Molluscum Contagiosum Infection Research Articles

Facial vs Non-facial Molluscum Contagiosum Infection in Children: A Cross-sectional Study.

Molluscum contagiosum is a common skin infection affecting different body areas, including the face. Previous data have shown cases of atypical lesions, notably on the face, and it was thought relevant to further examine differences between facial and non-facial lesions. All cases of children (0-18) diagnosed with molluscum contagiosum from 2013-2022 at the paediatric dermatology clinic of Soroka University Medical Center were retrospectively reviewed, and 615 children were included in the study. Facial lesions tended to be found in younger children (p = 0.018). Non-facial lesions were more erythematous (p < 0.001), itchier (p < 0.001), and showed similar patterns of ulceration (p = 0.078) and purulence (p = 0.779). The average lesion diameter was similar in patients with or without facial lesions (p = 1). Children with facial lesions were treated differently from patients without facial lesions (p < 0.001); however, there were no differences in treatment response. This research challenges assumptions concerning the severity of facial lesions, including eyelid lesions, by revealing that, overall, they exhibit less inflammation than non-facial lesions. Despite the potential for greater psychosocial burdens and impacts on self-esteem associated with lesions on the sensitive facial area, this study provides evidence that they are not inherently more worrisome and can be managed similarly to lesions found elsewhere in the body.

Skin reactions related to molluscum contagiosum infection

Molluscum contagiosum (MC) is a common viral infection in children, immunocompromised, and sexually active adults. Its usual clinical presentation is 2-5 mm, whitish or skin-colored papules, with a shiny surface and central umbilication, generally clustered and randomly distributed over the skin surface. Dermoscopy reveals yellowish-white polylobulated structures with peripheral telangiectasia. Diagnosis is usually clinical supported by dermoscopy. However, in some cases, inflammatory manifestations can be associated with this infection and can mimic other dermatological conditions, making the diagnosis difficult and leading to unnecessary treatments. The objective of this article is to describe the main skin reactions associated with MC infection in order to provide a diagnostic and initial management tool for clinicians dealing with these conditions. Reported manifestations include the BOTE sign, perilesional eczema, Gianotti-Crosti syndrome-like reaction, ID reaction, erythema annulare centrifugum, erythema multiforme, folliculitis, white halo, and atypical manifestations (giant, disseminated, necrotic, polypoidal, and nodular lesions, pseudocysts, abscesses). In pediatric patients with the clinical manifestations described above, infection by molluscum contagiosum pox virus should be considered among the differential diagnoses, and referral to a dermatologist should be made in selected cases.

Molluscum Contagiosum Profile At The Dermatology And Venereology Polyclinic Of Prof. I.G.N.G. Ngoerah Central General Hospital Denpasar

Molluscum contagiosum (MC) is a viral infectious disease caused by the Molluscum Contagiosum Virus (MCV). There are four subtypes of MCV (MCV-1, MCV-2, MCV-3, and MCV-4). The worldwide incidence of MK infection is estimated to be around 2% to 8%, while in the HIV/AIDS population, it is approximately 5% to 18%. To date, there is limited research reporting on the profile of MC patients in Indonesia. This is a descriptive cross-sectional research design. Data were obtained retrospectively and collected from the medical records of patients with molluscum contagiosum who visited the Dermatology and Venereology Polyclinic at Prof. I.G.N.G. Ngoerah General Hospital in Denpasar, Bali, from January 2018 to December 2020. In this study of molluscum contagiosum infection at the Dermatology and Venereology Polyclinic of Sanglah General Hospital in Denpasar, Bali, during the period of January 2018 to December 2020, the majority of participants were aged between 18-44 years (61.1%) and were male (61.1%). Most participants were from Bali (77.8%) and were married (55.6%). Moreover, the majority of participants were sexually active (77.8%) and had a negative HIV status (55.6%). Concerning sexual orientation, most participants identified as heterosexual (83.3%). Regarding the type of therapy received, most participants underwent enucleation (55.5%) and combination therapy (22.2%). Broad public education, especially for parents, regarding molluscum contagiosum should be enhanced to support more effective healthcare efforts encompassing treatment, prevention, and health promotion.

Association between filaggrin gene mutations and the clinical features of molluscum contagiosum: The Yamanashi Adjunct Study of the Japan Environment and Children's Study.

Previous studies have reported swimming, atopic dermatitis, and filaggrin (FLG) gene mutations as risk factors for molluscum contagiosum (MC) infection. FLG gene mutations impair skin barrier function. The aim of this study was to determine the impact of FLG mutations on the incidence and clinical features of MC. We used data from 2036 children who participated in the Yamanashi Adjunct Study of the Japan Environment and Children's Study, a prospective, birth cohort study. A questionnaire for caregivers (when children were 4 and 8 years of age) asked about clinical features including previous MC incidence and treatment, number of MC lesions at first visit, and time to resolution. Participants underwent genotyping to detect six FLG mutations that are common in the Japanese population. A logistic regression model was used to analyze the association between MC incidence and FLG mutations, adjusted for potential confounders. The cumulative incidence of MC at age 8 years was 47.1%. Among participants with a history of MC, 67.6% had undergone curettage. FLG mutation was a significant risk factor for MC incidence (adjusted odds ratio [aOR] 1.69, 95% confidence interval [CI] 1.18-2.42). Swimming and atopic dermatitis were also significant risk factors for MC. There was no significant association between FLG mutation and the number of MC lesions at the first visit or the time to resolution of lesions. FLG mutation is a risk factor for MC incidence; however, FLG mutations do not affect the number of MC lesions at presentation or the time to resolution.

Berdazimer gel for molluscum contagiosum in patients with atopic dermatitis.

Controlling molluscum contagiosum (MC) infections is critical in atopic dermatitis (AD) management. This post hoc analysis assessed the efficacy and safety of berdazimer gel, 10.3% (topical, antiviral, nitric oxide-releasing medication) versus vehicle in MC patients with or without AD. Three Phase 3, multicenter, randomized, double-blind, vehicle-controlled, parallel-group trials (B-SIMPLE[berdazimer sodium in molluscum patients with lesions]1, -2, -4) enrolled patients 6 months and older with 3-70 mollusca. Berdazimer or vehicle was applied once daily to all MC lesions for 12 weeks. Data from three Phase 3 studies were integrated for subgroup efficacy and safety assessments using several weighted meta-analysis approaches. Patients with concurrent AD or a history of AD/eczema were categorized as AD+ subgroup (AD- when absent). Primary efficacy endpoint: complete lesion clearance at Week 12. Safety endpoints included adverse events (AEs) through Week 24 and local skin reactions through Week 12. Of 1598 enrolled patients, 209 (13.1%) were AD+. Baseline mean lesion counts were greater in AD+ (26.4) than AD- (19.3). Complete clearance rates were higher at Week 12 for berdazimer compared with vehicle in AD+ (n = 209; 35.0% vs. 27.4%; odds ratio [OR], 1.3; 95% CI, 0.7-2.5) and AD- (n = 1389; 29.1% vs. 18.9%; OR 1.8; 95% CI 1.4-2.4) subgroups. AEs in AD+ were application-site pain (21.6% with berdazimer vs. 11.9% with vehicle), dermatitis (12.8% vs. 2.4%), and erythema (9.6% vs. 7.1%). Berdazimer gel showed favorable efficacy regardless of AD status. Berdazimer-induced erythema may be indistinguishable from AD symptoms or with inflammatory response upon resolution of molluscum.

Molluscum contagiosum presenting as periorbital abscess in immunocompetent children

Molluscum contagiosum presenting as a periorbital region abscess is unusual. The virus generally causes a self-limiting localized disease in children. Presentation as an abscess has been reported mainly in immunocompromised patients. We performed a retrospective study of ten children treated for Molluscum contagiosum infection presenting as periorbital abscess. Data investigated included age, immunocompetence, systemic antibiotic treatment, clinical findings, and histopathology. All children were immunocompetent. Bacterial cultures taken in six of the ten children were positive in two. Seven patients received oral antibiotics before presentation but required IV antibiotics on admission. One patient received IV antibiotics only. All antibiotic treatment had very limited effect. Two patients had no antibiotic treatment. CT imaging in one case where orbital cellulitis was suspected showed no significant intraorbital findings with anterior involvement only. Nine out of ten children had surgery and intra-operative cryotherapy at our center with immediate improvement and recovery. One child whose parents initially refused surgical excision had initial limited clinical improvement of periorbital swelling with antibiotics. However, the lesions were excised shortly following discharge from our hospital at another medical center with a complete cure. Molluscum is a cause of periorbital abscess in immunocompetent children which should be part of the differential diagnosis in periorbital/adnexal infection. Antibiotic treatment has a limited effect, and the abscess is most likely a virally triggered reaction. Surgical excision and intra-operative cryotherapy are curative of the disease in our experience.

Open-Label Observational Study of a Topical Formulation of Calcium Spirulan Contained in a Defined Extract of the Microalga Spirulina platensis in the Treatment of Children with Molluscum Contagiosum.

Molluscum contagiosum (MC) is a common viral skin infection primarily affecting children which is difficult to treat using available therapeutic approaches. The sulfated polysaccharide named calcium spirulan (Ca-SP) has demonstrated antiviral effects against herpes simplex virus in keratinocytes in vitro, and a cream containing 1.5% Ca-SP and 1% of a defined microalgae extract (Spiralin®) effectively prevented herpes labialis in a trial with susceptible individuals. This observational study aimed to show antiviral effects of a similar formulation (Spirularin® VS) against MC in children. Children with active MC lesions were treated with Spirularin® VS cream twice daily on affected skin over several months and asked to return for follow-up visits after 1 to 3 months. Clinical status of MC infection was documented at baseline and follow-up visits. Of the 31 children enrolled in the study, 26 completed treatment and returned for control visits. Spirularin® VS cream was applied twice daily over a period of 1 to 9 months (mean treatment duration 3.9 months). 19/26 (73.1%) children achieved complete clearance of MC lesions with no clinical evidence of bacterial skin infection during treatment. No irritative skin reactions or unpleasant symptoms were observed or reported. This open-label observational study suggests that a cream formulation containing 1.5% Ca-SP and 1% Spiralin® may be an effective and safe treatment option for children with active MC lesions. The high rate of complete clearance of MC lesions and lack of adverse reactions warrant further investigation in larger, controlled trials.

Translated article] Nonvenereal Infections in Spanish Dermatology Clinics: Results of the DIADERM Study

Background and objectiveThe burden of nonvenereal infections in Spanish dermatology practice has not yet been evaluated. The aim of this study was to analyze the overall weight of these infections in outpatient dermatology caseloads. Material and methodsObservational cross-sectional study of diagnoses made by a random selection of dermatologists from the Spanish Association of Dermatology and Venereology (AEDV) working in outpatient dermatology clinics. The data were obtained through the anonymous DIADERM survey. Diagnoses of infectious diseases were selected using codes from the International Classification of Diseases, Tenth Revision. After excluding sexually transmitted infections, the diagnoses were classified into 22 groups. ResultsSpanish dermatologists diagnosed an estimated 16Y190 (95% CI, 9338–23Y042) nonvenereal infections on average per week, a figure that accounted for 9.33% of the dermatology caseload. The most common diagnostic groups were nonanogenital viral warts (7475 diagnoses, 46.17% of nonvenereal infections), dermatophytosis (3336, 20.61%), and other viral infections (1592, 9.84%), which included Molluscum contagiosum infections. Nonvenereal infections were more common than noninfectious dermatologic conditions in private clinics (P<.0020) and adults (P<.00001). Patients with these infections were also more likely to be discharged than those with other conditions in both public (P<.0004) and private (P<.0002) practices. ConclusionsNonvenereal infections are frequent in dermatology. They are the third most common reason for outpatient visits, behind actinic keratosis and nonmelanoma skin cancer. By enhancing the participation of dermatologists in the management of skin infections and encouraging interactions with other specialists, we will be able to carve out a niche in an area we have scarcely ventured into to date.

Heterologous effect of influenza vaccination on molluscum contagiosum infection; a case report of siblings

BackgroundMolluscum contagiosum virus (MCV) is a benign, common cutaneous infection predominantly affecting the younger pediatric population. Traditional treatments may be time consuming with variable efficacy. Time to spontaneous resolution is variable and treatment is often sought to shorten duration of infection, prevent further autoinoculation, prevent infectious spread to others and treat cosmetic intolerability.Case presentationWe present the case of two patients with complete, simultaneous clearance of their molluscum contagiosum infections after receiving a routine 2018 quadrivalent influenza vaccination. Neither patient has had recurrence of molluscum contagiosum or permanent scarring. We review trials of intralesional immunotherapy in treatment of cutaneous infections to theorize the mechanism of MCV infection clearance post influenza vaccination.ConclusionWe propose a delayed-type hypersensitivity reaction was induced as a heterologous effect of the influenza vaccination, similar to that seen in current immunotherapy treatments. This is the first reported case of MCV-directed immune reaction with infection clearance after influenza vaccination.

Multiple Giant Molluscum Contagiosum Mimicking Epidermal Cysts in an HIV-Positive Patient with Miliary Tuberculosis: A Case Report

Introduction: Molluscum Contagiosum (MC) is a benign cutaneous viral infection caused by a double-stranded DNA virus of the family poxviridae. In patients with human immunodeficiency virus (HIV) infection, lesions often spread widely, atypical and don't show signs of self-healing. Here we report a case of multiple giant Molluscum Contagiosum in an HIV-positive patient with miliary tuberculosis. Case presentation: A 26-year-old man presented with a 1-year history of symmetrical exophytic lesions，physical examination showed that these lesions distributed over the bilateral thighs, and some giant papules reached 2 cm in diameter. He had a dry cough with little phlegm production, a low-grade fever, and fatigue for 8 months. The patient was finally diagnosed with MC, miliary tuberculosis and HIV infection. He was given anti-tuberculosis and antiviral treatment，the effect of cryotherapy on MC was unsatisfactory and the patient was lost to follow-up. Discussion: Molluscum contagiosum is a kind of infectious disease, which is easy to be diagnosed by clinical manifestations and laboratory examination. It is self-healing in patients with normal immunity, but in patients with immunodeficiency, the rash is often atypical and difficult to treat, and patients are also easy to merge with other microbial infections. Conclusion: Clinicians must bear in mind that patients with multiple giant molluscum contagiosum infections need to be excluded of HIV and other infectious diseases to avoid missed diagnosis and misdiagnosis.

Enfermedades infecciosas no venéreas atendidas en consultas de Dermatología en España: resultados del estudio DIADERM

Background and objectiveThe burden of nonvenereal infections in Spanish dermatology practice has not yet been evaluated. The aim of this study was to analyze the overall weight of these infections in outpatient dermatology caseloads. Material and methodsObservational cross-sectional study of diagnoses made by a random selection of dermatologists from the Spanish Association of Dermatology and Venereology (AEDV) working in outpatient dermatology clinics. The data were obtained through the anonymous DIADERM survey. Diagnoses of infectious diseases were selected using codes from the International Classification of Diseases, Tenth Revision. After excluding sexually transmitted infections, the diagnoses were classified into 22 groups. ResultsSpanish dermatologists diagnosed an estimated 16190 (95% CI, 9338-23042) nonvenereal infections on average per week, a figure that accounted for 9.33% of the dermatology caseload. The most common diagnostic groups were nonanogenital viral warts (7475 diagnoses, 46.17% of nonvenereal infections), dermatophytosis (3336, 20.61%), and other viral infections (1592, 9.84%), which included Molluscum contagiosum infections. Nonvenereal infections were more common than noninfectious dermatologic conditions in private clinics (P<.0020) and adults (P<.00001). Patients with these infections were also more likely to be discharged than those with other conditions in both public (P<.0004) and private (P<.0002) practices. ConclusionsNonvenereal infections are frequent in dermatology. They are the third most common reason for outpatient visits, behind actinic keratosis and nonmelanoma skin cancer. By enhancing the participation of dermatologists in the management of skin infections and encouraging interactions with other specialists, we will be able to carve out a niche in an area we have scarcely ventured into to date.

Molluscum Contagiosum Virus Evasion of Immune Surveillance: A Review.

Molluscum contagiosum (MC) is an acute infection caused by the molluscum contagiosum virus (MCV) with a worldwide incidence of approximately 8,000 cases per 100,000 individuals annually. Greater than 90% of MC cases occur in the pediatric population, and affected adults are more likely to be younger or immunocompromised. MC has minimal inflammation initially; however, a strong inflammatory response can occur during resolution of the infection, termed the beginning of the end (BOTE). MC infections may last months to years, and it is hypothesized that persistent infections may be due to suppression of immunity by MCV proteins, thus affecting MC&rsquo;s clinical progression. We reviewed the current proposed mechanisms of MCV immune evasion and discuss potential therapeutic options for MC treatment. A literature search was conducted using electronic databases (Pubmed, Google Scholar, Medline). We compiled 18 original research articles and identified 11 proteins produced by MCV that are postulated to participate in evasion of host immunity through various molecular pathways. These proteins and/or their downstream pathways may be influenced by MC treatments in phase 3 development, including berdazimer gel 10.3% and VP-102 cantharidin, 0.7%. MCV is distinctive in evading immune surveillance by inhibiting or dampening several immune pathways via the production of viral proteins. The result is decreasing local inflammatory response which contributes to the prolonged survival of MCV in the epidermis. Persistent MC can be a nuisance for some patients and treatment may be desired. Currently, no treatment has been approved by the US Food and Drug Administration (FDA). Two approaches in the pipeline may affect the immune avoidance mechanisms; nevertheless, their exact mechanisms between the potential therapeutics and viral proteins remain enigmatic. J Drugs Dermatol. 2023;22(2):182-189. doi:10.36849/JDD.7230.

A novel frameshift variant in the ADA2 gene of a patient with a neurological phenotype: a case report

BackgroundAdenosine deaminase 2 (ADA2) deficiency is an inherited autoinflammatory syndrome caused by a defect in the ADA2 gene. Most common manifestations include peripheral vasculopathy, early-onset stroke, immunodeficiency, and haematological manifestations. Patients with pathogenic variants that are more detrimental to ADA2’s enzymatic function (e.g. frameshift) have been reported to be prone to developing hematological phenotype. We report here the case of a 13-year-old Caucasian girl with a novel frameshift variant in the ADA2 gene and a clinical phenotype of early-onset stroke.Case presentationThe patient was admitted to hospital with complaints of weakness in her right arm, unilateral facial weakness and speech problems. Her initial laboratory workup was normal; however, magnetic resonance imaging of her brain confirmed acute/subacute ischaemic changes in the posterior limb of the left-sided internal capsule and in the apical part of the thalamus. She also had manifestations of immunodeficiency – recurrent skin infections and otitis, chronic Molluscum contagiosum infection in anamnesis and B cell deficiency with a low level of serum IgA. The patient’s DNA was analysed and two pathogenic variants were identified in the ADA2 gene, confirming a diagnosis of adenosine deaminase 2 (ADA2) deficiency. While one of the variants (c.506G > A (p.Arg169Gln)) has been reported previously, the other one is a novel frameshift variant, namely, c.464del (p.Pro155Hisfs*29). The patient received stroke rehabilitation, which significantly improved her functional state. Tumour necrosis factor inhibitor and methotrexate treatment was commenced, and the patient has remained stable with no further ischaemic events.ConclusionsAlthough rare, ADA2 deficiency should be considered in patients with early-onset stroke, especially with concomitant manifestations of inflammatory features or immunodeficiency. This case report extends the genotypic spectrum of ADA2 deficiency.

Reporte de caso en México de neumonía por Cedecea lapagei multidrogorresistente

Introduction: Cedecea lapagei&nbsp; is an opportunistic gram-negative bacteria that belongs to the Enterobacteriaceae family. It is considered an opportunistic pathogen. Case study: a 56-year-old male with long standing HIV infection abandoned therapy for 3 years. He started developing symptoms for 6 months characterized by weight loss, abdominal pain and dyspnea. He was diagnosed with poorly differentiated gastric adenocarcinoma, oral candidiasis and molluscum contagiosum infection. He developed respiratory distress and required mechanical ventilation. A sputum culture reported multi-resistant Cedecea lapagei. Discussion: we report the sixth case of pneumonia due to Cedecea lapagei in the world. Two of these cases have been reported in Mexico, both in an immunocompromised patient and requiring isolation measures during hospitalization. Conclusion: due to the lack of clinical and epidemiological information on this pathogen, in addition to the MDR characteristics found in this case, the need to have cultures of respiratory secretions before starting treatment with empirical antibiotics is reaffirmed, as well as the need to expand our knowledge on this pathogen, since it is not found in the EUCAST or CLSI clinical guidelines. This pathogen should be studied as an emergent opportunist due to its ability to infect people that suffer from some type of immunosuppression and are also hospitalized.

Palmar wart with ‘Myrmecia’ inclusions on histopathology – recap of an unusual entity

Cutaneous warts are a common skin condition affecting children and young adults and signify infection with human papillomavirus. They are of various types and show association with specific viral genotypes. The aim of this case report is to highlight one such case of deep palmoplantar wart also known as ‘Myrmecia wart’ because of its very peculiar clinical and histopathologic findings. A young male in his mid-20s presented with a warty growth in the index finger of his right hand. Biopsy and subsequent histopathological examination confirmed its categorization as Myrmecia wart. A thorough account of its typical cytopathic effects observed in histopathology as well its differentiating features from other common warts like verruca vulgaris and molluscum contagiosum infection on microscopy is warranted. Further, not so frequent incidence merits detailed review of this entity.

Molluscum Contangiosum Diagnosis, Manifestation and Management: A review Article

Introduction: Infectious skin disease with clinical manifestations of benign papules, which is often caused as a sexually transmitted disease in adults, caused by the molluscum contagiosum virus, a member of the poxvirus. Manifestations of the disease are asymptomatic, discrete, smooth papules. It usually develops from peduncled lesions up to 5 mm in diameter. The incubation period for Molluscum contagiosum is from one to several weeks to 6 months. Molluscum contagiosum is a viral infection that can heal spontaneously. There are 4 main subtypes of Molluscum Contagiosum 4 Virus (MCV), namely MCV I, MCV II, MCV III and MCV IV. These four subtypes cause similar clinical symptoms in the form of papular miliary lesions that are limited to the skin and mucous membranes. MCV I is known to have a greater prevalence than the other three subtypes. About 96.6% of molluscum contagiosum infections are caused by MCV I. However, in patients with decreased immune status, the prevalence of MCV II is 60%.

A Therapeutic Trial Comparing Modified Autoinoculation, a Novel Approach with Topical Potassium Hydroxide Application in the Treatment of Molluscum Contagiosum.

Context:Molluscum contagiosum (MC) is a common viral cutaneous infection. Despite multiple treatment options, there is no definitive treatment. In some cases, the lesions are severe, recurrent, and cosmetically odd. Modified autoinoculation (MAI) is a novel technique that induces cell-mediated immunity resulting in clearance of local as well as distant lesions. Potassium hydroxide (KOH) acts by dissolving the keratin and penetrating deeply destroys the hyperproliferative tissue. We would here like to compare MAI with topical KOH in the treatment of MC.Aims and Objective:The aim of this study was to assess the effectiveness of MAI in treatment of MC and to compare its response with topical KOH application.Settings and Design:This was an open-labeled longitudinal therapeutic outcome study carried out at a tertiary care center over a period of 1 year.Materials and Methods:Hundred consenting MC patients attending the department of dermatology were randomized into Group A and Group B. Group A patients were subjected to MAI and Group B to topical application of 10% KOH.Statistical Analysis Used:The continuous variables are presented as mean ± standard deviation (SD). The difference between the mean score was analyzed using Student’s t test for independent variable and paired t test for paired results.Results:At the end of 16 weeks, 91.48% showed complete clearance by MAI compared to 81.64% with topical 10% KOH solution. There was a significant reduction of mean score of lesions in patients treated by MAI compared to patients treated with KOH.Conclusion:MAI therapy provides a promising, easy, cost-effective, daycare option for MC infections.

Molluscum contagiosum in the setting of Fingolimod: The experience at one institution

Fingolimod treatment has been associated with opportunistic infections, most notably PML and cryptococcal meningitis. There are rare reports of other infections like molluscum contagiosum which are typically associated with impaired cellular immunity as seen in AIDS. Upon review of our multiple sclerosis patient database, we identified eight patients undergoing fingolimod treatment who developed molluscum contagiosum infections. We suspect that this association is a class effect and may also be observed with other S1P receptor modulators. While molluscum contagiosum infection is not life-threatening, it can be extremely distressing for patients, and resolution may require discontinuation of fingolimod.

Successful treatment of ankylosing spondylitis with alternative and complementary medicine withdrawal of adalimumab treatment

Background and purposeCurrent treatment strategies for ankylosing spondylitis (AS) include adalimumab and other biological drugs. However, treatment failures and side effects are commonly observed. This report documents the successful use of supplements and dietary changes to treat a patient with AS after cessation of adalimumab therapy. Patient presentationA 38-year-old human leukocyte antigen B27 positive female patient with AS showed no improvement when treated with a non-steroidal anti-inflammatory drug. The patient then began adalimumab therapy with some success; however, after nine months, she developed a disseminated and refractory Molluscum contagiosum infection. Adalimumab was withdrawn, and the patient started taking supplements, while adopting an anti-inflammatory diet (dairy-free, gluten-free, and sugar-free). Normalization of inflammatory markers was achieved after two months, and magnetic resonance imaging of the sacroiliac revealed a notable physical improvement.

SB206, a Nitric Oxide–Releasing Topical Medication, Induces the Beginning of the End Sign and Molluscum Clearance

The beginning of the end (BOTE) sign has been proposed to describe well-recognized clinical signs of inflammation (including erythema, induration, and scale) that predict imminent resolution of molluscum contagiosum (MC). This phenomenon has never been prospectively studied. An integrated analysis of two prospective, 12-week, randomized, double-blind clinical trials of topical nitric oxide–releasing SB206 gel evaluated an association between BOTE sign and MC lesion reduction. Of 707 randomized patients, ~80% exhibited BOTE signs regardless of treatment assignment. At week 12, MC lesion counts decreased from baseline by 50.7% for baseline BOTE+ versus 29.1% for BOTE– (P = 0.0015) vehicle-treated patients compared with a 63.3% decrease for baseline BOTE+ versus 51.7% for BOTE– (P = 0.0194) SB206-treated patients. Among vehicle-treated patients, 48 (22.3%) who were never BOTE+ had an 18.5% reduction from baseline in MC lesion counts versus a 34.0% reduction in 165 patients (76.7%) who experienced BOTE at any time, suggesting that the projected duration of lesion clearance for patients with 18–20 MC lesions is 15 months for BOTE– versus 6 months for BOTE+ patients. Patients who were both BOTE+ and treated with SB206 had the greatest reduction in MC lesion count. SB206 may trigger BOTE signs and shorten the duration of MC infection. The two studies whose data are analyzed in this study are registered at ClinicalTrials.gov with the identifiers NCT03927703 and NCT03927716