In dermatology, the “molluscum” is used as a prefix for infective and non-infective conditions. Originally, the Latin word “molluscum” referred to a fungus growing on maple tree. It is derived from “mollis” meaning “soft”. “Mollusca” also refers to a phylum in the animal kingdom, presumably named because of their soft bodies, e.g. octopus, squid. In dermatology, the term is used to describe soft papules or nodules with or without central umbilication; although over the years, it is popular perception to consider it synonymous with umbilication. Though, umbilicated lesions may be seen in a variety of infective, inflammatory, reactive, benign as well as malignant dermatological conditions, the term molluscum has only been used for a limited number of entities. We attempt to summarise the conditions in dermatology with the epithet “molluscum”. The specific conditions are described below.
It is a cutaneous viral infection, caused by Molluscum contagiosum virus (MCV), a poxvirus (dsDNA virus), which is the largest virus infecting humans.Four genotypes of the virus are known (namely MCV 1-4). Of these, MCV-1 is responsible for 76-97% of infections.
Clinically, it manifests as pearly white papules with a central umbilication, involving any cutaneous site however, the lesions in adults are more common in the anogenital area and can be sexually transmitted. Rarely, MCV can cause folliculitis in immunosuppressed individuals, called molluscum folliculitis. It presents as skin-coloured to red papules over the face. At times, a Type IV hypersensitivity or Id reaction to the virus can cause a dermatitis around the papule in 10% of individuals, ranging in size from 5 mm to 10 cm. It is known as molluscum dermatitis and it may lead to resolution of the papule. Vice-versa is also true, that is removal of the lesion results in resolution of the dermatitis.Patients with atopic dermatitis (AD) can also present with widespread MCV infection, commonly localized to eczematous skin lesions of AD; though it may extend beyond due to autoinoculation. This presentation is known as eczema.
To determine a possible role of Langerhans cells in viral infection of skin, we studied the distribution of Langerhans and indeterminate cells in the lesional skin of mollusca contagiosa, verrucae vulgaris, plantar warts, and condylomata acuminata. A total absence of Langerhans and indeterminate cells was observed in molluscum contagiosum, but their number appeared to be normal or increased in the perilesional normal skin. Few Langerhans and indeterminate cells were seen in the suprabasal location in verrucae vulgaris and plantar warts, and normal numbers were noted in the perilesional skin. In contrast, a larger number of Langerhans and indeterminate cells reaching up to stratum granulosum were found in the condylomata acuminata. It is possible that alteration of keratinocytes by viral infection may effect the migration of Langerhans cells to the epidermis. The lack of Langerhans cells may lead to a paucity of inflammatory response (in particular, T cell-mediated response) to the cells infected with the virus.
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The medicines that can be thought of use are:-
- Teucrium marum varum