a few cases, this has resulted in newborns developing the condition shortly after birth.
Risk Factors and Frequency for Molluscum Contagiosum (Water Warts)
Molluscum contagiosum is a widespread medical issue, with about 122 million cases reported in 2010. This condition happens around the globe but is often more common in warm and humid places. Molluscum contagiosum is typically diagnosed in young children between the ages of two and five, sexually active teens and adults, and individuals with weaker immune systems. If you have a skin condition like atopic dermatitis, you may be at greater risk for molluscum contagiosum because this weakens the skin’s protection and immune response. For individuals living with HIV, their chances of having molluscum contagiosum can be as high as 18%. Both males and females are equally likely to get this condition.
- Molluscum contagiosum is a common health concern, accounting for 122 million cases in 2010.
- The condition is more prevalent in warm, humid regions, but can occur anywhere in the world.
- It’s most commonly diagnosed in children aged two to five, sexually active teenagers and adults, and those with compromised immune systems.
- Having atopic dermatitis could increase the risk of developing molluscum contagiosum as it weakens the skin barrier and immune function.
- In individuals living with HIV, the risk of having molluscum contagiosum could go up to 18%.
- The condition affects both males and females equally.
Signs and Symptoms of Molluscum Contagiosum (Water Warts)
Molluscum contagiosum is a skin condition that typically doesn’t cause symptoms, but could cause cosmetic issues. The bumps it causes, known as mollusca, may be painless, or they may become itchy or painful. Particularly in individuals with atopic conditions, inflamed skin patches, or eczema, can develop around the mollusca weeks after they appear. It’s also common for an inflammatory reaction to occur, either from scratching or when the mollusca begin to heal. These reactions need to be differentiated from a bacterial infection. Lastly, if the mollusca are scratched off or removed, they may bleed.
Testing for Molluscum Contagiosum (Water Warts)
Molluscum contagiosum, a type of skin disease, is typically diagnosed by a physical check-up. Its primary symptom is firm, pearly white or flesh-colored bumps, ranging from one millimeter to one centimeter in size. These bumps have a characteristic dimple in the center and if squeezed, a creamy substance may come out.
In children, these bumps usually appear on the face, body, arms, and armpits, but not on the palms of the hands or the soles of the feet. If contracted through sexual transmission, the lesions typically appear in the genital area, abdomen, and inner thighs. Generally, there are no more than 20 to 30 bumps and they often group together. However, the disease can be more extensive, particularly in people with weakened immune systems.
For children, molluscum contagiosum can be mistaken for other skin conditions, including syringoma (non-cancerous bumps caused by excessive sweat glands), closed comedones (whiteheads), and different kinds of warts. In people with weak immune systems, the bumps may look unusual and may even be mistaken for skin cancer or other contagious diseases. This is particularly the case for larger bumps or those that are widespread on the body.
If the doctor is uncertain about the diagnosis, different tests like dermoscopy, reflectance confocal microscopy, and histopathology might be performed. A dermoscopy would highlight a white or yellow center with blood vessels branching out at the edges. Reflectance confocal microscopy, on the other hand, would highlight a well-defined central region separated by septa into hypo-reflective roundish areas. In histopathology, these areas appear as enlarged keratinocytes – cells in the outer skin layer. They are full of viral inclusions, or extra pieces of cells, and a peripheral nucleus. This is accompanied by acanthosis – a thickening of the skin.
Treatment Options for Molluscum Contagiosum (Water Warts)
People may opt for treatment of molluscum contagiosum for various reasons such as improving appearance, avoiding social embarrassment, or concerns about spreading the condition to others. The treatment selection largely depends on what the patient (or their parents) prefer. Since this condition often goes away on its own, you might consider waiting for it to resolve naturally. However, do remember that it can take several months for molluscum contagiosum to fully clear up. While a number of treatments have been suggested, none have been proven to be consistently effective. Current treatment strategies include physical removal of the lesions, topical medications, and systemic treatment.
Physical removal of the lesions is primarily done through cryotherapy, which uses extreme cold, or curettage, which involves scraping off the lesion. These procedures can be combined. Laser treatment can also be an option, though it’s not usually the first choice. Physical removal of the lesions can be painful and might leave scars, so it might require local anesthesia. Topical trichloroacetic acid can also be used to treat lesions with minimal scarring.
There are numerous topical treatments available for molluscum contagiosum. These include podophyllotoxin (not recommended for pregnant women), potassium hydroxide, salicylic acid, benzoyl peroxide, and tretinoin. These treatments are primarily aimed at inducing inflammation to speed up the healing process, and they are meant to be applied to each lesion. However, recent findings indicate that imiquimod, a medication that alters the immune system, and cantharidin, a blister-causing substance, are not more effective than other options.
In cases where physical removal might be too distressing for children (except for facial cases), oral cimetidine has been suggested as an alternative. Although, a recent study did not show cimetidine to be particularly effective. Cidofovir, a medication that inhibits a viral enzyme, has been reportedly effective in those with weakened immune systems, but it can have side effects like kidney toxicity and reduced neutrophil count when given intravenously. For individuals living with HIV/AIDS, the best strategy for managing molluscum contagiosum seems to be antiretroviral therapy.
What else can Molluscum Contagiosum (Water Warts) be?
The following conditions may appear similar to certain skin disorders, but are distinct illnesses:
- Keratoacanthoma
- Lichen planus
- Epidermal cyst
- Pyoderma
- Verruca vulgaris
- Folliculitis
- Cutaneous fungal disorders, like histoplasmosis and sporotrichosis
- Basal cell cancer
- Condyloma acuminatum
- Varicella-zoster
Possible Complications When Diagnosed with Molluscum Contagiosum (Water Warts)
Common Issues:
- Inflammation or infection (commonly referred to as cellulitis)
- Irritation
- Conjunctivitis, which can occur if the lesions are present on the eyelids
- Abscess or a build-up of pus
