Introduction
Molluscum contagiosum is a skin infection caused by the virus Molluscum contagiosum. It produces benign raised bumps, or lesions, on the upper layers of the skin. It affects mostly children and persons with a compromised immune system. The small bumps are usually painless. They disappear on their own and rarely leave scars when they’re left untreated. The length of time the virus lasts varies, but the bumps can remain from two months to four years. Molluscum contagiosum is spread by direct contact with someone who has it or by touching an object contaminated with the virus, such as a towel or a piece of clothing. Medication and surgical treatments are available, but treatment isn’t necessary in most cases. The virus can be more difficult to treat if you have a weakened immune system.
Signs & symptoms
No symptoms of infection for up to six months. The average incubation period is 2-7 weeks.
First sign is the appearance of a small group of painless lesions. These bumps can appear alone or in a patch of as many as 20. They’re usually:
- very small, shiny, and smooth in appearance
- flesh-coloured, white, or pink
- firm and shaped like a dome with a dent or dimple in the middle
- filled with a central core of waxy material
- between 2 to 5 mm in diameter, or between the size of the head of a pin and the size of an eraser on the top of a pencil
- present anywhere except on the palms of the hands or the soles of the feet.
In a person with a weakened immune system, symptoms can be more significant. Lesions may be as large as 15 mm in diameter. The bumps appear more often on the face and are typically resistant to treatment.
Causes
Transmission of molluscum contagiosum is by direct contact. It happens mostly by touching the lesions on the skin of a person who has this infection. Children can transmit the virus during playing with other children.
Teens and adults are more likely to contract it through sexual contact. Infection can happen during sports that involve touching bare skin, such as wrestling.
It is also spread by handling towels, clothing, toys, or other items that have been contaminated.
Sharing sports equipment that someone’s bare skin has touched can also cause the transfer of this virus. The virus can remain on the equipment to be transmitted to another person. This includes items such as bats, balls, or helmets.
The virus can be transferred from one part of the body to another by touching, scratching, or shaving a bump and then touching another part of the body.
Risk factors
- children between the ages of 1 and 10
- people who live in tropical climates
- people with weakened immune systems caused by factors such as organ transplants or cancer treatments
- people who have atopic dermatitis, which is a common form of eczema that causes scaly and itchy rashes
- people who participate in contact sports, such as wrestling or football, in which bare skin-to-skin contact is common
Pathophysiology
The molluscum contagiosum virus replicates in the cytoplasm of epithelial cells, producing cytoplasmic inclusions and enlargement of infected cells. This virus infects only the epidermis. Infection follows contact with infected persons or contaminated objects, but the extent of necessary epidermal injury is unknown. The initial infection seems to occur in the basal layer, and the incubation period is usually 2-7 weeks. This is suggested by the fact that, although viral particles are noted in the basal layer, viral deoxyribonucleic acid (DNA) replication and the formation of new viral particles do not occur until the spindle and granular layers of the epidermis are involved. Infection may be accompanied by a latent period of as long as 6 months.
Following infection, cellular proliferation produces lobulated epidermal growths that compress epidermal papillae, while fibrous septa between the lobules produce pear-shaped clumps with the apex upwards. The basal layer remains intact.
Cells at the core of the lesion show the greatest distortion and are ultimately destroyed, resulting in large hyaline bodies (i.e., molluscum bodies, Henderson-Paterson bodies) containing cytoplasmic masses of virus material. These bodies are present in large numbers and appear as a white depression at the centre of fully developed lesions. Occasionally, the lesions can progress beyond local cellular proliferation and become inflamed with attendant oedema, increased vascularity, and infiltration by neutrophils, lymphocytes, and monocytes. Viral-derived proteins inhibit mitochondrial-mediated apoptosis.
As with other poxviruses, molluscum contagiosum virus does not appear to develop latency but evades the immune system through the production of virus-specific proteins. Cell-mediated immunity is most important in modulating and controlling the infection. Children and patients with HIV infection generally have more widespread lesions. Humoral immunity in regression of lesions is not established. Reinfection is common.
Usually, a clinical evaluation is sufficient due to its distinct appearance. A skin scraping or biopsy can confirm the diagnosis.
Treatments
In persons with a healthy immune system, no treatment is necessary to treat the lesions caused by molluscum contagiosum. The bumps will fade away without medical intervention.
However, treatment is needed if:
- the lesions are large and located on face and neck
- an existing skin disease such as atopic dermatitis is associated
- serious concerns about spreading the virus is present
The most effective treatments for molluscum contagiosum include cryotherapy, curettage, laser therapy, and topical therapy.
- During cryotherapy, the doctor freezes each bump with liquid nitrogen.
- During curettage, the doctor pierces the bump and scrapes it off the skin with a small tool.
- During laser therapy, the doctor uses a laser to destroy each bump.
- During topical therapy, the doctor applies creams containing acids or chemicals to the bumps to induce peeling of the top layers of the skin.
In some cases, these techniques can be painful and cause scarring. Anaesthesia may also be necessary.
Since these methods involve treating each bump, a procedure may require more than one session.
Medications used are:
- trichloroacetic acid
- topical podophyllotoxin cream (Condylox)
- cantharidin (Cantharone), which is obtained from the blister beetle and applied by your doctor
- imiquimod (Aldara)
In persons with immune system weakened by a disease such as AIDS or by drugs such as those used for treating cancer, it may be necessary to treat molluscum contagiosum. Successful treatment is more difficult for people with weakened immune systems than it is for those with healthy immune systems.
Antiretroviral therapy is the most effective treatment for people with HIV if they contract molluscum contagiosum because it can work to strengthen the immune system to fight the virus.
Preventive measures include:
- Practice effective hand washing with warm water and soap.
- Instruct children in proper hand-washing techniques since they’re more likely to use touch in play and interaction with others.
- Avoid sharing personal items. This includes towels, clothing, hairbrushes, or bar soaps.
- Avoid using shared sports gear that may have come in direct contact with someone else’s bare skin.
- Avoid picking at or touching areas of the skin where the bumps exist.
- Keep the bumps clean and covered to prevent yourself or others from touching them and spreading the virus.
- Avoid shaving or using electrolysis where the bumps are located.
Prognosis
A molluscum contagiosum infection will usually go away on its own if your immune system is healthy. Typically, this happens gradually within 6 to 12 months and without scarring. In some cases, it may take from a few months up to a few years for the bumps to disappear. The infection can be more persistent and last even longer for people with immune system problems.
Complications
Complications of molluscum contagiosum include irritation, inflammation, and secondary infections. Lesions on eyelids may be associated with follicular or papillary conjunctivitis. Bacterial superinfection may occur but is seldom of clinical significance.
Disease & Ayurveda
Ajagallikā is described in the context of kṣudrarogas, the diseases which have less or no symptoms, with less pain or without pain explained in classics.
Nidana
Not particularly mentioned
Purvaaroopa
Not particularly mentioned
Samprapti
Dooshyas are Kapha & Vaata and get sthaanasamsraya on skin to form small round lumps on skin.
Lakshana
Pidakas which are:
- snigdha (unctuous),
- savarṇa (of the same color),
- grathita (firm),
- niruja (painless)
- mudga sannibha (papules resembling green gram)
Divisions
Not mentioned
Prognosis
Krichrasadhyam
Chikithsa
The treatment of Ajagallika can be divided into two, depending upon whether it is inflamed or not. In non-infectious cases, application of hebal pastes is done. Jalouka is advised for clearing the localised impurity of blood (raktadushti). Once it is inflamed, treatment of thewound shpuld be done.
Samana
Lepanam with Rookshana dravyas
Swedanam
Vimlapanam
Sodhana
Jalouka
Paatanam
Then treatment of wound should be done
Commonly used medicines
Kanchanaraguggulu
Rasnadi choornam
Brands available
AVS Kottakal
AVP Coimbatore
SNA oushadhasala
Vaidyaratnam oushadhasala
Home remedies
Applying turmeric paste
Lose excess weight and shred off the excess fat
Apple cider vinegar intake
Avoid intake of fat in food
Take enough omega 3 fatty acids
Diet
- To be avoided
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Milk and milk products – increase kapha, cause obstruction in channels and obesity
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, honey
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Protect yourself from cold climate.
Better to avoid exposure to excessive sunlight wind rain or dust.
Maintain a regular food and sleep schedule.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Avoid sedentary lifestyle.
Yoga
Regular stretching and mild cardio exercises are advised. Also, specific yogacharya including naadisuddhi pranayama, bhujangaasana, pavanamuktasana is recommended.
Regular exercise helps improve bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within the body and with the surrounding system.
Pavanamuktasana
Nadisudhi pranayama
Bhujangasana
Simple exercises for lungs and heart health
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
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