Figure 1: 2 Molluscum lesions on the popliteal fossa of a 4-year- old girl.

Figure 2: Close up of Molluscum revealing the central dell.

Figure 3: First lesion has Molluscum bodies on top of lesion while second lesion is being extracted.

Figure 4: Molluscum body on surface of first wart. Preparing to extract second wart.

Molluscum Contagiosum is an infection of the skin caused by a poxvirus. The typical lesions of Molluscum are 2-5mm papules with a central dell. Molluscum can occur anywhere on the body as a group or as individual lesions. The most common locations are the face, abdomen, and the pubic region. Molluscum Contagiosum is often considered a sexually transmitted disease when found around the genitals in adults. Molluscum occur most commonly in children ages one to 12 but can be found in people of all ages.1 Also, some people may have immunity to the infection and, therefore, will not show symptoms of Molluscum.2 Although usually asymptomatic, symptoms may include redness, soreness, itchiness, and swelling.

On average, it takes up to 24 months for the immune system of a person to recognize that the poxvirus is abnormal and start to fight off the virus on its own. That is why lesions may resolve without treatment within six to 24 months in individuals with healthy immune systems. Patients with Molluscum usually do not have long-term issues or scarring. People often present to the physician with Molluscum because of the immune reaction to the virus, often called Molluscum dermatitis, or because of spread of the virus on a person or between people. Individuals with weakened immune systems often require treatment for the lesions to resolve.2 One may be considered contagious until all lesions have cleared.3

There is no FDA-approved treatment for Molluscum. Treatments may scar the skin. There are many options to try to treat Molluscum. Some of these include cryotherapy with liquid nitrogen, cantharidin destruction, laser ablation, curettage, injections of Candida antigen, topical imiquimod, topical retiniods, and oral cimetidine. There are so many options because no one option has proven safe and effective or optimal for all patients.

Antiviral effects and upregulation of the immune system may occur with topical imiquimod or intralesional Candida injections. In a previous paper, one of the authors (Johnson) reported clearance in 56 percent of pediatric patients after an average of three treatments with intralesional Candida injections.4

Figure 5: Histologic depiction of a Molluscum lesion (not from same patient as clinical photos) demonstrating the central dell filled with Molluscum bodies.

We present in this paper a novel and successful treatment for Molluscum that we utilize in our clinic. After identifying the Molluscum lesions and consenting or assenting the patient, we extract the Molluscum body with forceps. In our experience, usually only one treatment session is needed for eradication of the virus. There is minimal trauma or drama for the patient or the parent utilizing this treatment. We advise white petrolatum with a bandage for a few days for wound care. We have been treating Molluscum lesions with this technique for more than 15 years without any known scarring, complications, or follow-up phone calls from patients or parents. We present this treatment to be added to the armamentarium for the treatment of Molluscum Contagiosum. n

The authors have no conflicts of interest to report with this paper.

1. www.cdc.gov/poxvirus/molluscum-contagiosum/

2. http://kidshealth.org/parent/infections/skin/molluscum_contagiosum.html#

3. https://www.aad.org/dermatology-a-to-z/diseases-and-treatments/m---p/molluscum-contagiosum/diganosis-treatment

4. Clifton MM, Johnson SM, Roberson PK, Kincannon J, Horn TD. Immunotherapy for recalcitrant warts in children using intralesional mumps or Candida antigens. Pediatric Dermatology 2003;20(3):268-271.