Molluscum Contagiosum In Patients Research Articles

Cantharidin topical solution (Ycanth) for molluscum contagiosum.

The FDA has approved cantharidin 0.7% solution (Ycanth – Verrica) for topical treatment of molluscum contagiosum in patients ≥2 years old. Ycanth was the first drug to be approved in the US for this indication. A 10.3% gel formulation of berdazimer (Zelsuvmi), a nitric oxide-releasing agent, has also been approved by the FDA for treatment of molluscum contagiosum (in patients ≥1 year old); it will be reviewed in a future issue.

Molluscum contagiosum of the eyelid: case report in a man receiving methotrexate and literature review of molluscum contagiosum in patients who are immunosuppressed secondary to methotrexate or HIV infection

Molluscum contagiosum is a benign viral infection of the skin. Lesions typicallypresent as dome-shaped, flesh-colored, umbilicated papules that range in size from 1 to 5 millimeters in diameter. They areusually asymptomatic, but can become tender or pruritic. Children and immunocompromised adults,including individuals being treated with immunosuppressive drugs, are most susceptible toinfection. Single or multiple lesions most commonly appear on the extremities, face, genitals, andtrunk. However, albeit rarely, molluscum contagiosum may also develop at other sites, including theeyelids. We describe the clinical and pathologic findings of a man who developed molluscumcontagiosum of the eyelid while receiving methotrexate. We also review the characteristics of otherpatients with molluscum contagiosum acquired either during treatment with methotrexate orassociated with human immunodeficiency virus (HIV) infection and summarize the unusual sites ofpresentation for the viral lesions in these individuals. The features of a man receiving methotrexate who developed molluscumcontagiosum of the eyelid are presented. Using PubMed, the following terms were searched andrelevant citations assessed: adalimumab, contagiosum, Enbrel, etanercept, Humira, infliximab,methotrexate, molluscum, Remicade, TNF alpha, and tumor necrosis factor alpha. In addition, theliterature on methotrexate treatment and molluscum contagiosum is reviewed. Several small papules were observed on the eyelid of a 24-year-old man who had beenreceiving methotrexate and adalimumab (Humira) for the treatment of Crohn disease. The lesions wereremoved by shave biopsy. Microscopic examination revealed epidermal hyperplasia composed ofkeratinocytes filled with large eosinophilic intracytoplasmic inclusions. Based on correlation ofthe clinical presentation and histopathologic findings, a diagnosis of molluscum contagiosum wasestablished. The patient applied mupirocin 2% ointment to the biopsy sites, which subsequentlyhealed without complication or recurrence. Molluscum contagiosum is a benign viral papular eruption that frequently affectschildren and immunocompromised adults. Patients treated with immunosuppressive agents, such asmethotrexate, have a heightened risk of developing molluscum contagiosum lesions. It remains to bedetermined whether adjunct therapy with a tumor necrosis factor alpha inhibitor increasesthe risk of this viral infection. Diagnosis can usually be established by clinical presentation,although a biopsy is sometimesrequired to exclude other conditions. Molluscum contagiosum is generally self-limiting and oftenresolves spontaneously within18 months. However, topical (cantharidin) or locally destructive (curettage, cryotherapy, and/orlaser) therapy may be indic tedfor patients who are concerned about persistent lesions and for children who are particularlysusceptible to autoinoculation.

Unusual Manifestation of Molluscum Contagiosum: Eruptive Papules on the Face and Neck of an Immunocompetent Patient

Dear Editor: Molluscum contagiosum (MC) is a common benign skin disease caused by the pox virus and usually affects young children. Most MC in adults occurs in people with an immunosuppressive status, but it can also appear in immunocompetent adults who have experienced friction or scrubbing. We herein report a case of MC that presents multiple pinhead-sized eruptive skin-coloured papules covering the whole face and neck in a patient without a history of epidermal trauma. A 60-year-old Korean woman with a history of recent onset diabetes presented to our clinic with sudden eruptive papules on her face and neck, which had been persistent for the past 6 months. She had been treated with topical hydrocortisone in the local clinic, but no improvements were observed. Even though she was mostly asymptomatic, the patient complained of occasional mild pruritus. She had no history of towel scrubbing or massage. Upon physical examination, multiple 2 to 3-mm-sized skin-coloured papules were observed on her face and neck (Fig. 1). Fig. 1 (A) Multiple 2- to 3-mm-sized skin-coloured papules observed on the face and neck. (B) Close up view of the skin-coloured papules. Keratin-like material was observed after extractions of some lesions, resulting in the performance of punch biopsy under the initial impression of milium. Histopathologic examination revealed epidermal cells bearing large eosinophilic cytoplasmic inclusion bodies, typical of the molluscum body, and the lesion was diagnosed as MC (Fig. 2). Due to diffuse distributions across the face and neck, imiquimod cream, oral gamma linolenic acid 360 mg and oral cimetidine 2,000 mg were used daily for 3 months, until all the lesions were resolved. We believe that the immunomodulating effects from imiquimod cream and oral cimetidine could have contributed to the resolution. Fig. 2 Epidermal cells bearing large eosinophilic cytoplasmic inclusion bodies, typical of the molluscum body (H&E, ×100). There have been several reports of disseminated molluscum contagiosum in patients with hematologic malignancies, human immunodeficiency (HIV) infection, or in patients taking immunosuppresants such as methotrexate or azathioprine1,2. Cases associated with traumas and contacts have also been reported, such as molluscum folliculitis after shaving or molluscum developed after use of a nylon towel at a public spa3,4. In this case, the patient was a healthy woman without any evidence of systemic diseases other than diabetes and was not taking any medicine that could impair cellular immunity. Lab data including complete blood counts and routine chemistry were within normal values and venereal disease research laboratory (VDRL) was non-reactive. Anti-HIV antibodies were also negative. In addition, she had no history of shaving, friction or massage, which might cause the inoculation of pox virus from epidermal trauma. However, an incidental MC infection could have spread to her whole face and neck due to the application of hydrocortisone cream after a misdiagnosis. In conclusion, our case suggests that dermatologists should perceive various clinical features of MCs in order to avoid misdiagnosis due to unusual clinical features. Additionally, the diagnosis of mollosum contagiosum should not be excluded, even if the patient is a healthy person without immunodeficiency.

Spontaneous Regression of Highly Immunogenic Molluscum contagiosum Virus (MCV)-Induced Skin Lesions Is Associated with Plasmacytoid Dendritic Cells and IFN-DC Infiltration

Molluscum contagiosum virus (MCV) infection induces self-limiting cutaneous lesions in an immunocompetent host that can undergo spontaneous regression preceded by local inflammation. On histology, a large majority of MCV-induced lesions are characterized by islands of hyperplastic epithelium containing infected keratinocytes and surrounded by scarce inflammatory infiltrate. However, spontaneous regression has been associated with the occurrence of a dense inflammatory reaction. By histology and immunohistochemistry, we identified MCV-induced lesions showing a dense inflammatory infiltrate associated with cell death in keratinocytes (inflammatory Molluscum contagiosum (I-MC)). In I-MC, hyperplastic keratinocytes were highly immunogenic as demonstrated by the expression of major histocompatibility complex class I and II molecules. Immune cell infiltration consisted of numerous cytotoxic T cells admixed with natural killer cells and plasmacytoid dendritic cells (PDCs). Accordingly, a type I IFN signature associated with PDC infiltration was demonstrated in both keratinocytes and inflammatory cells. Among the latter, a cell population resembling IFN-DC (CD123(+)CD11c(+)CD16(+)CD14(+)MxA(+)) was identified in proximity to islands of apoptotic keratinocytes. In vitro-generated IFN-DCs expressed a strong cytotoxic signature, as demonstrated by high levels of tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) and Fas ligand (FasL). This study establishes a previously unreported model to underpin the role of innate immune cells in viral immune surveillance.

Eyelid molluscum contagiosum in patients with human immunodeficiency virus infection

PURPOSE . Molluscum contagiosum (MC) is a common viral infection in patients with human immunodeficiency virus (HIV) infection. This study aimed to describe the relationship between the presentation of MC and the stage of HIV infection as measured by T-cell subsets. METHODS . A retrospective study is presented of 11 patients with MC of the eyelids and HIV infection in whom their CD4+ T lymphocytes were determined. RESULTS . Ten patients were in stage C3. The overall mean CD4+ count, CD4+ percentage and CD4+/CD8+ ratio were 71.63, 4.37%, and 0.085, respectively. Seven patients have died of AIDS-related conditions; the mean survival time was 12 months and the median 9 months from the diagnosis of MC. CONCLUSIONS . MC of the eyelids appears in advanced HIV infection when the CD4+ counts are less than 80 cells/µl.

P312 Resolution of recalcient Molluscum Contagiosum in patients on protease inhibitors — A desireable side effect

P312 Resolution of recalcient Molluscum Contagiosum in patients on protease inhibitors — A desireable side effect

FC139 New treatment for molluscum contagiosum in patients with HIV infection

FC139 New treatment for molluscum contagiosum in patients with HIV infection

Facial and perioral molluscum contagiosum in patients with HIV infection: A report of eight cases

Facial and perioral molluscum contagiosum is a common and often disfiguring condition in patients with HIV infection. The purpose of this study was to report on the clinical aspects of eight HIV-positive patients with facial molluscum contagiosum. Also we describe the histopathologic and electron microscopic findings and discuss the treatment modalities for this unusual disease.

Molluscum Contagiosum in Patients With Acquired Immunodeficiency Syndrome

To the Editor. —Profound defects in cell-mediated immunity predispose patients with acquired immunodeficiency syndrome (AIDS) to infections by a pernicious panoply of pathogens, including viruses. Invasion, damage, and destruction of patients with AIDS have been ascribed to cytomegalovirus, Epstein-Barr virus, herpes simplex virus types I and II, papillomavirus, papovavirus, varicella zoster virus, and, recently, the poxvirus that causes molluscum contagiosum (MC).1-3 In otherwise healthy hosts, MC is a common, usually self-limited, cutaneous infection, often with fewer than 20 lesions. Spontaneous resolution typically takes three to 12 months; many therapeutic modalities can readily shorten this course. In adults, involvement of the genitalia, lower abdomen, and upper thighs indicates sexual transmission. Typical individual lesions of MC are shiny, pearly white, centrally umbilicated papules 3 to 5 mm in diameter. The 35-year-old woman seen in the Figure was an intravenous drug abuser who had hadPneumocystis cariniipneumonia and the immunologic markers