Molluscum contagiosum

With all the information about skin conditions, bacteria, and sexually transmitted infections available to the general public there are still a few conditions which we continue to strive to understand. One of these is Molluscum Contagiosum.

What is molluscum Contagiosum?

There are actually conflicting reports and answers to this question. It is usually the first question asked by a patient for a condition that is not unusual yet not well understood by health care providers. Molluscum is sometimes referred to as MCV, Molluscum Contagiosum Virus.

There are various reports that molluscum (MCV) is caused by a pox virus or even a fungus that works in symbiosis (mutually beneficial interaction) with a pox virus. This theory operates under the thought process that the virus is contracted first and this virus acts as a cover for the fungus – thus hiding it from the body’s immune response. The virus provides this cover for the fungus because the pearly colored wax-like core of the lesion provides an ideal place for the actual virus to continue to reproduce.

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It is believed that the actual core of each lesion is the most contagious portion of the lesion and is responsible for most new cases. The efforts and reaction of molluscum to not respond to treatment is almost like a parasite the way it evades and resists the host who is trying to rid themselves of it. An interesting and alarming fact of molluscum is the way it hides from the immune system and thus replicates freely and quickly avoiding the body’s normal inflammatory response as well as white cell macrophage response.

Molluscum seems to have sub-dermal root system (under the skin) and this root system provides the means for new lesions to grow. This is why (much like HPV) each lesion must be treated to actually rid the body of molluscum. If there is one lesion omitted in treatment, no matter how small, it leaves the body open to new lesions due to the root system. Remember, although molluscum is transferred by skin-to-skin contact it is believed in this symbiotic theory that the majority of the infection lies in the waxy-white core and that waxy-like core hides the manifestation of the fungus that may be the cause of the molluscum. Any continued root system provides the open door for new lesions to begin again if the lesions are not all treated and eliminated.

What causes Molluscum Contagiosum?

Until recently little has been known about MCV because the virus can not be grown in culture and more effective treatments will not be found except by trial and error in clinical settings. There is no test as of yet to determine who is infected and in fact – the nature of the real organism responsible – virus, bacteria, fungus or even possibly a multicellular parasite is truly unknown.

According to Keith MacTerrel in his article titled: “Symbiots, Parasites and Diseases”, he states, “Only a minority of genetically independent organisms that occupy the human body are diseases – organisms that disrupt the functioning of the body and cause harm to the individual. Some are benign parasites. Others, like bacteria in our intestines help us to digest food and extract essential nutrients. That is a helpful symbiot.” It is too early in studies to say for sure what category mollusca can be placed in. If it turns out to cause health-problems in the long term, then disease would be the correct label. The evidence thus far is inconclusive. There are efforts on-going to develop testing for the molluscum Contagiosum virus, according to Dr. Phillip Dwyer, but because the body’s immune system is not aware of the organism due to a period of latency (the virus is inactive or said to be hiding) the patient has no symptoms and is unaware. The patient then gets a fever, swollen lymph glands and the pus filled bumps appear as a sign of the active infection.

The host’s immune system develops antibodies and fights the organism or the host receives treatment from a health care provider. Researchers investigating MCV say they are not “finding” the molluscum in the patient samples. It is possibly because those samples are not usually received from the patient until the organism has done its work and is destroyed in the host. What has been learned is that once and outbreak has been successfully eliminated it is likely to return within 6 months to a year in a milder form, and if this outbreak is eliminated successfully then molluscum may be gone forever.

How does MCV spread?

Molluscum is not a systemic condition (affecting the entire body or a particular body system) but a localized one (confined or restricted to a particular location). Molluscum can appear anywhere on the body except the palms of the hands and the soles of the feet. It is spread from physical skin-to-skin contact or coming into contact with a contaminated surface. It is known that every lesion must be treated or the molluscum will continue to spread relentlessly.

The two peak incidence groups are children under age 5 and young adults. Men contract MCV 5 times more than females. 25% of cases of molluscum are clustered in families and in one informal study 21% of college students in the US report symptom consistent with MCV. With adults sexual contact is one way of contracting molluscum and lesions are usually found in the pubic area. For women that is due to the friction against the partner’s skin. For males it lesions are usually found on the penis. It can also be seen initially on the thighs or buttocks if it has been contracted from a public facility. Surprisingly molluscum provides an unusual side affect in adults of an increased libido which may be a method for MCV to encourage it’s own continued existence. This side affect has not been studied abundantly in adolescents but makes it very important to stop the progression of MCV in children quickly, just in case.

In the majority of cases reported from children it is unlikely to be sexually transmitted.

If lesions are seen on children in the pubic or anal area sexual abuse could be a conclusion. Even in some cases where this has occurred it was simply the act of the children touching a contaminated area and then scratching themselves. The contaminated surface may have well been a public bathroom or even another child while playing. If the child is in pre school and naps are taken the child can get molluscum from sleeping on a mat where another child with molluscum had previously slept. Consider that these mats are rolled up or stacked on top of one another, stored in a closet and there is sweat on them. Plastic covered mats, which can be washed with disinfectant, and covering the sleeping surface with the child’s own personal blanket is a better alternative.

The primary way a child gets molluscum is in public swimming pools. The main body of water is treated properly with chlorine but the sides of the pool that are depressed and hold water can harbor the molluscum for up to 4 hours until an unsuspecting host comes into contact with that water. If a child or adult is sunburned the skin is susceptible if it comes into contact with a surface exposed to MCV.

There is also a high concentration of MCV seen in wrestlers due to the large amount of body contact involved. Sometimes, depending on where the lesion is, the lesion can be covered with a dressing and the person is allowed to compete. However many times the contender is kept from the competition until no lesions are visible. Some small children are kept from attending pre school until they are lesion free.

All of us are susceptible to molluscum. Illness, bacteria, viruses, parasites and fungi are not selective. Treatments for MCV are varied and some can cause damage to skin. Molluscum Contagiosum treatments are discussed more fully in the accompanying article.

Molluscum can be disfiguring and cause emotional scarring as well in both children and adults if not treated.

The HIV community is at a large risk for molluscum due to their suppressed immune system. The good news is the extended life expectancy for those living with AIDS, but with that comes molluscom Contagiosum and advanced MCV. Molluscum is a huge additional health concern for the immuno compromised and the possible disfigurement of advanced MCV along with the social stigma of living with HIV can be devastating.

What is agreed upon by most health care providers and researchers is that early and aggressive treatments be taken to slow down or destroy molluscum Contagiosum before it spreads to other areas of the body or to other people or becomes more unlivable than necessary, negatively affecting the quality of life.

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Molluscum contagiosum