Molluscum contagiosum AIDS. Molluscum contagiosum

The disease usually heals on its own within 6 to 24 months, so it does not always require treatment. Molluscum contagiosum does not pose a health hazard, but it creates visible cosmetic defects, which many people want to get rid of with treatment, without waiting for the rash to go away on its own.

General characteristics of the disease

Molluscum contagiosum is also called contagious mollusk, molluscum epitheliale or epithelioma contagiosum. The disease is a viral infection that affects the skin. The virus enters the cells of the basal layer of the epidermis and causes accelerated division of cellular structures, as a result of which small growths-nodules of a round shape with an umbilical depression in the center are formed on the surface of the skin. The depression in the central part of the nodule is formed due to the destruction of epidermal cells. The growths themselves contain viral particles and a large number of randomly located epidermal cells.

Molluscum contagiosum is a benign disease and is not classified as a tumor, since the formation and growth of nodules is caused by the impact of the virus on a specific small area of ​​the skin. There is no inflammatory process in the epidermis in the growth zones of molluscum contagiosum nodules.

Molluscum contagiosum is quite widespread in the population, and people of any age and gender get sick. However, the infection most often occurs in children 2–6 years old, adolescents and people over 60 years old. Children under one year of age almost never become infected with molluscum contagiosum, which is most likely due to the presence of maternal antibodies transmitted to the baby through the placenta during fetal development.

Most at risk of infection molluscum contagiosum people with weakened immune systems, for example, HIV-infected people, cancer patients, allergy sufferers, those suffering from rheumatoid arthritis and taking cytostatics or glucocorticoid hormones. In addition, there is a high risk of contracting an infection among those who are constantly in contact with the skin of a large number of people, for example, massage therapists, nurses, doctors, nurses in hospitals and clinics, pool trainers, bathhouse attendants, etc.

Molluscum contagiosum is widespread, that is, in any country and climate zone, infection with this infection is possible. Moreover, in regions with a hot and humid climate, as well as with a low level of everyday household hygiene, epidemics and outbreaks of molluscum contagiosum are even recorded.

The disease is caused orthopoxvirus, which belongs to the family Poxviridae, subfamily Chordopoxviridae and genus Molluscipoxvirus. This virus is related to the variola, chickenpox and vaccinia viruses. Currently, 4 varieties of orthopoxvirus have been identified (MCV-1, MCV-2, MCV-3, MCV-4), but molluscum contagiosum is most often caused by viruses of types 1 and 2 (MCV-1, MCV-2).

Molluscum contagiosum virus is transmitted from a sick person to a healthy person through close contact (skin to skin), as well as indirectly when using common household items, for example, shower accessories, underwear, dishes, toys, etc. In adults, infection with molluscum contagiosum usually occurs sexually, and the virus infects a healthy partner not through the secretions of the genital organs, but through close contact of bodies. That is why in adults, molluscum contagiosum nodules are very often located in the groin, on the lower abdomen, in the perineum, and also on the inner thighs.

However, it has now been established that many people, even when infected, do not get sick with molluscum contagiosum, which is due to the peculiarities of the functioning of the immune system, which does not allow the virus to multiply, but suppresses and destroys it, preventing the infection from becoming active.

From the moment the molluscum contagiosum virus enters the skin of a healthy person until nodules appear, it takes from 2 weeks to six months. Respectively, incubation period infection ranges from 14 days to 6 months.

After completion of the incubation period, the disease enters the active stage, in which dense protruding nodules spherical or oval in shape and of various sizes - from 1 to 10 mm in diameter. Sometimes nodules merging with each other can form giant plaques up to 3–5 cm in diameter. The nodules of molluscum contagiosum are dense, shiny, pearly white, pink or gray-yellow. Some nodules may have a umbilical-shaped depression in the center, colored red-pink. However, such depressions are usually not present in all nodules, but only in 10–15%. When you press on the nodule with tweezers, a white pasty mass comes out of it, which is a mixture of dead epidermal cells and viral particles.

The nodules slowly increase in size, reaching their maximum size 6 to 12 weeks after appearance. After this, the formations do not grow, but gradually die off, as a result of which they disappear on their own after 3 to 6 months.

The number of rashes can vary - from single nodules to numerous papules. Due to the fact that self-infection is possible, the number of nodules may increase over time, as the person himself spreads the virus throughout the skin.

Typically, molluscum contagiosum nodules are concentrated in one limited area of ​​the skin, and are not scattered throughout the body, for example, in the armpits, abdomen, face, groin, etc. Most often, nodules are localized on the neck, torso, armpits, face and genital area. In rare cases, elements of molluscum contagiosum are localized on the scalp, soles, skin of the lips, tongue, and mucous membrane of the cheeks.

Diagnostics Molluscum contagiosum is not difficult, since the characteristic appearance of the nodules makes it possible to recognize the disease without the use of any additional techniques.

Treatment Molluscum contagiosum is not carried out in all cases, since usually within 6 to 9 months the nodules go away on their own and no longer form. In rare cases, self-healing is delayed for a period of 3 to 4 years. However, if a person wants to get rid of nodules without waiting for self-healing, then the formations are removed in various ways (mechanical scraping with a Volkmann spoon, cauterization with a laser, liquid nitrogen, electric current, etc.). Typically, removal of molluscum contagiosum nodules is recommended for adults so that they do not serve as a source of infection for others. But in the case of illness in children, dermatovenerologists most often recommend not treating the infection, but waiting until the nodules go away on their own, because any procedure for removing formations is stressful for the child.

Molluscum contagiosum – photo

Photo of molluscum contagiosum in children.

Photo of molluscum contagiosum in men.

Photo of molluscum contagiosum in women.

Causes of the disease (molluscum contagiosum virus)

The cause of molluscum contagiosum is a pathogenic microorganism - orthopoxvirus from the family Poxviridae of the genus Molluscipoxvirus. This virus is widespread and affects people of any age and gender, as a result of which the population of all countries suffers from molluscum contagiosum.

There are currently 4 known varieties of orthopoxvirus, which are designated by Latin abbreviations - MCV-1, MCV-2, MCV-3 and MCV-4. The cause of molluscum contagiosum in the countries of the former USSR is most often viruses of the first and second types - MCV-1 and MCV-2. Moreover, in children, molluscum contagiosum is usually provoked by orthopoxvirus type 1 (MCV-1), and in adults by type 2 virus (MCV-2). This situation is due to the fact that type 1 virus is transmitted mainly by contact and indirectly, through shared objects, and type 2 virus is transmitted through sexual contact. However, all types of the virus cause the same clinical manifestations.

Routes of transmission

Molluscum contagiosum is transmitted only from person to person, since animals do not suffer from this infectious disease and are not virus carriers.

Transmission of the molluscum contagiosum virus occurs from a sick person to healthy people through household contact, indirect contact, sexual contact and through water. Contact and household path transmission involves infecting a healthy person through touching the skin of a child or adult suffering from molluscum contagiosum. Accordingly, any tactile contact (for example, hugs, handshakes, pressing close to each other during rush hours on public transport, massage, wrestling, boxing, breastfeeding, etc.) with a person suffering from molluscum contagiosum can lead to infection of any healthy person with this infection, regardless of age and gender.

Indirect contact path transmission of molluscum contagiosum is the most common and involves infecting healthy people through touching common household items on which viral particles remain after they were used by a person suffering from the infection. That is, infection can occur through toys, cutlery, dishes, bedding and underwear, carpets, upholstery, towels, washcloths, razors and any other items that a person suffering from molluscum contagiosum has come into contact with. Due to the possibility of indirect infection in close groups, especially children's, outbreaks of the disease occur occasionally when almost the entire group becomes infected.

Sexual tract transmission of molluscum contagiosum is typical only for adults who have unprotected sexual contact (without a condom). With this route of transmission, the nodules are always located in close proximity or in the genital area.

Waterway transmission can be conditionally classified as indirect contact, since in this case, a person suffering from molluscum contagiosum introduces viral particles into the aquatic environment, which can be “picked up” by any other person in contact with the same water. This route of transmission makes it possible to become infected with molluscum contagiosum when visiting swimming pools, baths, saunas, water attractions, etc.

In addition, a person who already has molluscum contagiosum may autoinfection through friction and scratching of the skin.

Regardless of the route of transmission, the course and clinical manifestations of molluscum contagiosum are always the same.

Not all cases of exposure to the virus will result in infection, as some people are immune to the infection. That is, even if a person who is immune to molluscum contagiosum comes into contact with the virus, he will not become infected and will not develop an infection. All other people become infected and develop clinical signs upon contact with the virus.

The most vulnerable and susceptible to infection with molluscum contagiosum are people with reduced activity of the immune system, such as, for example, HIV-infected people taking glucocorticoid hormones, people over 60 years of age, etc.

Molluscum contagiosum - symptoms

Course of the disease

From the moment of infection with molluscum contagiosum to the first appearance of clinical symptoms, it takes from 2 to 24 weeks. After the incubation period is completed, small dense painless nodules, ranging in size from 1 to 3 mm in diameter, appear on the area of ​​the skin where the molluscum contagiosum virus has been introduced. These nodules slowly increase in size to 2–10 mm in diameter over 6–12 weeks, after which they disappear on their own within 6–12 weeks. In total, from the moment the first nodules appear until they completely disappear, an average of 12 to 18 weeks passes, but in some cases the disease can last much longer - from 2 to 5 years. After recovery from molluscum contagiosum, lifelong immunity is developed, so re-infection occurs only in exceptional cases.

However, until all the nodules on the skin have disappeared, self-infection is possible when scratching or rubbing the affected areas of the skin against healthy ones. In this case, new nodules of molluscum contagiosum appear on the newly infected area of ​​skin, which will also grow within 6–12 weeks, after which they will involute on their own over 12–18 weeks. Accordingly, the approximate period of self-recovery should be calculated by adding 18 months to the date of appearance of the last nodule.

Molluscum contagiosum is a harmless disease that tends to go away on its own, without any special treatment, as soon as your own immune system suppresses the activity of the virus. Rashes, as a rule, do not bother a person, since they do not hurt or itch, but are for the most part only a cosmetic problem. In addition, the virus does not spread through the blood or lymph throughout the body and does not affect other organs and systems, as a result of which molluscum contagiosum is a safe disease, which most often for this reason is recommended not to be treated with special means, but simply to wait until your own immunity is killed the virus and, accordingly, the nodules will not disappear.

However, often people do not want to wait until the nodules of molluscum contagiosum go away on their own, but want to remove them for cosmetic reasons, or so as not to be a source of infection for others. In such cases, you need to be mentally prepared for the fact that after removing the existing nodules, new ones will appear, since solely the process of destroying the rash does not affect the activity of the virus in the thickness of the skin, and until its own immune system suppresses it, the pathogenic microorganism can cause the formation of nodules again and again.

After the spontaneous disappearance of the nodules of molluscum contagiosum, there are no traces left on the skin - scars or scars, and only in rare cases small areas of depigmentation can form. If the nodules of molluscum contagiosum were removed by various methods, then small and inconspicuous scars may form at the site of their localization.

Sometimes the skin around the nodules of molluscum contagiosum becomes inflamed, in which case topical application of antibiotic ointments is necessary. The appearance of a nodule on the eyelid is a problem and an indication for its removal, since the growth of the formation can lead to visual impairment and loss of eyelash hair follicles.

If a person develops molluscum contagiosum nodules in large numbers, in different parts of the body, or are very large in size (more than 10 mm in diameter), this may indicate immunodeficiency. In such cases, it is recommended to contact an immunologist to correct your immune status.

Symptoms of molluscum contagiosum

The main and only symptom of molluscum contagiosum that can be seen with the naked eye is the characteristic nodules protruding above the surface of the skin. Nodules can be localized on any part of the skin, but most often formations form on the face, neck, upper chest, armpits, hands and forearms, lower abdomen, inner thighs, pubis, around the anus and on the skin in genital area. However, despite the wide range of localization options for molluscum contagiosum nodules, as a rule, all formations are always grouped in only one area of ​​the skin. For example, nodules can be located on the neck, face or abdomen, but all formations are grouped in only one area and are absent from other parts of the body. Moreover, usually all nodules of molluscum contagiosum are located on the area of ​​​​the skin into which the infection virus has penetrated. In rare cases, nodules can be randomly located over the entire surface of the body.

The nodules do not appear one at a time and gradually, but almost simultaneously, several formations are formed that begin to grow slowly. As a rule, from 5 to 10 nodules appear, but in some cases their number can reach several dozen.

At the time of appearance, the nodules are small, 1–2 mm in diameter, but within 6–12 weeks they grow to 2–10 mm. Sometimes some elements can grow up to 15 mm in diameter, and usually there are nodules on the skin of different sizes, but of the same appearance. If the formations of molluscum contagiosum are located close to each other, then they can merge, forming one giant tuberous surface up to 5 cm in diameter. Such giant nodes can become inflamed and suppurate, resulting in the formation of crusts and ulcers on their surface.

At any stage of growth, the nodules protrude above the surface of the skin, have a hemispherical shape and slightly flattened on top, smooth edges, dense consistency, and are colored pearl-white or pale pink. Moreover, at the beginning of the disease, the formations have a dome shape, a very dense consistency and a color slightly lighter than the surrounding skin, but over time they become soft, take on the shape of a semicircle, and the color may change to pinkish. Often the nodules may have a waxy sheen. A few weeks after the appearance of the formations, a depression similar to a navel appears in the central part of the formations. When the nodules are squeezed from the sides, a white, pasty mass containing dead epidermal cells and viral particles is released from the umbilical opening.

The nodules have a smooth surface and are slightly different in color from the surrounding skin. The skin around the formations is usually unchanged, but sometimes an inflammatory rim is observed around the perimeter of the nodules. The formations do not bother a person because they do not hurt, do not itch, and, in principle, may not be noticed at all if they are localized in areas of the skin that are usually covered by clothing and are not visible. In rare cases, the nodules may itch occasionally. At these moments, it is very important to restrain yourself and not scratch the formations, since scratching and traumatizing the nodules can lead to subsequent transfer of the virus to other areas of the skin. In such situations, self-infection occurs, and elements of molluscum contagiosum form on another area of ​​the skin into which the virus was introduced. It must be remembered that until the last nodule disappears, molluscum contagiosum remains infectious.

When nodules are localized on the eyelids, molluscum contagiosum can lead to conjunctivitis.

The described clinical picture of molluscum contagiosum is a classic form of infection. However, in addition to this, the disease can occur in the following atypical forms, which differ from the classical morphological characteristics of the nodules:

• Giant form– single nodules measuring 2 cm in diameter or more are formed.
• Pedicular form– large large nodules are formed by the merging of closely located small ones. Moreover, such large nodes are attached to the unchanged skin with a thin stalk, that is, they seem to hang on the skin.
• Generalized form– several dozen nodules are formed, scattered over the entire surface of the skin of the body.
• Miliary form– the nodules are very small, less than 1 mm in diameter, resembling milia in appearance ("grass").
• Ulcerative-cystic form– large nodes are formed by the fusion of several small ones, the surface of which becomes ulcerated or cysts form on it.

Molluscum contagiosum: characteristics of the rash, infection, incubation period, symptoms, quarantine, consequences (opinion of a dermatovenerologist) - video

Molluscum contagiosum in children

About 80% of cases of molluscum contagiosum occur in children under 15 years of age. Thus, it can be said that children are more susceptible to infection compared to adults. Molluscum contagiosum most often affects children aged 1 to 4 years. Until the age of one, children almost never get an infection, because, as scientists suggest, they are protected by maternal antibodies received during fetal development. In addition, children who suffer from eczema, atopic dermatitis, or who are taking glucocorticoid hormones to treat any other condition are known to be at greater risk of infection.

Most often, children become infected with molluscum contagiosum when visiting the pool and while playing those sports that involve close tactile contact and contact of bodies with each other (for example, wrestling, boxing, etc.).

Symptoms and course Molluscum contagiosum in children is exactly the same as in adults. However, due to weak volitional control of their desires, children can often scratch the nodules of molluscum contagiosum and thereby become self-infected, transferring the virus to other areas of the skin, which leads to the constant appearance of new foci of rashes and prolongs the course of the disease. In addition, scratching the nodules can lead to their inflammation and secondary infection, which requires treatment with antibiotics.

In children, nodules can be localized on any part of the body, but most often they are located on the chest, abdomen, arms, legs, armpits, groin area and genitals. The location of formations in the genital area does not necessarily mean that the child became infected during sexual contact. The baby could simply get the molluscum contagiosum virus on his fingers from a sick person, and then scratch the skin in the genital area, as a result of which infection occurred precisely in this area of ​​the skin.

Diagnostics Molluscum contagiosum in children is not difficult, since the nodules have a characteristic appearance. Therefore, a dermatologist will make a diagnosis based on a simple examination of the formations. In some cases, when the dermatologist is in doubt, he may take a biopsy or scraping from the nodule to examine its structure under a microscope.

Treatment Molluscum contagiosum is usually not performed in children, because after 3 months - 4 years all nodules disappear on their own, that is, self-healing occurs as a result of the immune system suppressing the activity of the virus. Therefore, given the fact that molluscum contagiosum heals itself after some time, so as not to cause discomfort to the child, the nodules are not removed. However, in some cases, doctors recommend removing nodules on the skin of children, since they constantly scratch them and become self-infected, as a result of which the disease lasts a very long time. In such situations, the nodules are removed mechanically, by freezing with liquid nitrogen, or using formulations containing wart-removing agents, such as salicylic acid, tretinoin, cantharidin, or benzoyl peroxide.

Despite the availability of various methods for removing molluscum contagiosum nodules, doctors prefer not to use them in children, since all these methods will only help eliminate the formations, but will not prevent their reappearance while the virus in the skin is active and is not suppressed by the child’s own immune system. In addition, any method can lead to the formation of scars, scars, burns or areas of depigmentation at the site of localization of the nodules. And when the nodules go away on their own, scars or cicatrices are never formed at the site of their localization, only sometimes there may be foci of depigmentation.

For the fastest self-healing of molluscum contagiosum in children, the following rules must be followed:

• Do not scratch, rub or injure the nodules;
• Wash your hands frequently with soap;
• Wipe areas of the body with nodules with disinfectant solutions (alcohol, chlorhexidine, etc.) 1–2 times a day;
• If you are going to have contact with other children or people, then to reduce the risk of infecting them, it is recommended to seal the nodules with an adhesive plaster and cover them with clothing;
• Do not shave hair on areas of the body where nodules are located;
• Lubricate dry skin with cream to avoid cracks, ulceration and inflammation of nodules.

Molluscum contagiosum in women

The clinical picture, causative factors, course and principles of treatment of molluscum contagiosum in women do not have any features compared to men or children. Molluscum contagiosum also does not affect the course of pregnancy, the growth and development of the fetus, so women who are carrying a child and become infected do not have to worry about the health of the unborn baby.

Features of the disease in men

Molluscum contagiosum in men, as in women, does not have any obvious features. The only feature that may be a distinctive feature of the infection in men is the possibility of localization of nodules on the skin of the penis, which leads to difficulties in sexual intercourse. In women, molluscum contagiosum never affects the mucous membranes of the vagina, but can only be localized on the skin in the genital area. Of course, this also creates difficulties during sexual intercourse, but not as pronounced as when localizing nodules on the penis.

Features of molluscum contagiosum of various localizations

Molluscum contagiosum on the face. When localizing nodules on the face, it is recommended not to remove them, but to leave them and wait for self-healing, since if the formations disappear on their own, then in their place there will be no traces and scars that create cosmetic defects. If you remove nodules using any modern method, there is a risk of scars and cicatricial formation.

Molluscum contagiosum on the eyelid. If the nodule is localized on the eyelid, it is recommended to remove it, since otherwise it can injure the mucous membrane of the eye and cause conjunctivitis or other more severe eye diseases.

Molluscum contagiosum on the genitals. If the nodules are localized near the genital organs, in the anus or on the penis, then it is better to remove them in any way, without waiting for them to disappear on their own. This tactic is based on the fact that the location of the nodules on the genitals or in the genital area leads to their traumatization during sexual intercourse, which, in turn, provokes infection of the partner and the spread of infection to other areas of the skin. As a result, nodules that appear on the genitals can very quickly spread throughout the body.

Diagnostics

Diagnosis of molluscum contagiosum is not difficult and, as a rule, is made on the basis of examination of characteristic nodules by a dermatologist. In almost all cases, no additional diagnostic methods are required to confirm the diagnosis of molluscum contagiosum.

However, in some rather rare cases, when the doctor has doubts to confirm molluscum contagiosum, additional examinations are carried out. Such additional examinations involve taking a small piece of the nodule and then examining it under a microscope. Microscopy of a nodule biopsy allows one to determine exactly what the nodule is and, accordingly, whether it is a manifestation of molluscum contagiosum or some other disease (for example, keratoacanthoma, syphilis, etc.).

Nodules of molluscum contagiosum must be distinguish from the following externally similar formations, also localized on the skin:

• Flat warts. Such warts, as a rule, are multiple, localized on the face and back of the hands, and are small round-shaped blisters with a smooth surface, colored in the color of the surrounding skin.
• Vulgar warts. As a rule, they are localized on the back of the hand and are dense blisters with an uneven and rough surface. Papules may be scaly and lack a umbilical-shaped depression in the center.
• Keratoacanthomas. They are single convex formations, hemispherical in shape and colored pale red or a shade of normal surrounding skin. Keratoacanthomas are usually located on open areas of the skin and have depressions on the surface that look like small craters, which are filled with horny scales. Horny masses are easily removed from the craters, and their cleaning does not cause bleeding. Attempts to remove the pasty contents of molluscum contagiosum nodules, on the contrary, often lead to bleeding.
• Miliums ("grass"). They are small white dots located in the sebaceous glands of the skin. Milia are formed due to the production of too dense sebum, which does not flow out of the pores, but remains in them and clogs their lumen. These formations are associated with a disorder of fat metabolism and are localized on the face in the form of numerous or single white dots.
• Acne vulgar. They are inflamed conical-shaped papules with a soft consistency, colored pink or bluish-red.
• Scabies. With scabies, small red or flesh-colored papules appear on the skin, arranged as if in lines. Scabies papules itch very much, unlike molluscum contagiosum nodules. In addition, scabies nodules are usually localized in the spaces between the fingers, on the crease of the wrist and under the mammary glands in women.
• Dermatofibromas. They are hard and very dense nodules of various colors that are pressed into the skin when you press on them from the side. Dermatofibromas are never found in groups.
• Basal cell carcinoma. Externally, the formations are very similar to the nodules of molluscum contagiosum; they also have a pearlescent sheen and are raised above the skin. But basal cell carcinoma is always single; these formations are never located in groups.

Which doctor should I contact for molluscum contagiosum?

If molluscum contagiosum develops, you should contact Dermatologist (make an appointment), which diagnoses and treats this disease. If the dermatologist is unable to perform any necessary removal procedures, he will refer the patient to another specialist, e.g. surgeon (make an appointment), physiotherapist (make an appointment) etc.

Molluscum contagiosum - treatment

General principles of therapy

Currently, molluscum contagiosum, unless the nodules are localized on the eyelids or in the genital area, is recommended not to be treated at all, since after 3 to 18 months the immune system will be able to suppress the activity of the orthopoxvirus, and all formations will disappear on their own, leaving no traces on the skin. or traces (scars, scars, etc.). The fact is that immunity to the molluscum contagiosum virus is developed, but this happens slowly, so the body needs not a week to heal itself from the infection, as in the case of ARVI, but several months or even up to 2 - 5 years. And if you remove the nodules of molluscum contagiosum before they disappear on their own, then, firstly, you can leave scars on the skin, and secondly, this increases the risk of their reappearance, and in even larger quantities, since the virus is still active. Therefore, given that self-healing always occurs, and it is only a matter of time, doctors recommend not treating molluscum contagiosum by removing the nodules, but simply waiting a little until they disappear on their own.

The only situations when it is still recommended to remove nodules of molluscum contagiosum are their localization on the genitals or eyelids, as well as severe discomfort caused by the formation to a person. In other cases, it is better to leave the nodules and wait for them to disappear on their own after the activity of the virus is suppressed by the immune system.

However, if a person wants to remove the nodules, then this is done. Moreover, the reason for such a desire, as a rule, is aesthetic considerations.

For the removal of molluscum contagiosum nodules, the following surgical methods have been officially approved by the Ministries of Health of the CIS countries:

• Curettage (scraping out nodules with a curette or Volkmann spoon);
• Cryodestruction (destruction of nodules with liquid nitrogen);
• Husking (removing the core of nodules with thin tweezers);
• Laser destruction (destruction of nodules with CO 2 laser);
• Electrocoagulation (destruction of nodules by electric current - “cauterization”).

Such chemical methods for removing shellfish cannot be called traditional methods, since they involve the use of medications, as a result of which they are considered to be unofficial, practice-tested methods, but not approved by the Ministries of Health. Since these methods, according to reviews from doctors and patients, are quite effective and less traumatic compared to surgical methods for removing molluscum contagiosum nodules, we will also consider them in the subsection below.

Removal of molluscum contagiosum

Let's consider the characteristics of surgical and informal conservative methods of removing molluscum contagiosum. But first, we consider it necessary to point out that any surgical methods for removing nodules are quite painful, as a result of which it is recommended to use local anesthetics for manipulation. EMLA ointment 5% provides the best pain relief to the skin. Other anesthetics, such as lidocaine, novocaine and others, are ineffective.

Laser removal of molluscum contagiosum. The nodules are targeted with a beam of a CO 2 laser or pulsed laser. To destroy formations, it is optimal to set the following parameters of the laser beam: wavelength 585 nm, frequency 0.5 - 1 Hz, spot diameter 3 - 7 mm, energy density 2 - 8 J/cm 2, pulse duration 250 - 450 ms. During the procedure, each nodule is irradiated with a laser, after which the skin is treated with a 5% alcohol solution of iodine. If, after a week after the procedure, the nodules have not crusted over and fallen off, then another session of laser irradiation of the formations is performed.

These methods are unsuitable for removing nodules for cosmetic reasons, since as a result of curettage or peeling, sinking scars may form at the site of the formations.

Ointment for molluscum contagiosum - removal of nodules with chemicals. To remove nodules of molluscum contagiosum, they can be lubricated regularly, 1-2 times a day, with ointments and solutions containing the following substances:

• Tretinoin (Vesanoid, Lokacid, Retin-A, Tretinoin) - ointments are applied to the nodules pointwise 1 - 2 times a day for 6 hours, after which they are washed off with water. The nodules are lubricated until they disappear;
• Cantharidin (Spanish fly or homeopathic preparations) - ointments are applied to the nodules pointwise 1 - 2 times a day until the formations disappear;
• Trichloroacetic acid - a 3% solution is applied pointwise once a day to the nodules for 30 - 40 minutes, after which it is washed off;
• Salicylic acid – 3% solution is applied 2 times a day to the nodules without rinsing off;
• Imiquimod (Aldara) – cream is applied to the nodules pointwise 3 times a day;
• Podophyllotoxin (Vartek, Condilin) ​​- cream is applied pointwise to the nodules 2 times a day;
• Fluorouracil ointment - applied to the nodules 2 - 3 times a day;
• Oxolinic ointment - applied pointwise to the nodules 2 - 3 times a day in a thick layer;
• Chlorophyllipt - the solution is applied pointwise to the nodules 2 - 3 times a day;
• Benzoyl peroxide (Baziron AS, Ekloran, Indoxyl, Effezel, etc.) - ointments and creams are applied pointwise to the nodules in a thick layer 2 times a day;
• Interferons (Infagel, Acyclovir) - ointments and creams are applied to the nodules 2 - 3 times a day.

Molluscum contagiosum: removal of papules by curettage, laser, Surgitron, liquid nitrogen (advice from a dermatologist) - video

Molluscum contagiosum, treatment with antiviral drugs and immunomodulators: Acyclovir, Isoprinosine, Viferon, Allomedine, Betadine, Oxolinic ointment, iodine - video

Treatment of molluscum contagiosum in children

Treatment of molluscum contagiosum in children is carried out using the same methods as in adults, and in compliance with the general principles of therapy. That is, the optimal treatment for molluscum contagiosum in children is no treatment and simply waiting for the body itself to suppress the activity of the virus, and all the nodules simply disappear without a trace. But if your child scratches the nodules or they cause him discomfort, then it is recommended to try removing them at home with various ointments and solutions containing ingredients to eliminate warts (for example, salicylic acid, tretinoin, cantharidin or benzoyl peroxide). These solutions are applied pointwise to the nodules of molluscum contagiosum 1 - 2 times a day until they disappear.

Parents report the effectiveness of Oxolinic ointment for removing molluscum nodules in children, so you can use this recommendation. So, parents recommend applying a thick layer of ointment to the nodules 1-2 times a day until they disappear completely. In this case, at first, under the influence of the ointment, the nodules may turn red and become inflamed, but there is no need to be afraid of this, since after 1 - 2 days the formations will crust over and begin to dry out.

If a decision is made to remove nodules from a child using any surgical method, then this should be done only with the use of adequate anesthesia. EMLA cream 5%, produced by AstraZeneka, Sweden, best anesthetizes the skin and, accordingly, is optimally suited for use as an anesthetic during surgical removal of molluscum contagiosum nodules. For adequate pain relief, the cream is applied to the skin in the area where the nodules are localized, covered with the occlusive film that comes with the drug, and left for 50–60 minutes. After an hour, the film is removed, the remaining cream is removed with a sterile cotton swab, and only after that an operation is performed to remove the nodules of molluscum contagiosum.

When using EMLA cream, a good level of pain relief is achieved, as a result of which the child does not feel pain and, accordingly, does not receive additional stress.

Molluscum contagiosum: causes, treatment, diagnosis and prevention. Relieving itching, inflammation and redness - video

Treatment at home

The best way to treat molluscum contagiosum at home is either pharmaceutical preparations or various folk remedies made independently from medicinal herbs, which are applied to the nodules and contribute to their disappearance.

Thus, the most effective among traditional methods for treating molluscum contagiosum at home are the following:

• Garlic lotions. Fresh garlic cloves are crushed to a paste, butter is added in a ratio of 1:1 (by volume) and mixed well. The finished composition is applied pointwise to the nodules in a thick layer, fixed with a plaster or bandage and the lotion is replaced with a fresh one 2 - 3 times a day. Such applications are applied to the nodules of molluscum contagiosum until they completely disappear.
• Garlic juice. Garlic cloves are passed through a meat grinder, the prepared pulp is placed on cheesecloth and the juice is squeezed out. Rub the nodules with fresh garlic juice 5-6 times a day until they disappear completely.
• Infusion of succession. Pour two tablespoons of dry herb into 250 ml of boiling water (one glass), bring the water to a boil again, remove from heat and leave for an hour in a warm place. With the prepared infusion, wipe the area of ​​skin where the nodules of molluscum contagiosum are localized 3-4 times a day until the formations disappear.
• Tincture of calendula. A pharmaceutical alcohol tincture of calendula is used to wipe the skin areas covered with nodules of molluscum contagiosum 3-4 times a day until the formations completely disappear.
• Bird cherry juice. Fresh bird cherry leaves are washed with water and passed through a meat grinder. The resulting pulp is spread on cheesecloth and the juice is squeezed out of the leaves. The juice of bird cherry leaves is mixed with butter in a volume ratio of 1:1 and the resulting ointment is applied to the nodules overnight.

Molluscum contagiosum - treatment with folk remedies: iodine, celandine, fucorcin, tar, calendula tincture - video

Currently the number of people infected molluscum contagiosum, is growing steadily. Doctors highlight several objective and subjective factors that contribute to the spread of the virus, among them :
- large overcrowding of the population in cities and megalopolises;
- deterioration of the environmental situation for many people;
- an increase in the number of HIV-infected and AIDS patients who are often infected with molluscum contagiosum and are its carriers;
- increase in the number of sexual partners throughout life.

If we briefly dwell on each of the listed points, we can note the following points. Molluscum contagiosum, as a viral disease, is easier to catch through daily contact with a large number of people, some of whom may be infected with the virus. Previously, molluscum contagiosum was more often diagnosed in children, who were more susceptible to infection with the virus due to an insufficiently developed immune system. Nowadays, for various reasons, the immune system can also be weakened in adults; infection in them is also easier.

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Spontaneous disappearance of external manifestations of the disease is most often observed after 6 months; a high risk of relapses persists for up to 9 months. However, even after a complete “cure”, it is impossible to guarantee the absence of a possible relapse of molluscum contagiosum: the virus remains in the human body for life. Stress, exacerbation of chronic diseases, and those suffered can “wake him up” and provoke another relapse.

The routes of infection with molluscum contagiosum can be as follows: :
-contact, including during sexual intercourse. In this case, there is direct transmission of the virus from person to person.
-domestic. The virus can be transmitted through various objects touched by a sick person; you can become infected not only from a sick person in the house, but also in the swimming pool, public transport, gym, etc..
Dermatologists tend to classify outbreaks of molluscum contagiosum in kindergartens and schools. Usually there is a mixed type of infection, contact-household, which can ultimately lead to illness in a large number of children.

The source of infection can be determined at the initial stage of the disease. So, when infected during intimacy, the rash will initially be localized in the groin, genitals, lower abdomen or inner thighs. When infected in a household way the rash most often appears on the hands

The incubation period for infection with molluscum contagiosum can last from several weeks to two months. The course of the disease includes two stages .

First stage: single, few hemispherical rashes with a dent in the middle appear on the skin, each the size of a millet grain. The rash has a flesh-colored or slightly more pinkish color, the shell is quite hard, when pressed, a whitish curdled mass is released, the patient complains of itching.

Ultimately, usually after about six months, the body copes with the virus itself and the external signs of the disease disappear.

There is no specific treatment for molluscum contagiosum. After final confirmation of the diagnosis based on the clinical picture of the disease and laboratory tests of the contents of the vesicles, the doctor usually tries to determine the source of infection and, if possible, limit the patient’s contact with other people. The patient is advised to strictly adhere to personal hygiene rules, stick to special vegetable-dairy diet with limitation fatty, salty and sweet. In addition to vegetables and fruits rich in vitamins, it is recommended to take complex multivitamin preparations. In case of bacterial infection, rashes are prescribed antibiotics. In severe cases of the disease, with multiple rashes and significant weakening of the immune system, they can be used antiviral drugs local and general action (most often based on Acyclovir), as well as various immunomodulators.

Self-medication in the case of molluscum contagiosum is strictly prohibited : in addition to the fact that its skin manifestations can easily be confused with other diseases (in particular, with neoplasms on the skin), in some cases the appearance of this infection may be associated with HIV infection and AIDS.

ethnoscience To reduce itching with molluscum contagiosum, he recommends lotions from infusion of succession or calendula. You can also wipe the affected areas alcohol tincture of calendula, Rotokan(calendula + chamomile) – these preparations additionally dry and disinfect well.

Preventive measures aimed at preventing infection with molluscum contagiosum are quite simple.:
- strictly observe the rules of personal hygiene, be sure to teach this to your children;
- upon returning home, wash your hands immediately, especially after traveling on public transport, going to stores, or visiting public places;
- never use other people’s washcloths and combs, do not let strangers “wear” your things;
- after a swimming pool, bath or sauna, be sure to take a shower and monitor the condition of your skin;
- strengthen your immune system - include more seasonal fresh vegetables and fruits in your diet, spend more time outdoors;
- be selective when choosing sexual partners;
- if there is a sick person in the house, change his bed and underwear daily (washing + disinfection is necessary, at least by boiling), wipe your hands often with disinfectant solutions.

Good health to everyone!

– a chronic highly contagious skin disease, the causative agent of molluscum contagiosum is part of the smallpox group of viruses – Molluscipoxvirus. According to the international classification of diseases, molluscum contagiosum does not belong to venereological diseases, however, WHO includes molluscum contagiosum in the list of sexually transmitted infections. Persons of both sexes are susceptible to infection, regardless of age groups, but people who are promiscuous in sexual contacts and children are at risk.

Pathogenesis of molluscum contagiosum

Molluscum contagiosum is a benign skin tumor; DNA virus synthesis occurs in the keratinocytes of the epidermis; after the virus multiplies in the host cells, the activity of T-lymphocytes is blocked, and therefore immune cells are absent when damaged, which explains immune tolerance, which favors the pathogen during infection.

Routes of infection and pathogenesis of molluscum contagiosum

Molluscum contagiosum is a disease that affects only humans. Infection occurs through direct contact of a sick person with a healthy person, but there is an indirect route of infection - through contaminated objects.

Adults are mainly infected with molluscum contagiosum through sexual contact; infection occurs through contact of the skin of partners, and not through coitus, which is why some international medical organizations do not classify molluscum contagiosum as a sexually transmitted infection. The affected area during sexual intercourse is usually the perineum, inner thighs, lower abdomen, and external genitalia.

When infected through domestic means, there is no specific localization of molluscum contagiosum; neoplasms can be found on any area of ​​the skin. The presence of damage and microtrauma to the skin is a favorable condition for inoculation of the virus. Cases of infection are usually isolated, despite the highly contagious nature of the mollusk, but in kindergartens the lesions can be endemic.

Factors such as crowding, skin contact, and humid atmosphere favor dissemination. The incubation period for molluscum contagiosum ranges from several weeks to several months, so it can be difficult to determine the source of infection. After the appearance of clinical manifestations, molluscum contagiosum spreads throughout the body through self-infection. Cellular immune deficiencies, congenital and acquired, contribute to infection; in people with HIV infection, the incidence of molluscum contagiosum is several times higher.

Since the causative agent of molluscum contagiosum is a DNA virus, it is impossible to achieve a complete cure, however, modern methods of treatment make it possible to achieve long-term and stable remission.

Clinical manifestations of molluscum contagiosum

After the incubation period, single, painless, dense, round-shaped nodules appear on the skin; the color of the skin affected by molluscum contagiosum is usually unchanged or acquires a pink tint; sometimes a waxy or pearlescent sheen may be noted. Next, the number of elements of molluscum contagiosum increases due to self-infection. The sizes of the rashes range from millet grains to peas; sometimes, when the elements merge, giant molluscum contagiosum can form; they look like hemispherical papules with a sunken central part.

The nodules are located everywhere on the body, but since at the second stage of development of molluscum contagiosum self-infection occurs through the hands, the areas of the skin that are most often touched are affected. This is the face, neck, upper torso and the hands themselves. Molluscum contagiosum rashes are chaotic, and their number sometimes reaches several hundred; rubbing of hands and involuntary scratching increase the number of disseminations.

When pressed with tweezers or accidentally damaged by molluscum contagiosum, a white mushy mass is released from it, which consists of keratinized cells and lymphocytes. But it also contains inclusions of mollusc-shaped bodies, which is how the disease got its name. There are no subjective sensations, but some patients with molluscum contagiosum note itching and slight infiltration, which occurs when a secondary infection occurs.

With atypical forms of molluscum contagiosum, the characteristic concave center on the rash may not be, and the elements themselves may be very small in size. Profuse forms of molluscum contagiosum are diagnosed in children with atopic dermatitis, in children with leukemia and immunodeficiencies, as well as in HIV-positive patients. As a rule, the course of molluscum contagiosum passes without complications; aseptic and purulent abscesses of the skin around the affected area are possible. In very rare cases, superinfection occurs, which leaves scars.

Diagnosis of molluscum contagiosum

Treatment of molluscum contagiosum

Surgical removal using curettage after preliminary local anesthesia under a film gives a good effect, since a large number of molluscum contagiosum can be removed in one session due to the almost complete absence of pain during the procedure. Usually one session is performed per month, and complete clinical recovery occurs within a few months. With this method of treatment, no nodule contents remain, trauma to the skin is minimal, and after curettage, in some cases, electrocoagulation of the affected areas is indicated.

Removal of skin formations of molluscum contagiosum is possible by cryodestruction or radio wave method. Laser removal is also used. If there are few molluscum contagiosum rashes, then chemotherapy drugs have a good effect, but long-term use is not recommended due to their irritating effect on the skin. With minor dissemination, UV irradiation of the affected skin with therapeutic ultraviolet light and the use of creams with acyclovir are indicated for all patients with molluscum contagiosum.

The method of applying Tuberculin to the area affected by molluscum contagiosum is especially often used in pediatric dermatology, as it is painless. This technique is new, and therefore there are no accurate statistical data on its effectiveness. But children must be previously vaccinated with BCG or isoprinosine.

Prevention and prognosis

In most cases, the prognosis for infection with molluscum contagiosum is favorable, with the exception of patients with immunodeficiency conditions. Prevention consists of maintaining personal hygiene both in public places and at home. It is necessary that each family member has his own washcloth and other bath accessories. When molluscum contagiosum is diagnosed in children, infected children are isolated and quarantined for the duration of the incubation period with a daily preventive examination of the entire children's team and service personnel.

Molluscum contagiosum is an infectious disease characterized by the appearance of small, dense, slightly shiny erythematous nodules in the lower abdomen, on the genitals, pubis, and inner thighs.

The infection is caused by a virus. The virus spreads easily through contact but is virtually harmless.

Symptoms of molluscum contagiosum

The rash usually has a circular depression in the center (see photo). They are slightly smaller than the eraser on the end of a pencil. The rash is painless. They can appear alone or in groups. They most often appear on the torso, face, eyelids, or genital area. The rash may become inflamed and red.

People who have a weakened immune system may have dozens of large rashes up to 1.5 cm in size. In this case, special treatment will likely be required.

Typically within 6-12 months molluscum contagiosum disappears on its own without leaving any traces. In rare cases, the self-healing process can take up to 4 years.

Spread of Molluscum Contagiosum

Adults most often become infected through sexual contact. However, it is also possible to become infected during contact sports where there is close skin-to-skin contact. Small children attending kindergartens and schools are also often infected through contact.

Virus molluscum contagiosum can survive on surfaces that have been touched by the skin of an infected person. This could include towels, clothing, toys, sports equipment, or other items that have been contaminated.

A person can spread the infection to other parts of his body by touching them.

Diagnostics molluscum contagiosum

Due to the fact that skin manifestations are very characteristic of molluscum contagiosum, Diagnosis is most often limited to a doctor’s examination. A skin scraping or biopsy can confirm the diagnosis.

Risk factors for molluscum contagiosum

• children aged 1 to 10 years
• inhabitants of tropical climates
• people with a weakened immune system caused by factors such as HIV, organ transplants, or cancer treatment
• patients who have atopic dermatitis, eczema, and other skin diseases that reduce the barrier functions of the skin
• athletes who participate in contact sports such as wrestling or football

Complications of molluscum contagiosum

Complications molluscum contagiosum are rare. These are mainly secondary skin infections. These infections are caused by bacteria and can result in soreness and redness.

Removing elements of molluscum contagiosum can lead to the formation of scars. This should only be done in extreme cases.

Treatment of molluscum contagiosum

Medical and surgical treatments are available, but in most cases, no treatment is required. The virus may be more difficult to treat if the patient is immunocompromised.

In some situations, treatment may be justified. If the lesions are located on the face and neck, if there are concomitant skin diseases such as atopic dermatitis, treatment may be needed.

The most effective treatments molluscum contagiosum include:

• cryotherapy - liquid nitrogen is used to freeze every stroke
• curettage - removal of rashes using a special surgical instrument
• laser therapy
• local therapy with creams containing acids or exfoliants

In some cases, these methods can be painful and lead to scarring. Anesthesia may also be necessary.

The patient ate a large number of elements molluscum contagiosum, repeated courses of treatment may be needed every 3-6 weeks until the symptoms disappear.

Below is a list of those used for treatment molluscum contagiosum drugs:

• trichloroacetic acid
• podophyllotoxin
• cantharidin
• imiquimod
• cimetidine
• cidofovir

If there are problems with the immune system, such as HIV infection, antiretroviral (anti-HIV) drugs are used, which are also effective against molluscum contagiosum in these patients.

How to prevent the spread of molluscum contagiosum

The best way is to avoid molluscum contagiosum- Avoid touching the skin of another person who has an infection. Here are some useful tips for preventing infection:

• Practice effective hand washing with warm water and soap.
• Teach children proper hand washing techniques
• Avoid sharing personal items such as towels, clothes, hair brushes, soap
• Avoid using shared sports equipment
• Avoid touching another person's skin if they have symptoms molluscum contagiosum A
• If there molluscum contagiosum it is necessary to cover the lesions with adhesive tape so as not to infect other people
• Avoid shaving or epilating the areas where the elements are located molluscum contagiosum
• Avoid sexual contact if infected molluscum contagiosum

Among the many skin diseases, there are a number of pathologies related to markers of HIV infection, which allow the clinician to suspect it and offer the patient to undergo additional examination to determine the true cause of the disease.

According to the order of the Ministry of Health No. 446 of 07/06/2006 “On the approval of the Instructions on the implementation of the procedure for voluntary consultation and testing for HIV infection (protocol) for anti-tuberculosis, dermatovenerological and drug addiction patients about bury your health”, to skin diseases for which testing for HIV infection is advisable include the following nosological units :
dermatophytosis affecting the scalp, beard growth area, common skin lesions in adults;
dermatophytosis of the feet and hands (eczematized forms) in patients of different ages;
deep dermatophytosis;
Kaposi's sarcoma;
viral warts;
molluscum contagiosum;
pyogenic granuloma;
seizure due to candidiasis;
seizure due to lack of riboflavin;
lupus;
dermatitis;
folliculitis;
onychomycosis.

Molluscum contagiosum is a benign viral disease characterized by rashes on the skin and mucous membranes in the form of hemispherical nodules the size of a pinhead to a pea with a central umbilical depression.

The disease was first described in 1817 (Beterman), and its infectious nature was proven in 1841 (Paterson).

Etiology

The disease is caused by a DNA-containing molluscum contagiosum virus (molluscum contagiosum virus). According to modern concepts, the virus belongs to the family Poxviridae(from the English pox - pustule, pockmark), subfamily Chordopoxvirinae, genus Molluscipoxvirus.

Biology

The poxvirus virion is either brick-shaped with an outer lipid membrane or oval-shaped. The poxvirus genome consists of double-stranded DNA, the ends of which are closed by covalent bonds. The mass of the virion is about 5x10 -15 g.

Epidemiology

Viruses Chordopoxvirinae spread by aerosol and contact, as well as mechanically - by arthropods. All known human poxviruses, except molluscum contagiosum and smallpox viruses, are classified as anthropozoonoses. The source of infection with molluscum contagiosum is a patient or a carrier. Human infection occurs through direct contact, as well as through contaminated household items (bed, washcloth, towel). Molluscum contagiosum occurs at any age, but children are more often affected; Epidemic outbreaks are sometimes observed in children's groups.

Pathogenesis

The process of interaction between the virus and the cell goes through several stages. At the first stage, the virus, through its specialized receptor proteins, attaches to certain structures of the cell surface, resulting in the fusion of the viral and cellular membranes. At the next stage, the virus passes through the cell membrane, is freed from its own envelope, and the viral DNA enters the cytoplasm, where transcription and replication of the viral genome occurs.

Clinic

The incubation period lasts from 2 weeks to several months. Single or multiple hemispherical nodules, ranging in size from 0.2 to 1.0–1.5 cm, appear on the skin, the color of normal skin or pale pink, dense consistency, painless. The surface of the nodules is smooth; in the center there may be an umbilical depression with a small hole. When you press on the nodule, a mushy mass containing mollusc bodies is released. The location of molluscum contagiosum can be different, but most often it occurs on the neck, face, and torso. There are no subjective sensations. The disease is often reported in HIV-infected people.

Features of the course of HIV infection

According to the Department of Dermatology and Venereology of the Goethe University Hospital, Frankfurt am Main, the incidence of molluscum contagiosum was 13% of the total number of skin diseases among HIV-infected people who visited the clinic between 1982 and 2000. According to other authors, molluscum contagiosum occurs in 10–20% of HIV-infected patients.

The infection may occur in an atypical manner. Elements of the rash are found on the genitals and in the perianal area. Spontaneous resolution of the rash is rare; Many patients have a large number of rash elements, typically affecting the face and neck.

Multiple elements of molluscum contagiosum should be differentiated from hematogenous dissemination of infections such as:

• cryptococcosis;
• histoplasmosis;
• coccidioidosis.

The listed conditions occur with symptoms of general intoxication, which is accompanied by fever, headache, weakness, malaise, and sometimes infiltrates in the lungs. In this situation, it is necessary to perform a biopsy followed by a culture test to identify the pathogen, as well as a chest x-ray.

Single elements of molluscum contagiosum with a diameter of more than 1 cm and exophytic growth need to be differentiated from the following diseases:

• keratoacanthomas;
• squamous cell and basal cell skin cancer;
• simple wart.

Keratoacanthoma has a grayish-pink color; in the central part of the tumor there are dense dark gray horny masses surrounded by a ridge.

Basal cell skin cancer It is a pale pink nodule that increases in size to 3 cm or more. The surface of the tumor may be smooth, but the central part may ulcerate with the formation of bloody crusts.

Squamous cell carcinoma manifests itself in the form of a single tumor, which quickly grows deeper and gradually ulcerates to form a deep, painful ulcer with dense edges.

Wart It is distinguished by an uneven, rough or papillary surface covered with hyperkeratotic masses, as well as the absence of an umbilical depression on the surface of the nodule.

For the period 2007–2008 At an outpatient clinic, as well as during consultations in the inpatient department, the author identified 7 people with clinical manifestations of molluscum contagiosum.

Clinical cases

Patient D. Born in 1979, he consulted a dermatovenerologist with complaints of the presence of rashes on the outer layer of the foreskin, the skin of the shaft of the penis, and in the groin area (Fig. 1).

From the anamnesis: considers himself sick for about 6 months. Used drugs. HIV infection was first identified in 2005.

The clinical picture is represented by multiple round pink nodules (about 20 pieces) with an umbilical depression, dense consistency, merging with each other in places.

Survey results

General blood analysis: erythrocytes - 3.86x10 12 /l, leukocytes - 4.55x10 9 /l, hemoglobin - 134 g/l, hematocrit - 38.4%, neutrophils - 40.3%, lymphocytes - 47%, monocytes - 9.34% , eosinophils – 2.69%, basophils – 0.69%, platelets – 259x10 9 /l.

Blood chemistry: ALT – 27 U/l, AST – 44 U/l, urea – 5.0 mmol/l, creatinine – 0.087 mmol/l, total protein – 78 g/l, albumin – 48 g/l, thymol test – 20, 1 unit, total bilirubin – 14 µmol/l, direct bilirubin – 2 µmol/l, blood glucose – 4.9 mmol/l.

T-lymphocytes – 1810 cells/µl (N=946–2079 cells/µl), T-helpers – 220 cells/µl (N=500–1336 cells/µl); T-suppressors – 1345 cells/μl (N=372–974 cells/μl).

- the result is negative.

Patient S., Born in 1982, who was undergoing inpatient treatment in a department for HIV-infected people, he consulted a dermatovenerologist with complaints of rashes on the skin of his face.

From the anamnesis: considers himself sick for 1.5 years. Used drugs. HIV infection was first identified in 2008.

The pathological process is localized on the skin of the left half of the face and is represented by multiple papular flesh-colored elements of a hemispherical shape, merging into a single conglomerate in the area of ​​the lower and upper eyelid of the left eye. An umbilical depression is clearly visible on many elements (Fig. 2).

Survey results

General blood analysis: erythrocytes - 3.79x10 12 /l, leukocytes - 4.60x10 9 /l, hemoglobin - 109 g/l, hematocrit - 31.2%, neutrophils - 59.7%, lymphocytes - 25.7%, monocytes - 11, 5%, eosinophils – 1.68%, basophils – 1.24%, platelets – 159x10 9 /l, ESR – 30 mm/h.

Blood chemistry: ALT – 28 U/l, AST – 80 U/l, urea – 5.4 mmol/l, creatinine – 0.056 mmol/l, total protein – 72 g/l, albumin – 37 g/l, thymol test – 15, 9 units, total bilirubin – 9 µmol/l, direct bilirubin – 4 µmol/l, blood glucose – 5.4 mmol/l.

Determination of the content of T-lymphocytes in the blood: T-lymphocytes – 1110 cells/μl; T-helpers – 31 cells/μl; T-suppressors – 560 cells/µl.

Express diagnosis of syphilis with cardiolipin antigen - the result is negative.

Patient V. was in the intensive care ward of the department for HIV-infected people. It was not possible to take an anamnesis because the patient was unconscious. Some time later the patient died.

The skin process is localized on the chest. Elements of the rash are represented by isolated, light-brown, hemispherical papules of varying diameters (Fig. 3).

Survey results

General blood analysis: erythrocytes - 4.19x10 12 /l, leukocytes - 20x10 9 /l, hemoglobin - 147 g/l, hematocrit - 42.8%, neutrophils - 90.2%, lymphocytes - 5.21%, monocytes - 3.98% , eosinophils – 0.4%, basophils – 0.12%, platelets – 186x10 9 /l; ESR – 20 mm/h.

Blood chemistry: ALT – 95 U/l, AST – 72 U/l, urea – 25.9 mmol/l, creatinine – 0.208 mmol/l, total protein – 55 g/l, albumin – 27 g/l, thymol test – 0, 3 units, total bilirubin – 35 µmol/l, direct bilirubin – 11 µmol/l, blood glucose – 5.5 mmol/l.

Determination of the content of T-lymphocytes in the blood: T-lymphocytes – 615 cells/μl; T-helpers – 81 cells/μl; T-suppressors – 513 cells/µl.

Study for hepatitis markers: HBsAg – negative result, HCV – positive (total antibodies to hepatitis C were detected).

Serological testing for HIV opportunistic infections (blood testing using PCR): antigen Toxoplasma gondii– result negative, cytomegalovirus (CMV) antigen – negative, HSV 1/2 antigen – negative, antigen Mycobacterium tuberculosis– negative.

Express diagnosis of syphilis with cardiolipin antigen - the result is negative.

Patient A., Born in 1974, he consulted a dermatovenerologist about a rash on the tip of the nose.

From the anamnesis: considers himself sick for 7–8 months. Didn't use drugs. HIV infection was first identified in 2008.

The pathological process is localized on the skin of the wings of the nose, the right upper eyelid, and the forehead. Elements of the rash are represented by separately located flesh-colored papules ranging in size from 3 to 8 mm, in the center of which there is an umbilical depression (Fig. 4, 5).

Survey results

General blood analysis: erythrocytes - 2.61x10 12 /l, leukocytes - 9.18x10 9 /l, hemoglobin - 85.5 g/l, hematocrit - 24.3%, neutrophils - 88.9%, lymphocytes - 5.13%, monocytes - 5.39%, eosinophils – 0.3%, basophils – 0.29%, platelets – 210x10 9 /l, ESR – 52 mm/h.

Blood chemistry: ALT – 32 U/l, AST – 44 U/l, urea – 13.1 mmol/l, creatinine – 0.241 mmol/l, total protein – 71 g/l, albumin – 20 g/l, thymol test – 20, 1 unit, total bilirubin – 9 µmol/l, direct bilirubin – 2 µmol/l, blood glucose – 4.5 mmol/l.

Determination of the content of T-lymphocytes in the blood: T-lymphocytes – 337 cells/µl; T-helpers – 14 cells/μl; T-suppressors – 285 cells/µl.

Study for hepatitis markers: HBsAg – negative result, HCV – negative (antibodies to hepatitis C were not detected).

Serological study for HIV opportunistic infections: IgM antibodies to T. gondii– the result is negative, IgG antibodies to T. gondii– negative; IgM antibodies to CMV – negative, IgG antibodies to CMV – 122 DU; IgM antibodies to HSV 1/2 – negative, IgG antibodies to HSV 1/2 – 102 DU; IgG antibodies to Chlamydia trachomatis– negative, IgA antibodies to C. trachomatis– negative.

Express diagnosis of syphilis with cardiolipin antigen - the result is negative.

Discussion

Obviously, the diagnosis of “molluscum contagiosum” does not cause difficulties, since it has a fairly clear clinical picture. Additional laboratory and instrumental tests are not performed to establish a diagnosis, so the author did not compare laboratory indicators of blood glucose levels, clinical blood tests (except for the number of lymphocytes), and biochemical blood parameters. They do not play any role in the pathogenetic aspects of this pathology.

The table shows that in 5 out of 7 cases the content of T-helper cells in the blood was<100 клеток/мкл. В этой подгруппе у 5 пациентов из 5 высыпания локализовались на коже лица, что совпадает с данными других авторов, касающимися зависимости расположения элементов высыпаний от количества Т-лимфоцитов, однако у одного пациента уровень Т-хелперов был >100 cells/µl (number of T-helpers – 171 cells/µl). In 2 patients, rashes were noted on other areas of the skin: on the genitals (the number of T-helper cells - 220 cells/μl), on the skin of the chest (the number of T-helper cells - 81 cells/μl).

Treatment

The following methods are used to treat molluscum contagiosum:

• surgical removal with special tweezers;
• electrocoagulation;
• scraping;
• cryodestruction;
• laser removal.

When treating patients diagnosed with Molluscum Contagiosum, the author uses a high-frequency electrosurgical device EHVA - 350M/120B "Nadiya-2" in the "cutting" mode, power 120 W, to remove elements of the rash. To prevent secondary infection, the wound surface is treated with a 0.1% desmistin solution. In order to improve the repair of erosive areas after surgery, it is recommended to topically lubricate the lesions with Pantestin-Darnitsa gel, methyluracil ointment with miramistin, jelly or solcoseryl ointment. Observations of patients suggest that healing of skin areas at the surgical site occurred without the formation of scars.

conclusions

If there are manifestations of molluscum contagiosum, the patient should be offered an examination for HIV infection, but it must be remembered that, according to the current legislation of Ukraine, this examination is strictly voluntary, and can also be anonymous and confidential. If the patient agrees to testing, he fills out the appropriate form.

The use of the EHVA 350M/120B Nadiya-2 device is an effective method of surgical treatment of patients with this pathology.

Literature

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