List of Abbreviations
HIV – human immunodeficiency virus
DNA – deoxyribonucleic acid
ICD – International Classification of Diseases
MCV – molluscum contagiosum virus
Terms and Definitions
Molluscum contagiosum is a viral skin disease characterized by the appearance on the skin, and less frequently on mucous membranes, of hemispherical papules ranging from the size of a pinhead to a pea, with a central umbilication.
Autoinoculation is the transfer of inoculated material from one area of the skin or mucosa to another.
Cryotherapy is the application of liquid nitrogen to remove pathological lesions.
Laser therapy is the removal of pathological lesions using a CO2 laser or pulsed dye laser.
Evisceration (shelling out) is the mechanical removal of pathological lesions using fine forceps.
1. Brief information on the disease or condition
1.1 Definition of the disease or condition
Molluscum contagiosum is a benign viral skin disease characterized by the appearance on the skin, and less frequently on mucous membranes, of hemispherical papules ranging from the size of a pinhead to a pea, with a central umbilication.
1.2 Etiology and pathogenesis of the disease or condition (group of diseases or conditions)
The disease is caused by an orthopoxvirus belonging to the family Poxviridae, subfamily Chordopoxviridae, genus Molluscipoxvirus. There are 4 types of molluscum contagiosum virus: MCV-1, MCV-2, MCV-3, and MCV-4. MCV-1 is the most common; MCV-2 is typically detected in adults and is transmitted sexually. The orthopoxvirus is a DNA-containing virus, does not replicate in chicken embryo tissues, and is non-pathogenic to laboratory animals.
1.3 Epidemiology of the Disease or Condition
The prevalence of the disease in various countries ranges from 1.2% to 22% of the population. The disease occurs universally and affects individuals of any age. Infection occurs through direct contact with an infected person or virus carrier, or indirectly through personal and household items. The incubation period of the disease ranges from 1 week to several months, averaging 2 to 7 weeks.
The disease is more commonly detected in children aged 1 to 4 years. In older children, infection typically occurs when visiting a swimming pool or practicing contact sports. Children suffering from eczema or atopic dermatitis who receive corticosteroid therapy used in dermatology are more frequently affected. In young adults, infection with molluscum contagiosum often occurs sexually. In middle-aged and elderly individuals, a predisposing factor for the development of the disease can be the long-term use of glucocorticoids and antitumor drugs (cytostatics). In HIV-infected patients, due to an immunodeficient state, there is an increased tendency to develop molluscum contagiosum characterized by a relapsing course.
1.4 Features of Coding the Disease or Condition
B08.1 – Molluscum contagiosum
1.5 Classification of the disease or condition
There is no universally accepted classification.
1.6 Clinical presentation of the disease or condition
Molluscum contagiosum lesions can be located on any area of the skin.
In children, lesions are more frequently localized on the skin of the face (more commonly on the eyelids and forehead region), neck, upper chest (especially in the axillary regions), and upper extremities (dorsum of the hands); in adults, they are localized on the skin of the lower abdomen, pubic area, inner thighs, external genitalia, and perianal region. Eyelid involvement may be accompanied by conjunctivitis. In HIV-infected individuals, lesions are most commonly localized on the skin of the face, neck, and trunk.
Molluscum contagiosum elements present as papules measuring 0.1–0.2 cm, hemispherical or slightly flattened, firm, painless, skin-colored or pale pink, often with a waxy luster and a central umbilication. The papules rapidly increase in size up to 0.5–0.7 cm, occur isolated on unchanged skin, and are less frequently surrounded by a mild inflammatory rim. When papules are compressed laterally, a white, crumbly (pultaceous) mass oozes from the central opening, consisting of degenerative epithelial cells with large protoplasmic inclusions. The number of rash elements varies from 5–10 to several dozen or more.
Atypical forms of molluscum contagiosum include:
giant molluscum (3 cm or more in diameter);
keratotic molluscum;
cystic molluscum;
ulcerated molluscum;
molluscum resembling milia, acne, or warts;
pedunculated molluscum (located on a thin stalk).
2. Diagnostics, medical indications and contraindications for diagnostic methods
The diagnosis is established based on the characteristic clinical presentation of the disease.
2.1 Complaints and Anamnesis
Patients complain of papular rashes on various areas of the skin. In the vast majority of cases, the rashes are not accompanied by subjective sensations and present only a cosmetic problem for the patient. Typically, the disease is self-limiting, and morphological elements can disappear spontaneously even without treatment after a few months. However, children experience a prolonged course of molluscum contagiosum (from 6 months to 5 years) as a result of autoinoculation of the causative agent.
2.2 Physical Examination
Objective clinical manifestations of molluscum contagiosum detected during physical examination are described in the «Clinical Presentation» section.
2.3 Laboratory Diagnostics
It is recommended to confirm the diagnosis in atypical forms of the disease by microscopic examination of the nodule contents stained with Romanowsky-Giemsa, Gram, Wright, or Papanicolaou, which allows the detection of large, brick-shaped intracellular inclusions of viral bodies [1,2].
GCP CLOE 5Grade of Recommendation C (Level of Evidence 5)
Comments: Examination of the histological specimen reveals large, brick-shaped intracellular inclusions of viral bodies [1,2].
2.4 Instrumental Diagnostics
Not applicable.
2.5 Other Procedures
Not applicable.
3. Treatment, including drug and non-drug therapies, diet therapy, and pain management
3.1 Conservative Treatment
It is recommended to perform cryodestruction: treating each element of molluscum contagiosum with liquid nitrogen for 10–20 seconds. If rashes persist, the cryodestruction procedure is repeated in a week [1,3,4,17].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
Comments: The cryotherapy procedure is accompanied by pain and blister formation; skin pigmentation disorders and mild scar formation are possible afterward. The use of this method for removing molluscum contagiosum in children is the least preferred, as it is painful and can cause scarring and hypo- or hyperpigmentation.
To remove fresh rashes, it is recommended to perform evisceration—enucleation of molluscum contagiosum elements using fine forceps [5,12,20,21,22].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
Comments: this method makes it possible to obtain material for laboratory studies.
or curettage (scraping of rashes using a curette) [12,18,19]
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
Comment: Due to the high accessibility of this method, its simplicity, and relatively low pain, this method is the most preferred for treating pediatric patients. Also, when treating children, preliminary topical anesthesia with an anesthetic cream is recommended.
It is recommended to perform laser destruction of molluscum contagiosum elements: treating each element using a carbon dioxide laser system for dermatology (CO2 laser) or other dermatological laser devices (pulsed dye laser) [6–12,13,14,15,22]. If rashes persist, repeat laser destruction is performed after 2–3 weeks.
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
It is recommended to perform electrocoagulation of molluscum contagiosum elements [12,16,22].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
It is recommended to treat the skin areas where molluscum contagiosum lesions were located with antiseptics and disinfectants (such as iodine + [potassium iodide + ethanol], 5% alcohol solution, etc.) to reduce the recurrence rate and the risk of complications after lesion destruction [12,22].
LeR CLoE 5Level of Recommendation C (Level of Evidence — 5)
3.2 Surgical Treatment
Not applicable.
3.3 Other Treatment
Diet therapy is not used.
It is recommended to use local anesthesia to reduce pain and discomfort during the destruction of molluscum contagiosum lesions [8,17,22].
GCR CLEL 5Grade of Recommendations C (Level of Evidence 5)
4. Medical Rehabilitation and Sanatorium-Resort Treatment
Not applicable.
5. Prevention and Dispensary Observation
5.1 Prevention
It is recommended: isolation of sick children from organized childcare groups until full recovery [2];
GCR CLEL 5Grade of Recommendations C (Level of Evidence 5)
It is recommended to observe personal and public hygiene rules [2];
GCR CLEL 5Grade of Recommendation C (Level of Evidence 5)
It is recommended: conducting preventive examinations of children in preschool institutions and schools for early detection of molluscum contagiosum cases [2,24];
LoR CLE 3Level of Recommendation C (Level of Evidence 3)
It is recommended: examination of sexual partners and their treatment if the disease is present [2].
GCR CLEL 5Grade of Recommendations C (Level of Evidence 5)
It is recommended to prohibit visiting swimming pools, gyms, public baths, and saunas during the treatment period [2].
GCR CLEL 5Grade of Recommendations C (Level of Evidence 5)
6. Organization of Medical Care
Hospitalization in a medical organization is not required.
7. Additional Information
Information is not available.
Criteria for Evaluating the Quality of Medical Care
№ | Quality criteria | Performance evaluation |
1 | Microscopic examination of lesion contents performed (to confirm the diagnosis in atypical forms of the disease) | Yes/No |
2 | Curettage, cryodestruction, evisceration, laser destruction, or electrocoagulation of molluscum contagiosum lesions performed | Yes/No |
References
Show references
Hanson D., Diven D.G. Molluscum contagiosum. Dermatol Online J – 2003; 9: 2.
Nguyen H.P., Tyring S.K. An update on the clinical management of cutaneous molluscum contagiosum. Skin Therapy Lett 2014; 17 (2): 5–8.
Hanna D., Hatami A., Powell J. et al. A prospective randomized trial comparing the efficacy and adverse effects of four recognized treatments of molluscum contagiosum in children. Pediatr Dermatol 2006; 23 (6): 574–579.
Valentine C.L., Diven D.G. Treatment modalities for molluscum contagiosum. Dermatol Ther 2000;13: 285–289.
Al-Mutairi N., Al-Doukhi A., Al-Farag S. et al. Comparative study on the efficacy, safety, and acceptability of imiquimod 5% cream versus cryotherapy for molluscum contagiosum in children. Pediatr Dermatol 2010; 27 (4): 388–394.
Chatproedprai S., Suwannakarn K., Wananukul S. et al. Efficacy of pulsed dye laser (585 nm) in the treatment of molluscum contagiosum subtype 1. Southeast Asian J Trop Med Public Health 2007; 38 (5): 849–854.
Nehal K.S., Sarnoff D.S., Gotkin R.H. et al. Pulsed dye laser treatment of molluscum contagiosum in a patient with acquired immunodeficiency syndrome. Dermatol Surg. 1998; 24 (5): 533–535.
Binder B., Weger W., Komericki P., Kopera D. Treatment of molluscum contagiosum with a pulsed dye laser: Pilot study with 19 children. J Dtsch Dermatol Ges 2008; 6 (2): 121–125.
Hughes PS.Treatment of molluscum contagiosum with the 585-nm pulsed dye laser. Dermatol Surg. 1998; 24 (2): 229–230.
Michel J.L. Treatment of molluscum contagiosum with 585 nm collagen remodeling pulsed dye laser. Eur J Dermatol 2004; 14 (2): 103–106.
European Handbook of Dermatological Treatment. Ed. by A.D. Katsambas, T.M. Lotti. – M.: MEDpress-inform, 2009. – P. 736.
Viral Dermatoses. In: Skin and Venereal Diseases: A Guide for Physicians. In 2 volumes. Ed. by Yu.K. Skripkin, V.N. Mordovtsev. M.: Meditsina, 1999. – Vol. 1. – P. 443–465.
Kruglova L.S., Materikin A.I. Molluscum contagiosum: old problems, new solutions. Klinicheskaya Dermatologiya i Venerologiya. 2017;16(3):76-81. Kruglova L S, Materikin A I. Molluscum contagiosum: old problems, new solutions. Klinicheskaya Dermatologiya i Venerologiya. 2017;16(3):76-81. https://doi.org/10.17116/klinderma201716376-81
Michel J.L. Treatment of molluscum contagiosum with 585 nm collagen remodeling pulsed dye laser. Eur J Dermatol. 2004;14(2):103–6.
Hammes S., Greve B., Raulin C. Molluscum contagiosum: treatment with pulsed dye laser. Hautarzt. 2001;52(1):38–42.
Khaldin A. A., Molochkov A. V., Gilyadov A. D., Bykhanova O. N., Lapushko O. V., Isaeva D. R., Bagramova G. E., Obydennova K. V. Warts and molluscum contagiosum: difficult cases of "simple" diagnoses. Klinicheskaya dermatologiya i venerologiya. 2014;12(3):63-71.
Khaldin A A, Molochkov A V, Giliadov A D, Bykhanova O N, Lapushko O V, Isaeva D R, Bagramova G É, Obydennova K V. Warts and molluscum contagiosum: complex cases of simple diagnoses. Klinicheskaya Dermatologiya i Venerologiya. 2014;12(3):63-71.
Nguyen H, Tyring S. An Update on the Clinical Management of Cutaneous Molluscum Contagiosum.
Silverberg N. Pediatric molluscum contagiosum: optimal treatment strategies. Paediatr Drugs. 2003;5(8):505-12. doi: 10.2165/00148581-200305080-00001. PMID: 12895133.
Meza-Romero R, Navarrete-Dechent C, Downey C. Molluscum contagiosum: an update and review of new perspectives in etiology, diagnosis, and treatment. Clin Cosmet Investig Dermatol. 2019 May 30;12:373-381
Martin-Garcia R.F., Garcia M.E., Rosado A. Modified curettage technique for molluscum contagiosum. Pediatr Dermatol. 2007;24(2):192–94.
Simonart T, De Maertelaer V. Curettage treatment for molluscum contagiosum: a follow-up survey study. Br J Dermatol. 2008;159(5):1144–47. http://reference.medscape.com/medline/abstract/17461823.
N.S. Syrmais, T.V. Rubasheva, V.P. Kovalyk. Molluscum contagiosum: modern concepts and review of treatment methods. Farmateka; 2018. – 3: 18-23. DOI: https://dx.doi.org/10.18565/pharmateca.2018.s5.18-23
M.V. Shchetkina, K.A. Sidelnikova. Sexually transmitted infections. System of measures aimed at preventing their spread. Zdravookhranenie Dalnego Vostoka • No. 1 • 2021. DOI: 10.33454/1728-1261-2021-1-78-82
Murashkin, N.N. et al. "Molluscum contagiosum in children: clinical features and modern approaches to therapy". Pediatricheskaya Farmakologiya 13.6 (2016): 597-600.
Appendix A1. Working Group Composition
Kubanov Alexey Alekseevich – Academician of the Russian Academy of Sciences, President of the Russian Society of Dermatovenereologists and Cosmetologists (RODVK), Director of the State Research Center of Dermatovenereology and Cosmetology of the Russian Ministry of Health.
Letyaeva Olga Ivanovna – Doctor of Medical Sciences, Associate Professor, Professor of the Department of Dermatovenereology at SUSMU of the Ministry of Health, Member of the Russian Society of Dermatovenereologists and Cosmetologists.
Ziganshin Oleg Raisovich – Doctor of Medical Sciences, Professor, Chief Physician of the Chelyabinsk Regional Clinical Skin and Venereological Dispensary, Head of the Department of Dermatovenereology at SUSMU of the Russian Ministry of Health, Member of the Russian Society of Dermatovenereologists and Cosmetologists.
Zaslavsky Denis Vladimirovich – Doctor of Medical Sciences, Professor, Head of the Department of Dermatovenereology at Saint Petersburg State Pediatric Medical University of the Russian Ministry of Health, Member of the Russian Society of Dermatovenereologists and Cosmetologists.
Nefedyeva Yulia Vladimirovna – Candidate of Medical Sciences, Associate Professor, Associate Professor of the Department of Dermatovenereology at SUSMU of the Ministry of Health, Member of the Russian Society of Dermatovenereologists and Cosmetologists.
Kudrevich Yulia Valerievna – Candidate of Medical Sciences, Associate Professor of the Department of Dermatovenereology at SUSMU of the Ministry of Health, Member of the Russian Society of Dermatovenereologists and Cosmetologists.
Chikin Vadim Viktorovich – Doctor of Medical Sciences, Senior Researcher at the Department of Dermatology of the State Research Center of Dermatovenereology and Cosmetology of the Ministry of Health, Member of the Russian Society of Dermatovenereologists and Cosmetologists.
Lysenko Olga Vasilyevna – Doctor of Medical Sciences, Professor, Professor of the Department of Dermatovenereology at SUSMU of the Ministry of Health, Member of the Russian Society of Dermatovenereologists and Cosmetologists.
Baranov A. A. – Academician of the RAS, Professor, D.Sc. (Medicine), Honorary President of the Union of Pediatrists of Russia, Advisor to the Head of the Research Institute of Pediatrics and Child Health of the Central Clinical Hospital of the RAS, Chief freelance pediatric specialist of the Russian Ministry of Health
Namazova-Baranova Leila Seymurovna – Academician of the RAS, Professor, President of the Union of Pediatrists of Russia; Past President of EPA/UNEPSA; Head of the Research Institute of Pediatrics and Child Health of the Central Clinical Hospital of the RAS, Head of the Department of Faculty Pediatrics, Pediatric Faculty, Pirogov Russian National Research Medical University of the Russian Ministry of Health, Chief freelance pediatric specialist in preventive medicine of the Russian Ministry of Health
Vishneva Elena Aleksandrovna – D.Sc. (Medicine), Deputy Head for Science at the Research Institute of Pediatrics and Child Health of the Central Clinical Hospital of the RAS, Associate Professor at the Department of Faculty Pediatrics, Pediatric Faculty, Pirogov Russian National Research Medical University of the Russian Ministry of Health, Member of the Russian Association of Allergologists and Clinical Immunologists, Member of the Union of Pediatrists of Russia
Aslamazyan Lianna Kamsarovna – Ph.D. (Medicine), Leading Researcher at the Department of Pediatric Dermatology, Dermatovenereologist, Research Institute of Pediatrics and Child Health of the Central Clinical Hospital of the RAS
Murashkin Nikolay Nikolaevich – D.Sc. (Medicine), Professor, Head of the Department of Dermatology with a Laser Surgery Group, National Medical Research Center for Children's Health of the Russian Ministry of Health, Member of the Russian Society of Dermatovenereologists and Cosmetologists.
Conflict of Interest: The authors declare no conflict of interest.
Appendix A2. Methodology for Developing Clinical Guidelines
Target audience for these clinical guidelines:
Medical specialists: dermatovenereologists, therapists, rheumatologists, pediatricians, general practitioners (family physicians);
Residents and trainees of continuing professional education programs in the specified specialties.
Table 1. Level of Evidence (LoE) grading scale for diagnostic methods (diagnostic interventions)
LoE | Definition |
1 | Systematic reviews of studies with reference standard control or systematic reviews of randomized controlled trials with meta-analysis |
2 | Individual studies with reference standard control or individual randomized controlled trials and systematic reviews of studies of any design, except randomized controlled trials, with meta-analysis |
3 | Studies without consecutive reference standard control or studies with a reference standard not independent of the test method, or non-randomized comparative studies, including cohort studies |
4 | Non-comparative studies, case report |
5 | Only justification of mechanism of action or expert opinion is available |
Table 2. Level of evidence (LoE) grading scale for prevention, treatment, and rehabilitation methods (preventive, therapeutic, and rehabilitative interventions)
LoE | Definitions |
1 | Systematic review of RCTs with meta-analysis |
2 | Individual RCTs and systematic reviews of studies of any design except RCTs, with meta-analysis |
3 | Non-randomized comparative studies, including cohort studies |
4 | Non-comparative studies, case reports or case series, case-control studies |
5 | Only justification of the mechanism of action of the intervention (preclinical studies) or expert opinion is available |
Table 3. Grade of Recommendation (GoR) scale for prevention, diagnostic, treatment, and rehabilitation methods (preventive, diagnostic, therapeutic, and rehabilitative interventions)
GoR | Definition |
A | Strong recommendation (all considered efficacy criteria (outcomes) are important, all studies are of high or acceptable methodological quality, and their conclusions on the outcomes of interest are consistent) |
B | Conditional recommendation (not all considered efficacy criteria (outcomes) are important, not all studies are of high or acceptable methodological quality, and/or their conclusions on the outcomes of interest are inconsistent) |
C | Weak recommendation (lack of adequate quality evidence (all considered efficacy criteria (outcomes) are unimportant, all studies are of low methodological quality, and their conclusions on the outcomes of interest are inconsistent) |
Procedure for updating clinical guidelines.
The clinical guidelines update mechanism provides for their systematic revision—at least once every three years, as well as upon the emergence of new evidence-based data regarding the diagnosis, treatment, prevention, and rehabilitation of specific diseases, or the presence of justified additions/comments to previously approved clinical guidelines, but no more frequently than once every 6 months.
Appendix A3. Reference Materials
These clinical guidelines were developed taking into account the following regulatory legal documents:
Order of the Russian Ministry of Health No. 924n dated November 15, 2012, "On Approval of the Procedure for Providing Medical Care to the Population in the Profile 'Dermatovenereology'"
Order of the Russian Ministry of Labor No. 142n dated March 14, 2018, "On Approval of the Professional Standard 'Dermatovenereologist'"
Appendix B. Physician Action Algorithms
Appendix C. Patient Information
Due to rapid progression and high contagiousness of the disease, treatment should be initiated as early as possible.
Patients with atopic dermatitis are recommended to receive treatment to manage the exacerbation of atopic dermatitis prior to starting molluscum contagiosum therapy.
Shaving skin areas with rashes is not recommended, as this may lead to autoinoculation.
Visiting swimming pools, gyms, public bathhouses, and saunas is prohibited during the treatment period.
Until the completion of treatment, patients must use only their personal items and utensils, and avoid sexual and close physical contact.
Examination of sexual partners and their treatment if the disease is present is recommended.
Daily self-examination of the skin is recommended for timely detection of molluscum contagiosum lesions.
Appendix G. Assessment Scales, Questionnaires, and Other Evaluation Tools
There is no universally accepted rating scale.