Molluscum contagiosum- Case Report

Dr S R Bharath Kumar

ABSTRACT
Molluscum contagiosum, also called water warts, is a benign condition of the skin. The skin lesions of molluscum contagiosum are called mollusca. A double-stranded DNA poxvirus called molluscum contagiosum virus (MCV) causes molluscum contagiosum, the clinical prevalence of molluscum contagiosum may reach up to 18%. Homoeopathic remedies are effective in treating molluscum contagiosum without any complications. In this article Homoeopathic treatment for Molluscum contagiosum is explained through a case.

KEYWORDS : Molluscum contagiosum, double-stranded DNA poxvirus, Homoeopathic treatment, Nitric acid 200c.

INTRODUCTION
Molluscum contagiosum, also called water warts, is a benign condition of the skin. The skin lesions of molluscum contagiosum are called mollusca. The typical lesion appears dome-shaped, round and pinkish purple in colour.

ETIOLOGY
A double-stranded DNA poxvirus called molluscum contagiosum virus (MCV) causes molluscum contagiosum. Four subtypes of the molluscum contagiosum virus are known, and they are MCV-1 (98% of cases) is mostly seen in children, while MCV-2 is mainly responsible for skin lesions in people living with HIV. MCV-3 and MCV-4 are present in Asia and Australia. Currently, it is not possible to have cultures of molluscum contagiosum virus.

Molluscum contagiosum lesions are transmitted by direct skin-to-skin (including sexual) or indirect (towels, underclothes, toys, razor, tattoo supplies) contact. Molluscum contagiosum may also disseminate by autoinoculation to normal skin after mollusca scraping by the patients. Transmission from sharing swimming pools and other wet environments is possible but not fully proven. In utero and prepartum transmissions are occasionally reported, resulting in congenital molluscum contagiosum or skin lesions developing during the early months of life.

EPIDEMIOLOGY
Molluscum contagiosum is a common medical concern. In 2010, there were about 122 million cases. It occurs worldwide but seems to be more frequent in warm, humid regions. Molluscum contagiosum is diagnosed mainly in children aged two to five years, but also in sexually active teenagers and adults, and immunocompromised persons. Atopic dermatitis may increase the risk for developing molluscum contagiosum since it alters the skin barrier and immunity function. In people living with HIV (human immunodeficiency virus), the clinical prevalence of molluscum contagiosum may reach up to 18%. No gender predominance is noted.

PATHOPHYSIOLOGY
The incubation period ranges from two weeks to six months. Molluscum contagiosum virus infects only keratinocytes, and skin lesions are limited to the epidermis and do not have systemic dissemination. Molluscum contagiosum virus produces proteins inhibiting human antiviral immunity, thus preventing the development of innate immunity response, and contributing to the persistence of skin lesions.

HISTORY AND PHYSICAL EXAMINATION”
Molluscum contagiosum causes mainly cosmetic concerns. Mollusca is usually asymptomatic but may be painful or itchy. In atopic persons, eczema lesions may develop around mollusca weeks after their occurrence. An inflammatory reaction, secondary to scratching or occurring when mollusca start to resolve, is frequent and should be distinguished from secondary bacterial infection. When scratched or removed, molluscum contagiosum can lead to bleeding under each single element.

DIAGNOSIS
The diagnosis of molluscum contagiosum is based on clinical examination. Lesions are firm, white to flesh-colored, dome-shaped, pearly papules, having a central umbilication from which one can express a cheesy material. Mollusca is usually one millimetre to one centimetre in diameter.

In children, mollusca are located on the face, trunk, limbs and axillary areas. Palms and soles are not involved. In sexually transmitted forms, lesions are mainly observed in the anogenital area, abdomen, and inner thighs. There are rarely more than 20 to 30 elements over the skin and are usually grouped together. However, molluscum contagiosum may be extensive, mostly in immunocompromised persons.

DIFFERENTIAL DIAGNOSIS

• Keratoacanthoma
• Lichen planus
• Epidermal cyst
• Folliculitis
• Basal cell cancer
• Condyloma acuminatum
• Varicella zoster

Complications

• Inflammation or infection (cellulitis)
• Irritation
• Conjunctivitis if the lesions are on the eyelids
• Abscess

CASE REPORT

Summary
Male patient by name Y, aged 10 years presented on 17/07/2021 with vesicular (warty) eruptions around eyelids and eyebrow bilaterally for 6 months.

History
Patient initially had small pin point eruption over eyelids, started 6 months priorly and recurred every week. He had consulted an Ophthalmologist initially and later was referred to a Dermatologist.

Eruptions are soft, horny, no signs of inflammation.

Dermatologist diagnosed it to be MOLLUSCUM CONTAGIOSUM and treated with local applications. Eruption use to reduce with application of ointments and later again reappear after few days. Doctor had suggested for removal of the eruption.

Patient came for homoeopathic consultation on 17/07/2021.

Presented with above mentioned complaints.

Family history:

• Father- hypertension
• Mother apparently healthy.
• No history of any skin problems, hormonal problems, infectious and autoimmune diseases among blood relatives.

Personal history:

• Desires for oily fried foods, snacks. Dislikes sweets
• Thermals ambhithermal.
• Appearance-fair, flabby and short stature.
• Timid child, answers monosyllable to the questions asked.
• No other history was provided by the parents.

Prescription: 17/07/2021

Rubrics considered: Eye-warts-lids.

Skin- eruption- molluscum contagiosum

Rx-

1. Thuja 200 OD/3days
2. PL BD/2weeks.

CONCLUSION:
Homoeopathic medicine act faster and provide desired result only when selected appropriately. Though Molluscum contagiosum requires constitutional treatment, in this case I failed at arriving constitutional similimum, but this case was an eye opener for appropriate selection of pathological rubrics and results of the same. Furthermore such studies are required to show the efficacy of Homoeopathic treatment.

Acknowledgement: Informed consent was taken from the patient’s parents. I thank them for allowing me to share this case.

REFERENCES:

1. Molluscum contagiosum, Badri T Gandhi G R https://www.ncbi.nlm.nih.gov/books/NBK441898/
2. Synthesis repertory version 9.0
3. Pocket manual of Homoeopathic Materia Medica and Repertory, William Boericke.
4. Google images- Molluscum contagiosum.

Dr S R Bharath Kumar
PG Scholar, MD Part- II
Department of Homoeopathic Materia Medica
Government Homoeopathic Medical College and Hospital, Bengaluru, Karnataka.

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