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Molluscum

How is molluscum transmitted?

Molluscum contagiosum virus (MCV) may be sexually transmitted by skin-to-skin contact (does not have to be mucous membranes) and/or lesions. Transmission through sexual contact is the most common form of transmission for adults.

MCV may be passed on from inanimate objects, like towels or clothing that come in contact with the lesions. MCV transmission has been associated with swimming pools and sharing baths with an infected person.

MCV also may be transmitted by autoinoculation, such as touching a lesion and then touching another part of the body. To stop from further spreading the infection, do not shave over or close to areas that are visibly infected.

How long until a person shows symptoms?

The time between when a person is infected and when they begin to show symptoms is called the incubation period. For molluscum, the incubation period averages two to three months, but it may range from one week to six months. So someone may see symptoms in as little as a week, others may take as long as six months. On average, it takes two to three months.

What are the symptoms of molluscum?

  • Molluscum can cause small, painless lesions. These lesions are raised bumps that have a dimple in the center. They may begin as small bumps which can develop over a period of several weeks into larger sores/bumps. The lesions can be flesh colored, gray-white, yellow or pink. They can cause itching or tenderness in the area, but in most cases the lesions cause few problems.
  • Lesions are usually present on the thighs, buttocks, groin and lower abdomen of adults, and may occasionally appear on the external genital and anal region.
  • Lesions can last from 2 weeks to 4 years—the average is 2 years.
  • People with compromised immune systems may develop extensive outbreaks.

How is it diagnosed?

Diagnosis is usually made by the characteristic appearance of the lesion, so a provider can often tell by just looking. A provider can also take a specimen from the lesion and view it under a microscope to confirm.

Is molluscum treatable?

  • Most symptoms eventually resolve on their own, so treatment may not be necessary. But lesions can also be removed. This helps reduce the risk of further spreading the lesions on your own body of passing on MCV to others.
  • Lesions can be removed surgically and/or treated with a topical treatment such as podophyllin, cantharidin, phenol, or iodine.
  • Cryotherapy (freezing the lesion with liquid nitrogen) is an alternative method of removal.
  • Lesions may come back, but it is not clear whether this is due to reinfection or reactivation of a dormant infection.

What does it mean for my health?

The most common complication from molluscum is a secondary infection caused by bacteria. This can be more of a problem for people with compromised immune systems.

How can I reduce my risk?

Because transmission through sexual contact is the most common form of transmission for adults, preventing skin-to-skin contact with an infected partner will be most effective in preventing MCV.

Condoms or other barriers for vaginal, oral, and anal sex may help to prevent such contact. Using spermicides is not recommended as they can irritate the skin or vaginal tissue and, especially for women, cause abrasions (tiny openings in skin) that may make it easier to contract STDs/STIs.

If you do get molluscum contagiosum, avoid touching the lesion and then touching another part of the body without washing your hands to prevent any chance of spreading the infection.

Intraoral molluscum contagiosum in a young immunocompetent patient

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application/pdfIntraoral molluscum contagiosum in a young immunocompetent patient

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    Molluscum Contagiosum in Adults: Condition, Treatments, and Pictures – Overview

    51965
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    Information for
    AdultsTeen

    caption goes here…

    Images of Molluscum Contagiosum

    Overview

    Molluscum contagiosum is a common painless and usually harmless viral infection of the skin. Although it is painless and usually goes away after several months, some cases can last a few years. Molluscum can spread to surrounding skin by scratching or rubbing and can spread to others by skin-to-skin contact or handling contaminated objects such as towels, toys, and clothing. Poor hygiene and warm, moist climates encourage the spread of molluscum. Use of public or school swimming pools is associated with childhood infections.

    Who’s at risk?

    Adults and teens are more often infected by molluscum through sexual contact and tend to have genital lesions. Children from age 1–5 are most commonly affected with lesions appearing on the face, neck, arms, armpits, and hands (but usually not the palms). Patients with eczema may be more severely affected by molluscum.

    Signs and Symptoms

    In adults, the genital, stomach, buttock, and inner thigh areas are more often affected as intimate contact with another is the typical source of infection. Men are more often affected than women. Adults with defective immune systems (such as with HIV) may have severe, extensive infection.

    One or more small (1–5 mm) pink, white, or skin-colored, smooth, dome-shaped bumps, often with a tiny dot or depression in the center, occur in clusters and sometimes in a straight line from scratching and self-inoculation. In patients with a defective immune system, bumps can be larger than a nickel.

    • Mild – under 10 spots
    • Moderate – 10–50 spots
    • Severe – over 50 spots

    Self-Care Guidelines

    Treatment in mild infections is often not required, as molluscum infections goes away on their own. Care should be taken to not scratch or shave the areas. Keep the area covered to avoid transmission of the virus, and avoid sharing clothing, towels, and beds with others. Over-the-counter medications used to treat warts (with salicylic acid) may be helpful in removing the bumps, although these treatments can also be irritating.

    When to Seek Medical Care

    When there is a moderate or severe infection and there is a concern of spread or concern about appearance, seek medical care.

    Treatments Your Physician May Prescribe

    • Removal with freezing (cryosurgery), scraping (curettage), burning (electrocautery), or a laser
    • Application of chemicals (a strong acid or alkali) or Cantharone (an extract from a blister beetle)
    • Prescription of a cream with either tretinoin (derived from vitamin A) or imiquimod (a prescription product also used to treat warts, another type of viral infection)

    Trusted Links

    MedlinePlus: Sexually Transmitted Diseases
    MedlinePlus: Skin Infections
    MedlinePlus: Viral Infections
    Clinical Information and Differential Diagnosis of Molluscum Contagiosum

    References

    Bolognia, Jean L. , ed. Dermatology, pp.208, 1266-1267. New York: Mosby, 2003.

    Freedberg, Irwin M., ed. Fitzpatrick’s Dermatology in General Medicine. 6th ed. pp.1861, 2114-2116, 2332. New York: McGraw-Hill, 2003.

    Clinical Information | Molluscum Contagiosum | Pox viruses

    Etiology

    Molluscum contagiosum is a benign superficial skin disease caused by a poxvirus. It is characterized by small pearly papules with a central depression whose core may be expressed, producing a white cheesy material. The lesions average 2 to 5 mm in size and are usually painless, but may become inflamed, red, and swollen. Molluscum contagiosum is a self-limited infection; the papules usually disappear spontaneously within 6 to 12 months but may take as long as 4 years to resolve.

    Clinical Features

    The infection is found worldwide but is more common in developing countries and has traditionally been regarded as a pediatric disease. Successful vaccination against smallpox in infancy is not protective. Little has been verified with regard to the incubation period; however, it is estimated to be between 2 weeks and 6 months. Most cases occur in children over 1 year of age, with only one known case reported in an infant (at 7 days post-partum). Atopic dermatitis may be a risk factor for contracting molluscum contagiosum due to the barrier breaks and immune cell dysfunction in atopic skin. In addition, these patients may be more likely to autoinoculate (excoriation of primary lesions and spread to areas of normal skin) new areas of skin because of the underlying pruritus from their atopy.

    Patients with HIV/AIDS and other immunocompromising conditions (e.g., solid organ transplant recipients) can develop “giant” lesions (≥15 mm in diameter), larger numbers of lesions, and lesions that are more resistant to standard therapy. The following diseases should be considered in the differential diagnosis of molluscum contagiosum: cryptococcosis, basal cell carcinoma, keratoacanthoma, histoplasmosis, coccidioidomycosis, and verruca vulgaris. For genital lesions, condyloma acuminata and vaginal syringomas should be considered.

    Molluscum contagiosum lesions have recently come to be classified in one of three ways: the commonly seen skin lesions found largely on the faces, trunks, and limbs of children; the sexually transmitted lesions found on the abdomen, inner thighs, and genitals of sexually active adults; and the diffuse and recalcitrant eruptions of patients with AIDS or other immunosuppressive disorders.

    Molluscum Contagiosum (for Teens) – Nemours Kidshealth

    What Is Molluscum Contagiosum?

    Molluscum contagiosum is a skin rash caused by a virus. The rash has small clear or flesh-colored bumps. The bumps can spread from one part of the body to another or from person to person. Usually, the rash goes away on its own in 6–12 months, but can take longer.

    Molluscum contagiosum (pronounced: mol-US-kum kon-tay-jee-OH-sum), or molluscum for short, usually goes away on its own without medical treatment.

    What Are the Signs & Symptoms of Molluscum?

    The rash is the telltale sign of molluscum. Its bumps:

    • Start as very small spots about the size of a pinhead.
    • Grow over a few weeks. They can be as large as a pea or pencil eraser.
    • Are soft and smooth and may have a small dent in the center.
    • Often are painless, but can get itchy, sore, red, and/or swollen.
    • Can get infected with bacteria if people scratch or pick at them.
    • Can appear alone or in groups, or rows. Most people get between 1 and 20 bumps.
    • Can show up almost anywhere on the skin except for the palms and soles. Often, they’re on the trunk, arms, and face.

    What Causes Molluscum?

    The molluscum virus causes the rash after it enters a small break in the skin. Bumps usually appear 2–6 weeks after that.

    The molluscum virus spreads easily from skin touching skin that has bumps. People also can get it by touching things that have the virus on them, such as toys, clothing, towels, and bedding. Sexually active teens with bumps in the groin or inner thighs can spread them to partners.

    Who Gets Molluscum?

    Molluscum most often happens in kids. But teens can get it too, especially:

    • athletes who have close contact, such as wrestlers, or athletes who share equipment, such as gymnasts
    • teens with health problems treated with long-term steroid medicine use

    How Is Molluscum Diagnosed?

    Doctors can usually tell a rash is molluscum by looking at it. Sometimes they might suggest that a person see a dermatologist (skin doctor), but most teens won’t need this.

    Can Molluscum Be Prevented?

    Teens with molluscum can still go to school and play sports. To prevent the spread of molluscum to other places on their body and to other people, they should:

    • Wash their hands well and often with soap and water.
    • Cover the bumps with clothing or a bandage.
    • Cover the bumps with a watertight bandage before swimming or doing activities with close contact (like wrestling) or shared equipment (like gymnastics).
    • Not share towels.
    • Not shave over areas that have bumps.
    • Not touch, scratch, or rub the bumps.

    How Is Molluscum Treated?

    Most of the time, molluscum clears up on its own without treatment. Each bump goes away in about 2–3 months. New bumps can appear as old ones go away, so it can take 6-12 months (and sometimes longer) for molluscum to fully go away.

    Sometimes, doctors remove the bumps or help them go away more quickly. To do this, they can:

    • Freeze the bumps off.
    • Scrape or cut the bumps off.
    • Put a chemical on the bumps to make the body fight them away faster.
    • Put medicine on the bumps or give medicine to swallow.

    Many doctors don’t recommend these treatments, though. That’s because they can be painful and burn, blister, stain, or scar the skin. When deciding to treat a rash, they consider where the bumps are and if they’re causing itching, pain, or other problems.

    What Else Should I Know?

    To avoid molluscum and other skin infections, follow these tips:

    • Wash your hands well and often with soap and water.
    • Do not share towels or clothing.
    • Do not share kickboards and other water toys.
    • Do not touch or scratch bumps or blisters on your skin or other people’s skin.

    Talk with your doctor about the pros and cons of treating molluscum. The rash usually doesn’t cause long-term problems or leave scars. Often, the best way to handle it is to be patient, as hard as that might be.

    Molluscum Contagiosum in a 12-Year-Old Child – Report of a Case and Review of Literature

    Abstract

    Molluscum contagiosum (MC) is an infection of the skin and mucous membrane caused by a DNA virus from the poxvirus family. It usually affects any part of the body and presents as pearly, flesh colored dome shaped nodule with a central umbilication. Clinical diagnosis can be supplemented with histopathology for the confirmed diagnosis of MC. This article presents a case of 12-year-old male child afflicted with MC along with a review of the literature on MC.

    Keywords: Henderson–Paterson bodies, mollusca, molluscum contagiosum, pearly nodule

    Introduction

    Molluscum contagiosum (MC) is a common and self-limiting viral infection of the skin and mucous membrane, caused by molluscipox virus gene of the poxvirus family. MC infection usually affects children and also adults who are sexually active and those who are immunocompromised. Clinically MC appears as small bumps, which are called as “mollusca” on the skin or mucous membrane.1

    The clinical appearance of MC in most cases is diagnostic and, histopathology examination can be used as an aid in the diagnosis of cases that are not clinically obvious.

    Here, we report a case of MC in a male child with its clinical and histopathological findings.

    Case Report

    A 12-year-old male child reported to the Oral Medicine Department with a complaint of sudden eruptive papules in the right side of the face for the past 2 months. History revealed that the papules were noticed by his parents 2 months ago, which were small in size and not associated with any pain or discomfort.

    Extra-oral examination revealed two large papules measuring 4 mm in diameter and three small papules measuring 2 mm in diameter, which were seen on the right side of the skin of the face near the angle of the mouth. The surface of the lesions appeared smooth, round, blanched and pinkish with a dimple in the middle, and they were soft in consistency and non-tender ().

    Multiple smooth, round, and pinkish papules on the skin of the face near the angle of the mouth.

    Routine blood investigations revealed no abnormality in any of the parameters. HIV 1 and HIV 2 testing were also done, which was found to be negative. Fluorescent antinuclear antibody testing was done to check for autoimmune infection, and was found to be negative. On the basis of clinical examination, provisional diagnosis of MC was made, along with the differential diagnosis of Herpes simplex infection. Under local anesthesia, the two larger lesions were surgically excised, and the biopsied tissues were fixed in 10% formalin and sent for histopathological examination ().

    Gross picture of the excised specimens.

    Microscopic examination of the excised tissue by routine hematoxylin and eosin (H and E) staining revealed hyperplastic epidermis in the form of lobules invaginating into the dermis (). The basal layer showed enlarged basophilic nuclei and mitotic figures. Progressing toward the center of the lobule, the spinous cells showed cytoplasmic vacuolization and large intra-cytoplasmic, basophilic viral inclusions called Molluscum bodies or Henderson-Paterson bodies, which compress the keratinocyte nucleus ().

    Lobular hyperplasia of epidermis resulting in a cup shaped invagination into the dermis (H and E, ×4).

    Henderson–Paterson/molluscum bodies appearing eosinophilic in the spinous layer and basophilic in the granular layer (H and E, ×20).

    Along with H and E, special stains such as Gram’s, Giemsa, and Papanicolaou () were also done to demonstrate the viral inclusion bodies within the host cell. Correlating the clinical and histopathological findings the lesion was diagnosed as MC.

    Special stains used to demonstrate molluscum bodies; (a) Molluscum bodies appearing basophilic with gram stain (×10), (b) molluscum bodies appearing eosinophilic with giemsa stain (×10), (c) molluscum bodies appearing eosinophilic with papanicolaou stain (×10).

    Since MC is self-limiting condition, the smaller lesions were allowed to resolve spontaneously and the patient was reviewed after a month, and showed no recurrence or scarring in the excised area.

    Discussion

    MC is a superficial, viral infection, which is characterized by single, discrete or multiple papular or nodular lesions on the skin and mucous membrane. MC was first described by Bateman in year 1817.2 MC is caused by Molluscum contagiosum virus (MCV), which is a DNA virus belonging to the poxvirus family. MCV is of four types; MCV I to MCV IV of which MCV I is most prevalent and MCV II is usually seen in adults. 1

    MC is a common infection in children between the ages of 1-12 years. It is also seen in sexually active adults and those who are immunocompromised, such those with HIV.

    MCV is transmitted either via direct contact with infected people or indirectly through infected fomites. The virus also spreads through sexual contact or by autoinoculation. Traumatic inoculation such as that caused by tattoos can also transmit the virus.3 The incubation period usually varies from 2 to 8 weeks, and sometimes may extend upto 6-18 months.2

    In children, MCV lesions are frequently seen in the skin of the face, neck, armpits, arms and hands;4 and mucous membrane of lips, tongue and buccal mucosa.2 In sexually active adults and immunocompromised individuals such as those with AIDS, the lesions are commonly seen in the genital, abdomen and the inner part of the thigh.

    In children and immunocompetent adults, the lesion is self-limiting, but in patients with HIV the lesions are more extensive and cause disfigurement. Studies have suggested that in patients with severe immunodeficiency MC may be used as a cutaneous marker and could be a first indicator of HIV infection.5

    Clinically the lesion begins as a painless, small papule, which later becomes raised to a pearly, flesh colored dome shaped nodule with a central depression like a small pit or umblication. These dome shaped nodules are called as “mollusca.” The central pit contains central plug of waxy, cheesy, white material in which virus is present. The papules or nodules can be either solitary or multiple, and they measure about 2-5 mm and sometimes grow to as large as 10 mm.

    MCV lesions are generally painless, but they may itch or become irritated. Scratching or picking the papules or nodules can lead to secondary bacterial infection or can cause scarring. Scratching or picking the papules or nodules can also cause the spread of the virus to the neighboring skin in a process called as autoinoculation. Children usually develop widespread cluster of lesion due to autoinoculation.

    The differential diagnosis for MC in HIV patients includes Basal cell carcinoma, Keratocanthoma, Darier’s disease, Epithelial nevi, Atopic dermatitis, Cryptococcosis, and Histoplasmosis.5

    Diagnosis of the lesion is presumptively based on the distinctive, central umblication of the dome shaped lesion, and the lesion can be further confirmed by biopsy and examining it under the miscroscope.

    Histological section stained with H and E reveals inverted lobular hyperplasia of the epidermis in the form of a cup shaped nodule with central cellular and viral debris. The inverted epidermis exhibits acanthosis, and the basal layer shows enlarged basophilic nuclei and mitotic figures. Progressing upward, the keratinocyte cells of the spinous and granular layer exhibit intra-cytoplasmic, eosinophilic, granular viral inclusions called Molluscum bodies or Henderson–Paterson bodies.

    These intra-cytoplasmic inclusion bodies were first described by Hendrson and Paterson in the year 1841. 6 Ultrastructural studies of the molluscum bodies show membrane bound sacs that contain MCV. These inclusion bodies measure approximately 35 µ in diameter and are formed by the virus within the cytoplasm of the cell. Initially, the virion is formed as a small particle in the cytoplasm of the cells of the suprabasal layer, and they increase in size from the spinous to the granular layer. In the granular layer, these inclusion bodies compress the nucleus to the periphery of the infected cells. Near the granular cell layer the staining reaction of the molluscum bodies changes from eosinophilic to basophilic. The stratum corneum in the center of the lesion disintegrates and releases the molluscum bodies into the central crater. Usually the dermis is relatively unremarkable, but when the contents of the lesion are discharged into it, the dermis shows inflammatory reaction composed of histiocytes, lymphocytes, neutrophils, and occasional foreign body giant cells. The large brick-shaped Molluscum bodies can also be demonstrated microscopically by squash preparation. This is a technique, wherein the cellular material within the central umblication is extracted manually by an incision with a 16 gauge needle, and flattened between two microscopic slides to release the virions, and stained with 5-7 drops of Giemsa stain and observed under microscope to see the inclusion bodies.7 Gram, Wright, 10% KOH, and, Papanicolaou stains can also use to stain the smear to demonstrate the inclusion bodies. In our case, instead of the smear, the excised tissue sections were stained with geimsa, gram, and papanicolaou to demonstrate the inclusion bodies.

    Studies have shown that most patients with MCV produce anti-cellular antibodies and virus-specific antibodies of the immunoglobulin M class, and they can be demonstrated by immunofluorescence.8 MCV can be detected and categorized by polymerase chain reaction assay in skin lesions.

    MC lesions spontaneously resolve when left untreated within 6-18 months in children and immunocompetent adults. In immunocompromised and HIV infected adults the lesions can get protracted if left untreated. Treatment is recommended for aesthetic reasons and to prevent autoinoculation based on the patient’s age, immune status, and site of lesion.

    An easy home treatment is to gently scrub the affected area either with betadine surgical scrub or retin-A 0.025% gel for 5 min daily until the lesions resolves. The most common, quick, and efficient method to remove individual lesions is by cryosurgery using liquid nitrogen, dry ice, or frigiderm.9 Other methods include curettage with or without electrodessication,10 or by pulsed laser surgery11 or by the use of adhesive tape.12

    Surgical removal of the individual lesions may result in scarring. An effective method is to remove the lesions by using sharp instruments such as sharp tooth pick, scalpel, or the edge of a glass slide to eviscerate the central core.10 Topical agents such as trichloro acetic acid, potassium hydrochloride, cantharidium, 10% benzyl peroxide, imiquimod, retinoid and similarly, essential oils like Australian lemon myortie and tea tree oil with organically bound iodine can be used over the bumps. 2 Extensive lesions can also be treated by antiviral drugs such as cidofovir, either applied topically or administered by intralesional injections.13 Diphencyprone is a contact immunotherapy, which produces complete or partial regression in generalized MC in HIV patients.14 The complications of MC include irritation, inflammation, secondary bacterial infections, and cellulitis in patients who are HIV infected. The prognosis in healthy patients after treatments is usually effective, although lesions can cause disfiguring and scarring in generalized lesions.

    Molluscum contagiosum: an update and review of new perspectives in eti

    Introduction

    Molluscum contagiosum (MC) is a self-limited infectious dermatosis, frequent in the pediatric population, sexually active adults, and immunocompromised individuals. It is transmitted mainly by direct contact with infected skin and clinically is characterized by umbilicated pink or skin-colored papules.1,2 It is a frequent reason for consultation in pediatric dermatology and, given its self-limited nature,3 the decision to treat or not becomes complex and taken on a case-by-case basis. In this article, we performed an extensive review of the available literature on etiopathogenesis, epidemiology, typical and atypical clinical manifestations, complementary diagnostic tools, and possible treatment alternatives of MC.

    Search method

    The relevant literature was found by searching different databases: PubMed, Embase, LILACS, and the Cochrane library. Also, an extensive review of the bibliography of each of the inlcuded articles was performed. A summary of the key literature is available in Table 1.

    Table 1 Key literature of this review

    Etiology and epidemiology

    MC is caused by molluscum contagiosum virus (MCV), a double-strand DNA virus which belongs to the Poxviridae family; humans are MCV only host. MCV has 4 different genotypes: MCV 1, MCV 2, MCV 3, and MCV 4. MCV 1 is the most common genotype (75–96%), followed by MCV 2, while MCV 3 and 4 are extremely infrequent. 1,4,5 A Slovenian study4 showed that in children MCV 1 infection is more frequent than in adults, and in adult women, MCV 2 infection is more frequent than MCV 1.

    MCV infects the epidermis and replicates in the cytoplasm of cells with a variable incubation period between two and six weeks.6 Different studies have been developed to sequence the genome of this virus and determine possible genes involved in the evasion of the host immune response, a hypothesis that arose based on the absence of inflammation observed in histopathological samples of infected skin.7,8 To date, four viral genes have been identified that code proteins that would alter the activation of the nuclear factor kB (NF-kB): MC159, MC160, MC132, and MC005.8–11 NF-kB is a nuclear protein complex present in dendritic cells that regulate the transcription of DNA and facilitate the synthesis of pro-inflammatory cytokines (TNF, IL-1, IL-6, among others) and activation of innate and acquired immune response. 12 Brady et al8,11 have seen that MC132 and MC005 proteins would alter the activation of NF-kB by inhibiting pattern recognition receptors (PRRs). Added to this, MC132 would bind and stimulate the degradation of the p65 subunit of NF-kB and MC005 would inhibit the activation of the IKK complex (IkB kinase) binding to active NEMO subunit (essential modulator of NF-kB).

    MCV is transmitted by direct contact with infected skin, which can be sexual, non-sexual, or by autoinoculation. Additionally, it can be transmitted by contaminated fomites like bath sponges or towels.1 It has been associated with the use of the swimming pool.6

    MC occurs worldwide and is more frequent in children but can also affect adolescents and adults. It typically affects children between 2-5 years old, being rare under the age of 1 year. There are no gender differences.13 Data on the prevalence of MC is limited. A meta-analysis of cross-sectional surveys among children revealed an overall prevalence of 8. 28% (95% CI 5.1–11.5) and showed a higher frequency in geographical areas with warm climates.14 In the United States, it is estimated that the prevalence in children is less than 5%.15

    Regarding seroprevalence, the findings are variable in different populations. An Australian study16 using enzyme-linked immunosorbent assay (ELISA) revealed an overall seropositivity rate for MCV of 23% in children and adults. Sherwani et al17 found a seroprevalence of 14.8% in German children and adults between 0 and 40 years, and 30.3% in a population of 30 healthy individuals from the United Kingdom with a mean age of 27 years; in both studies, seroprevalence was determined by ELISA of antibodies against MC084 protein. Watanabe et al18 found a seroprevalence of 6% in a healthy Japanese population, determined by ELISA of antibodies against an N-terminal truncation of MC133 protein.

    In adolescents and adults, MC could occur either as a sexually transmitted disease or in relation to contact sports. 19 It is more common in immunosuppressed patients: In the 1980s, the number of reported cases of MC increased, apparently associated with the onset of the acquired immune deficiency virus (HIV) epidemic.20 It is estimated that in HIV patients the prevalence is close to 20%.21 Besides HIV, MC may be associated with iatrogenic immunosuppression or primary immunodeficiencies (eg, DOCK8 immunodeficiency syndrome).22

    Atopic dermatitis (AD) has been proposed as a risk factor for MC. However, studies on this subject are controversial. Some studies have found an increased risk of MC in patients with AD,23,24 with prevalence rates of AD in patients with MC of up to 62%.6,25 It has even been postulated an increased risk of MCV infection in patients with AD and filaggrin mutation.26 Other studies have shown no significant differences.27

    Clinical manifestations

    Patients infected with MCV present firm rounded papules from 2 to 5 mm, pink or skin-colored, with a shiny and umbilicated surface (Figure 1). The lesions may be single, multiple or clustered, and occasionally they may have an erythematous halo or be pediculated. Pruritus may be present.

    Figure 1 Firm, rounded, skin-colored papules with a shiny and umbilicated surface.

    In children, the main affected areas are sites of exposed skin, such as the trunk, extremities, intertriginous regions, genitals, and face, except the palms and soles.28 The involvement of the oral mucosa is rare.29 In adults, lesions are most frequently located in the lower abdomen, thighs, genitals, and perianal area, most of the cases transmitted by sexual contact. In children, genital lesions are mainly due to autoinoculation and are not pathognomonic of sexual abuse.30

    The duration of the lesions is variable, but in most cases, they are self-limiting in a period of 6 to 9 months; however, some cases may persist for more than 3 or 4 years. 3 It has described a phenomenon called “beginning of the end” (BOTE) sign which refers to clinical erythema and swelling of an MC skin lesion when the regression phase begins (Figure 2). This phenomenon is likely due to an immune response towards the MC infection rather than a bacterial superinfection.1,25,31

    Figure 2 Swelling and erythema of the “BOTE” sign.

    In immunosuppressed patients, such as those infected with HIV, lesions may be extensive, located in atypical sites, greater than 1 cm in diameter (giant MC) or refractory to treatment.32–34

    Patients may develop eczematous plaques around one or more lesions of MC, a phenomenon known as “molluscum dermatitis” (MD) or “eczema molluscorum” (EM) which is more frequent in patients with AD. It is estimated that 9–47% of the patients with MC develop MD.25 It is not clear whether the treatment of MD with topical corticosteroids impacts the resolution of MC lesions. 35,36

    MC lesions can also be congenital when transmitted vertically by contact with MCV in the birth canal.37,38 In this case, lesions are typically located on the scalp and have a circular arrangement.38 Other sites of atypical location,1 in addition to the oral mucosa, include the palms and soles, the areola/nipple,39,40 the conjunctiva,41 lips,42 eyelids,43 among others.44 Clinical presentation of periocular lesions has been described as erythematous, nodular umbilicated, big/giant, conglomerated, inflamed, or pedunculated.45 The periocular presentation has also been associated with conjunctivitis.46

    Diagnosis

    The diagnosis of MC is clinically based on the distinguishing characteristics of the lesions. A useful clinical tool in the diagnosis of MC is dermoscopy,1 which is a widely available tool that enables to observe structures not seen by the naked eye with a 10X magnification. MC display characteristic findings under the dermatoscope: a central pore or umbilication, polylobular white-to-yellow amorphous structures, and peripheral crown vessels (Figure 3).47–49 They can also have rosettes when seen under polarized light. Diagnosis is usually straightforward when typical MC findings are seen; however, some irritated or excoriated cases of MC may be indistinguishable from other tumors.50 Other emerging diagnostic modalities that may aid in the diagnosis of MC include reflectance confocal microscopy (RCM). Under RCM they appear as round, well-circumscribed lesions, with central round-to-cystic areas filled with bright refractile material.51,52

    Figure 3 Dermatoscopic findings of MC. Red arrows: white-to-yellow polylobular structures. Blue arrows: crown vessels. (Polarized-light dermoscopy, original magnification 10×).

    The histopathological study is indicated when the diagnosis is not clear (see differential diagnosis below). The characteristic findings correspond to large intracytoplasmic eosinophil inclusion bodies known as Henderson-Petterson bodies (Figure 4).30

    Figure 4 Large intracytoplasmic eosinophil inclusion bodies called Henderson-Petterson bodies. This photo was provided courtesy of Alejandra Villarroel-Pérez, MD. H&E, 10× magnification.

    The differential diagnoses include mainly inflammatory, infectious, and neoplastic etiologies; they mainly differ according to the age and immunologic status of the patient (Table 2).1 In immunosuppressed patients, the main differential diagnosis includes histoplasmosis and cryptococcosis which can be seen as umbilicated papules.53

    Table 2 Molluscum contagiosum differential diagnosis

    Treatment

    Currently, the need for active treatment in patients with MC is controversial, given the self-limited course of infection, the large number of therapeutic alternatives available, and the lack of evidence to define the best therapy. There is a consensus that treatment should be indicated in patients with extensive disease, secondary complications (bacterial superinfection, molluscum dermatitis, conjunctivitis), or aesthetic complaints.1 A retrospective study54 evaluated the resolution rate of the lesions in treated and untreated MC patients, showing a resolution at 12 months of 45.6% in the treated group and 48.8% in the untreated group. At 18 months, they found a resolution rate of 69.5% and 72.6% in the treated versus the untreated group, respectively. From this cardinal study, it appears that active treatment does not improve the resolution rate when compared to observation alone.

    For all patients, general measures are recommended to prevent the spread of MCV.1–3 It should be advised not to scratch or rub the lesions; besides, patients should not share towels, tub, or bath utensils.

    Active treatments can be classified as 1mechanical, chemical, immunomodulatory, and antiviral.

    Mechanical methods

    Cryotherapy is an effective treatment. It can be applied with a cotton-tipped swab or by portable sprayers, 1 or 2 cycles of 10 to 20 seconds are typically used.2 A prospective, randomized and comparative trial55 evaluated the efficacy of cryotherapy in MC treatment. The study demonstrated a complete clearance in 70.7% of the patients at 3 weeks and in 100% of them at 16 weeks. Another study56 showed full clearance in 83.3% of 60 patients (average age of 20 years) at 6 weeks. In both, the application of cryotherapy was administered weekly. The disadvantages of cryotherapy are the possibility of blistering, scarring, and post-inflammatory hypo or hyperpigmentation.2

    Curettage is also an effective method and involves the physical removal of skin lesions.2 One study showed that of 1,879 children, 70% were cured with one session while 26% needed two sessions, with overall satisfaction of 97% in both parents and children.57 A randomized, controlled trial58 showed a complete clearance with only one curettage session in 80.3% of the patients and without recurrences at 6 months of follow-up. It can be done with a curette, punch biopsy (Figure 5) or with an ear speculum.59,60 To reduce pain, topical application of EMLA (eutectic mixture of local anesthetics), a combination of 2.5% lidocaine and 2.5% prilocaine, may be required 1 hr before the procedure.57,61 Curettage can cause pain, bleeding, and scarring.

    Figure 5 Mechanical removal (curettage) of a molluscum contagiosum with a punch tool. The punch should be positioned in <30° to the skin surface and a shear movement should be performed to remove the molluscum in its entirety.

    After curettage, topical povidone iodine can be applied. This is an antiseptic useful in the treatment of MC based on case reports62 and our experience. A systematic review of 2017 showed that povidone-iodine 10% potentiates the effect of 50% salicylic acid, without adverse effects reported.3 For topical povidone iodine, we propose an application scheme of 3 times a day until the resolution of the cutaneous lesions. We use it routinely after use of other treatment modalities.

    Another useful mechanical method is pulse dye laser therapy, which due to its costs and limited availability is suggested to be left for refractory cases.1,63 It is an effective, safe, and well-tolerated treatment, with infrequent adverse effects.63 Cases of successful use in immunosuppressed patients have also been reported.64

    Chemical methods

    Chemical methods destroy skin lesions through the inflammatory response they produce. Cantharidin is a topical agent, an inhibitor of phosphodiesterase, which produces an intraepidermal blister, followed by resolution of the lesion and healing without a scar in some cases.65 The efficacy of cantharidin in the treatment of MC is variable, with cure rates varying between 15.4% and 100% among the different studies.66,67 It is recommended to apply cantharidin 0.7–0.9% at the site of the lesion, with or without occlusion, and to wash with soap and water 2–4 hrs later, each every 2–4 weeks until the resolution of lesions.2,58,65 In the face and anogenital region it should be used with precaution due to the risk of bacterial superinfection of blisters that form after 24–48 hrs.2,68

    Potassium hydroxide is an alkaline compound that dissolves keratin.2 It has been used in concentrations and therapeutic schemes that vary from 5% to 20%, two times a day or every other day for 1 week or until inflammation develops.69 A recent study70 showed that 10% and 15% potassium hydroxide clear lesions of MC entirely in 58.8% and 64.3% of the patients, respectively. It would be a safe and effective treatment that could be applied by patients, and its effectiveness has been compared with cryotherapy and imiquimod without significant differences.69,71

    Other chemical methods reported are: podophyllotoxin, trichloroacetic acid, salicylic acid, lactic acid, glycolic acid, benzoyl peroxide, and tretinoin.1,2,62

    Immunomodulatory methods

    Immunomodulatory methods stimulate the patient’s immune response against the infection. Imiquimod is an immune-stimulatory agent agonist of the toll-like receptor 7 that activates the innate and acquired immune response.2 It is a useful alternative in the treatment of MC based on case reports and uncontrolled studies.31,72 A prospective, randomized trial55 compared the efficacy of cryotherapy with 5% imiquimod, demonstrating a complete clearance in 100% of the patients at 16 weeks for cryotherapy versus 92% for imiquimod 5% (difference not statistically significant). Cutaneous adverse effects were more frequent in the cryotherapy group. However, a recent systematic review showed that it is not better than placebo in short-term improvement (3 months) or long-term cure (more than 6 months) and may produce adverse effects at the application site such as pain, blistering, scars and/or pigmentary changes.3 The current evidence positions imiquimod as a controversial therapeutic alternative.73

    Other immunomodulatory methods are oral cimetidine, interferon alfa, candidin, and diphencyprone.

    Oral cimetidine is an h3 receptor antagonist that would stimulate the delayed hypersensitivity response.2 It is a safe and well-tolerated drug, and the recommended dose is 25–40 mg/kg/day. It would be more effective in non-facial lesions.1

    Interferon alfa is a proinflammatory cytokine that is used in the treatment of MC in immunosuppressed patients with severe or refractory disease. It can be administered subcutaneously or intralesionally.74–76

    Candidin is intralesional immunotherapy derived from the purified extract of Candida albicans. It is an alternative in the treatment of MC, being applied purely or diluted at 50% with lidocaine in a dose of 0.2–0.3 mL intralesional every 3 weeks.2 A retrospective study evaluating the efficacy of candidin in the treatment of MC showed a complete resolution rate of 55% and a partial resolution of 37.9%, with an overall response rate of 93%.77

    Diphencyprone is a topical immunomodulator used in multiple skin diseases. Cases of successful treatment with diphencyprone have been reported in immunosuppressed and immunocompetent patients.78,79

    Antivirals

    Another method used in immunosuppressed patients with extensive or refractory disease is cidofovir, an antiviral drug initially used in cytomegalovirus retinitis in HIV patients. It can be used topically at a concentration of 1–3% or intravenously.80–82 The major problem with intravenous administration is nephrotoxicity.83

    New therapies

    New MC treatments include topical sinecatechins,84 intralesional 5-fluorouracil,85 hyperthermia,86 and zoster immune globulin.87 Evidence is preliminary to determine the effectiveness of these therapies.

    Conclusion

    MC is a frequent reason for consultation in dermatology and the decision to treat or not should be considered for each patient, taking into account its self-limited course and benign nature. There are multiple treatment alternatives with variable efficacy; risks and benefits should be balanced and discussed on a patient-by-patient basis. From our point of view, and based on the available evidence, it appears that curettage with or without topical anesthesia, or the application of 0.7% cantharidin, are the most cost-effective alternatives. Currently, a series of investigations are being carried out to determine the effectiveness of the available treatments and find new therapeutic options.

    Ethical concerns

    The figures presented in this article were taken from patients in our center, not from books or other articles, and the parents authorized their publication in all cases.

    Acknowledgment

    We would want to thank Alejandra Villarroel-Pérez, MD, for her collaboration with histopathological images of MC.

    Disclosure

    The authors do not have any conflicts of interest to declare in this work.

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    65. Moye V, Cathcart S, Burkhart CN, Morrell DS. Beetle juice: a guide for the use of cantharidin in the treatment of molluscum contagiosum. Dermatol Ther. 2013;26(6):445–451. doi:10.1111/dth.12105

    66. Ting PT, Dytoc MT. Therapy of external anogenital warts and molluscum contagiosum: a literature review. Dermatol Ther. 2004;17(1):68–101.

    67. Vakharia PP, Chopra R, Silverberg NB, Silverberg JI. Efficacy and safety of topical cantharidin treatment for molluscum contagiosum and warts: a systematic review. Am J Clin Dermatol. 2018;19(6):791–803. doi:10.1007/s40257-018-0375-4

    68. Rush J, Dinulos JG. Childhood skin and soft tissue infections: new discoveries and guidelines regarding the management of bacterial soft tissue infections, molluscum contagiosum, and warts. Curr Opin Pediatr. 2016;28(2):250–257. doi:10.1097/MOP.0000000000000334

    69. Can B, Topaloglu F, Kavala M, Turkoglu Z, Zindanci I, Sudogan S. Treatment of pediatric molluscum contagiosum with 10% potassium hydroxide solution. J Dermatolog Treat. 2014;25(3):246–248. doi:10.3109/09546634.2012.697988

    70. Teixido C, Diez O, Marsal JR, et al. Efficacy and safety of topical application of 15% and 10% potassium hydroxide for the treatment of Molluscum contagiosum. Pediatr Dermatol. 2018;35(3):336–342. doi:10.1111/pde.13438

    71. Metkar A, Pande S, Khopkar U. An open, nonrandomized, comparative study of imiquimod 5% cream versus 10% potassium hydroxide solution in the treatment of molluscum contagiosum. Indian J Dermatol Venereol Leprol. 2008;74(6):614–618.

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    75. Kilic SS, Kilicbay F. Interferon-alpha treatment of molluscum contagiosum in a patient with hyperimmunoglobulin E syndrome. Pediatrics. 2006;117(6):e1253–e1255. doi:10.1542/peds.2005-2706

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    90,000 Molluscum contagiosum in children – causes, symptoms, diagnosis and treatment of molluscum contagiosum in a child in Moscow at the SM-Doctor clinic

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    Contents:
    General information
    Symptoms in children
    Reasons
    Diagnosis
    Treatment
    Prophylaxis

    Molluscum contagiosum is a viral infection with characteristic skin manifestations.More often children under 10 years old and adults from 20 to 30 years old are ill. Pediatricians and dermatologists are involved in the treatment of the disease.

    General

    Molluscum contagiosum in children as a pathology is noted in the international classification of diseases (ICD-10) under the code B08.1. The chronic form of the disease in adolescents is a reason for postponement or sometimes denial of military service.

    With tense immunity, the disease goes away on its own in 3-6 months. If the immune system is weak, if left untreated, the pathology becomes chronic.

    Treatment of molluscum contagiosum in children, if started on time, is generally successful. The prognosis is good, complications and relapses are rare. Coping with the disease is easy – it is important to strengthen children’s immunity.

    Symptoms of molluscum contagiosum

    After the virus enters the body, it can take from 2 weeks to six months before the disease manifests itself. The pathology is characterized by rashes, which outwardly resemble ordinary papules (pimples) of a flesh color.Lumps resemble nodules or subcutaneous balls. In shade, they almost do not differ from the main color of the skin, although they may be slightly whiter. Pearl-colored top. As the nodule develops, an impression appears in the center, resembling a “navel”.

    Pimples are solitary or merge into groups. They are located mainly on the face, on the skin of the upper body. Less common on the legs, thighs, or buttocks. If you crush the bubble, a dry curd mass will stand out from it.

    It is impossible to say for sure what the danger of molluscum contagiosum in a child is. Rashes do not bother children. They do not itch, do not cause pain, do not fester or become inflamed. Secondary infection and infection can occur only when the contents of the vesicles are squeezed out, so it is better not to do this and not allow the child to scratch the rash.

    Causes of molluscum contagiosum

    Molluscum contagiosum is caused by a virus of the same name. There are 4 types, but the pathology is more often provoked by the 1st and 2nd types.The microorganism belongs to the group of smallpox viruses and is dangerous only for humans: animals are insensitive to it.

    Rashes on the face and body in children are usually caused by a type 1 virus. Infection with the second type, as a rule, manifests itself in the form of characteristic rashes in the genital area. Both microorganisms are characterized by a long incubation period of up to six months.

    Virus transmission in children occurs through contact. If there is a sick child in the team, other babies are more likely to catch the virus.Infection is carried out in the following ways:

    • through personal hygiene products;
    • when swimming in a common pool, pond;
    • by inhalation of dust (the virus remains well in the ground, dust).

    Weakened immunity, poor hygiene, allergic reactions, treatment with immunosuppressants, dermatological diseases increase the risk of infection. Shellfish is especially dangerous for HIV-positive children.

    Diagnosis of molluscum contagiosum

    The disease is difficult to identify on your own, since the nodules on the skin resemble common pimples.If the rash is single, adults most often do not pay attention to these signs and believe that they will go away on their own.

    Only experienced doctors work in the “CM-Doctor” clinic, who can easily make a correct diagnosis even at the first appointment.

    To confirm the diagnosis, a skin scraping is taken and the material is examined under a microscope. When infected with a virus, mollusc bodies are visible in the cytoplasm of the cells.

    A diagnosis of molluscum contagiosum does not mean that the child has serious health problems.It is necessary to treat not only the skin, but also to strengthen the immune system so that the body can cope with the pathogen itself.

    Treatment of contagious molluscum

    If in adults with strong immunity, the disease can not be treated, then children need a course of therapy. After consulting a pediatrician, the child should visit a dermatologist.

    How to treat molluscum contagiosum in children depends on the doctor’s choice:

    • You can remove the contents of “acne” with tweezers and a sharp spoon. After the procedure, the affected areas are smeared with iodine.
    • Can be cauterized with laser or current. This method of removing the pathogen is called diathermocoagulation.
    • You can cauterize rashes with dry ice or liquid nitrogen.

    If the rash occupies significant areas of the body, systemic therapy is indicated – immunostimulating medications and antibiotics. Children under 10 years of age are prescribed only immunomodulators, since antibiotics of the tetracycline series are contraindicated for them.

    It is impossible to completely get rid of the virus due to the peculiarities of the structure and vital activity of the microorganism.Medicines can only strengthen the immune system and quickly remove the external signs of the disease. Microorganisms remain in the human body for life. To avoid further relapses, you need to monitor your health, eat well, and strengthen your immune system. Parents need to teach their baby to be hygienic and healthy.

    Important! You cannot treat mollusc with folk remedies: herbs, moxibustion. Such measures only increase the affected area on the skin. It is better to see a doctor and get traditional treatment with proven effectiveness.

    Prevention of contagious molluscum

    It is difficult to avoid contracting the virus. This can happen at any time, since a sick person may be nearby in transport, meet when visiting a hospital and other public institutions, while using a swimming pool, etc. But a strong immune system will prevent the development of the disease.

    You can protect a child from the virus by observing preventive measures:

    • Replenish the baby’s diet with fruits and vegetables, adhere to proper nutrition;
    • take vitamin complexes;
    • to ventilate the room more often, to walk in the fresh air;
    • 90,033 exercise;

      90,033 avoid crowded places;

    • monitor the health of the child and treat viral diseases in time;
    • observe the rules of hygiene;
    • to use individual means to care for your body.

    Molluscum contagiosum in children is not dangerous, its manifestations are easily cured. But in order to avoid relapses in the future, you need to monitor the immune system, not to overcool, eat well and lead a healthy lifestyle. In the SM-Doctor clinic, experienced specialists will quickly and reliably establish a diagnosis, prescribe the most effective treatment regimens and recommend measures to prevent relapse.

    Doctors:

    Children’s clinic m.Marina Grove

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    Children’s Clinic Metro Voykovskaya

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    Children’s clinic m.Novye Cheryomushki

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    Children’s Clinic Metro Tekstilshchiki

    Bozunov Alexey Viktorovich

    Pediatric Dermatologist, Pediatric Mycologist

    Smoleva Maria Borisovna

    Pediatric dermatologist of the highest category, pediatric mycologist, pediatric trichologist, pediatric cosmetologist

    Korolkova (Simonovich) Polina Askoldovna

    Pediatric Dermatologist, Pediatric Trichologist, Pediatric Mycologist

    Zueva Ksenia Mikhailovna

    Pediatric dermatologist II category, pediatric mycologist, pediatric trichologist

    Ryazantsev Vyacheslav Viktorovich

    Children’s dermatologist, children’s mycologist, Ph.M.Sc.

    Chekrygina Marina Vyacheslavovna

    Children’s dermatologist, children’s mycologist, doctor of the highest category.Deputy Chief Physician for Medical Affairs in the Children’s Department at

    Volgogradsky Prospect

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    Children’s clinic m.Youth

    Kamurzaeva Madina Batarbekovna

    Pediatric Dermatologist, Pediatric Mycologist

    Didoruk Vitaly Alexandrovich

    Pediatric Dermatologist, Pediatric Mycologist

    Great Dane Albert Mukhamedovich

    Pediatric Dermatologist, Pediatric Mycologist, Pediatric Trichologist

    Gromov Mikhail Sergeevich

    Pediatric Dermatologist, Pediatric Mycologist

    Arshinova Daria Yurievna

    Pediatric allergist-immunologist, pediatric dermatologist, pediatric mycologist

    Garanina Irina Yurievna

    Pediatric dermatologist, pediatric mycologist, pediatric trichologist, category I doctor

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    Children’s clinic m.Chertanovskaya

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    Children’s Clinic, Moscow VDNKh

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    Children’s clinic in g.Solnechnogorsk, st. Red

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    Molluscum contagiosum – symptoms, treatment, causes of the disease, first signs

    Description

    Molluscum contagiosum is a viral disease that is manifested by the formation of nodules on the skin and mucous membranes.The disease occurs at any age, mainly in children and adolescents. In adults and the elderly, morbidity is often associated with a decrease in immunity, for example, while taking hormonal and anticancer drugs or in HIV-infected people.

    The virus that causes the disease got its name from its external resemblance to a bit early, and the word “contagious” is translated as “infectious”. Molluscum contagiosum has a contact type of transmission, that is, infection occurs through bodily contact with a sick person or a carrier of the virus – in the pool, during contact sports, and also indirectly through household items of common use – towels, clothes, children’s toys, bedding.Among young people, the sexual type of infection is common.

    The disease is caused by 4 types of molluscum contagiosum virus, which differ slightly from each other. However, the first type (which is called “childhood”) is found in patients most often – more than 95% of cases of molluscum contagiosum. The second type of virus is specific for the sexual type of transmission of the disease – it accounts for about 3% of all cases. In the body, the virus multiplies exclusively in the epithelial cells, therefore it does not cause any serious complications.Currently, molluscum contagiosum is successfully amenable to drug therapy at any stage of the development of the disease.

    After infection, until the first manifestations of the disease, it takes from one week to several months. During this time, the virus that has penetrated into the epithelial cells multiplies in sufficient quantity to trigger an immune response. Usually, elements of molluscum contagiosum in adults can disappear on their own after a few months, even in the absence of treatment. However, children have a long course – from six months to 5-6 years.

    Symptoms

    Photo: rd.com

    Rashes with molluscum contagiosum can occur anywhere on the skin except the palms and plantar surfaces of the feet. In children, most often, nodules are located on the skin of the face, neck, in the armpits, at the top of the chest and on the back of the hands. In adults, the most common localization of elements is the lower abdomen, inner thighs and the skin of the genitals.

    The elements of molluscum contagiosum are small nodules, 1-2 millimeters in size in the shape of a hemisphere, but rapidly increase to 5-7 millimeters.May be slightly flattened at the top. The nodules are dense and painless to the touch. The color can be that of normal skin or a pale pink. Often the nodules have a waxy sheen and a depression in the center. On the skin, the nodules are isolated from each other. The skin under the nodules is of normal color; a red, inflammatory rim is rarely seen. When squeezed on the sides, a white curdled mass is released from the nodule, which consists of dead epithelial cells and leukocytes. The number of nodules on the body varies from a couple of pieces to several dozen.Rashes are extremely rarely accompanied by any unpleasant sensations and give the patient an exclusively cosmetic problem.

    The medical literature describes atypical rare forms of molluscum contagiosum, which include:

    • Cystic molluscs – cysts of the same size appear at the site of the nodule;
    • Shellfish that look like acne or warts;
    • Keratinous molluscs – in place of a mollusk, the skin is heavily peeling, and skin scales constantly fall off from it;
    • Ulcerated molluscs – an area of ​​erosion appears at the site of the nodule, which quickly turns into a bleeding sore;
    • Pedicular molluscs – in this type of disease, the nodule is located above the surface of the skin on a thin stalk;

    Giant molluscs – nodules greatly increased in size (up to 30 millimeters or more)

    Diagnostics

    Photo: shareably.net

    The diagnosis of molluscum contagiosum is based on the data of the clinical picture – the detection of specific nodules on the patient’s skin. However, in cases of atypical forms, a scraping of the elements will be required for microscopic examination. Using special dyes, under a microscope, large brick-shaped viral bodies are found in epithelial cells.

    For the differential diagnosis of molluscum contagiosum, such skin diseases as: vulgar warts, flat warts, keratoacanthomas, milium, acne are excluded.

    Treatment

    Photo: 1obl.ru

    Treatment of molluscum contagiosum has two goals: to combat skin manifestations and to avoid relapses of the disease. Since there is a possibility of the spread of the mollusk to healthy areas of the skin from existing nodules, it is necessary to treat all elements at the same time. During treatment, the patient should not shave to avoid the spread of the shellfish.

    Molluscum contagiosum is treated on an outpatient basis. For adult patients without impaired immunity, various methods of destruction of the mollusk are shown for the fastest recovery.For this purpose, methods such as:

    • Evisceration, or hulling – using fine tweezers to remove the mollusc. This method is recommended for fresh elements and allows you to obtain material for laboratory research.
    • Curettage – removal of the affected epithelium is carried out using a curette. This method is painful for the patient and can lead to scarring in the future. With a large number of rashes, the method is ineffective, since it can lead to the appearance of new elements.
    • Electrocoagulation – moxibustion of shellfish using an electrocoagulator. The method is highly effective due to the point effect of electric current.
    • Laser therapy – with the help of a laser tuned to a certain mode, the elements of molluscum contagiosum are destroyed. After laser therapy, it may be necessary to repeat the procedure after 2-3 weeks if the rash persists.
    • Cryotherapy – exposure of each element of contagious molluscum with liquid nitrogen for 15 seconds.A rather painful procedure, after which blistering at the site of exposure is possible, as well as a violation of skin pigmentation and the appearance of subtle scars.

    When using any method of destruction of elements of molluscum contagiosum, the use of local anesthesia is indicated to reduce the pain and discomfort of the patient. After removing the shellfish, the skin is treated with antiseptic solutions.

    People suffering from molluscum contagiosum and having impaired immunity due to other common diseases should be extremely careful about methods that violate the integrity of the skin, as they can lead to infectious complications.When treating a disease in the genital area, frequent changes of underwear are necessary to avoid re-infection.

    In young children, with a small number of rashes, treatment can be limited to the topical application of various creams, ointments and antiviral drugs. But this practice is not always effective and parents, after a while, have to agree to a small, but still surgical intervention. In modern clinics, a plaster is glued to the place of removal of the mollusk, which contains an anesthetic, and after 40-60 minutes, when the drug works, the element is destroyed according to one of the above methods.In this case, the procedure is completely painless and low-traumatic, including for the psyche of the child and parents.

    Medicines

    Photo: chinastudy.it

    After the destruction of the molluscum contagiosum element, solutions of iodine, brilliant green, fucorcin are used for reliable and relatively long-term skin disinfection.

    For the treatment of molluscum contagiosum, topical agents containing antiviral and immunomodulatory components can be prescribed.For example:

    • Cycloferon, Viferon, Infagel. The agent has an anti-inflammatory effect and inhibits the ability of the virus to multiply. Effective in the fight against viruses of contagious molluscum, herpes, as well as infectious diseases of the oral cavity and genitals. It is applied twice a day for a week.
    • Imiquad. An immunostimulant cream that enhances the production of interferons in the body – special substances necessary to fight a viral infection.Apply to previously cleansed skin and do not rinse for a long time, for example at night.
    • Oxolinic ointment. Has a pronounced antiviral effect. It is applied two to three times a day until the elements of molluscum contagiosum disappear.
    • Acyclovir. In the form of an ointment, it is also applied to the nodules 2-3 times a day until recovery. Used in children from 3 years of age. To enhance the antiviral effect, it can be used in a mixture with oxolinic ointment in a 1: 1 ratio.

    To strengthen the immune system and better fight infection for internal use, the following can be prescribed:

    • Isoprinosine tablets.The medicine has anti-inflammatory and immunomodulatory properties, helps the body fight infection.
    • Viferon in the form of candles. Has similar effects. Convenient for children.

    Acyclovir and other antiviral agents are prescribed only to patients with impaired immunity.

    Folk remedies

    Photo: kräutererleben.at

    Traditional medicine has long been familiar with molluscum contagiosum and its treatment methods. To get rid of rashes, used:

    • Celandine juice.From a freshly plucked stalk of celandine, juice is applied directly to the mollusks once a day until complete recovery. This tool should be used with great care, since celandine contains poisonous components.
    • Broth from a string. Bring two tablespoons of dry string to a boil in 250 ml of water, let it brew for an hour and filter. The resulting broth is used within a week, wiping the area of ​​the rash three times a day.
    • Garlic. The head of garlic, ground to a state of gruel, is mixed with butter in a 1: 1 ratio.Before use, warm the oil to room temperature, lubricate the rash three times a day. If the skin is not sensitive to garlic, only the juice of this plant can be used for rubbing.
    • Alcohol tincture of calendula copes well with infection and prevents the development of bacterial complications.
    • Various oils and ointments based on eucalyptus extract can also be used to lubricate rashes.
    • After surgery, bird cherry juice will help to restore the integrity of the skin and prevent scarring.It has good regenerating properties and promotes rapid healing. The cherry juice is squeezed out of the leaves of the plant. It is recommended to take fresh juice for each new use, but it is also permissible to store it in the refrigerator for several days.
    • If you have potassium permanganate powder somewhere in your stocks, then a strong solution from it is suitable to fight molluscum contagiosum. The rash should be lubricated 2 times a day for a week.
    • Like celandine juice, nodules are processed from freshly picked stems and dandelion leaves with juice 2-3 times a day.Also, an alcoholic tincture can be prepared from the roots of dandelion, which should be used to treat large areas of rashes.
    • Herbal decoction. For its preparation, calendula, eucalyptus, juniper berries, pine shoots, birch buds, yarrow grass are used. Everything is taken in equal proportions, crushed to a homogeneous mass and thoroughly mixed. A fresh broth is prepared every day. A pinch of the mixture is needed for a glass of water. Bring to a boil, let cool. Take inside half a glass at a time, twice a day, and also lubricate the rash with gauze dipped in broth.

    Herbal tincture. Walnut leaves, calendula and celandine are mixed in equal proportions. After grinding, the mixture is poured with vodka in a ratio of 1: 3. In a dark cool place, it is infused for 3-4 weeks, after which the rash is smeared with the finished tincture 4 times a day.

    The information is for reference only and is not a guide to action. Do not self-medicate. At the first symptoms of the disease, see your doctor.

    Your comments on symptoms and treatment

    An uninvited guest who looks like a shellfish / Health / Nezavisimaya Gazeta

    An infectious skin disease that can be fought mechanically

    This is what a virus looks like under a microscope.Photo from the site www.herpes-coldsores.com

    What is molluscum contagiosum? Why does this ailment, which is quite common in recent years, arise and how does it manifest itself? What is the treatment? These questions concern many people, primarily parents. The fact is that this ailment mainly affects children and adolescents. However, adults are also often sick.

    Molluscum contagiosum is an infectious skin disease caused by a virus of the same name.It is characterized by rashes in the form of small neoplasms – painless nodules, similar to acne. When pressed, a white curdled mass is released from them, which is a source of infection.

    If we look at it under a microscope, then bodies are clearly visible, resembling a mollusk shell. Hence the name of the disease.

    Most often, a child becomes infected with it upon contact with a sick person, but pathogens can also be transmitted through toys, bedding, and hygiene items.Molluscum contagiosum also occurs in adults, and they often become infected with it during intimacy.

    The introduction of molluscum contagiosum into the skin occurs against the background of a decrease in the activity of the body’s defenses. The incubation (latent) period is usually 2-3 weeks, and sometimes more. The development of the disease can take place in several stages.

    The first (typical) is characterized by the presence on the body of a small number of nodules that are far from each other and do not cause much concern to the person.The second (generalized) is characterized by an increase in their number and distribution in different areas of the skin. The third stage (complicated) develops in the case of a bacterial infection. In this case, the skin around the nodules turns red, they become painful and pus is released from them when pressed.

    In children, nodules often appear on the face, neck, and hands. The spread of nodules to other parts of the body occurs due to scratching them when itching or rubbing against clothing.In adults who become infected through sexual contact, the picture is different: the nodules are located on the external genitals, thighs, and in the lower abdomen.

    Neoplasms have a flesh or pearlescent color, they can be dense and not very. The nodules are small, like grains, and large, like peas. Sometimes they merge, in which whole plaques are formed up to 3 cm in diameter.

    The typical picture of the disease is contagious
    shellfish.Illustration from the book Thomas
    Bateman, Description of Skin Diseases,
    London, 1817

    Rashes with molluscum contagiosum sometimes resemble the manifestations of another infectious skin disease – acrochordon. Therefore, an accurate diagnosis can only be made by a dermatologist.

    In order to determine the signs of molluscum contagiosum, an experienced specialist only needs to look at the rash. However, laboratory analysis is required for complete confidence in the initial diagnosis.For this purpose, the contents of the nodule are examined under a microscope. If at the same time, along with the keratinized epithelium (skin tissue), mollusc bodies are found, then the diagnosis made during the examination of the patient is confirmed.

    The treatment that the doctor prescribes is selected taking into account the individual characteristics of the body of a particular person and the extent of the lesion of his skin with molluscum contagiosum.

    First of all, it consists in the mechanical removal of nodules using a special tool or laser.In addition, antiviral ointments are prescribed, as well as immunostimulants.

    Prevention consists in observing the rules of personal hygiene, in particular, regularly changing underwear, as well as keeping the home clean. Since children are often infected in kindergarten or school, it is necessary to carefully examine them after returning home in order to recognize the ailment in time. As for adults, they should avoid casual relationships that can lead to illness.Well, the main recommendation is to try to strengthen your immunity as much as possible. To do this, you need to eat rationally, be in the fresh air more often, do not forget about hardening and engage in physical education and sports.

    Molluscum contagiosum – treatment, removal

    Molluscum contagiosum is characterized by special manifestations on the skin.

    Molluscum contagiosum symptoms.

    Localization of rashes with molluscum contagiosum has its own specifics.The rashes are characterized by specific papules with a characteristic umbilical depression, a dot on the top of the pimple, when they are squeezed out, a thick content is released – the body of a mollusk, round in shape. Molluscum contagiosum in size can vary greatly from 1 millimeter to 8-10 mm.

    How do we get infected with molluscum contagiosum?

    So in adults, rashes are mainly found in the lower abdomen, genitals. For adults, as a rule, infection during sexual intercourse is characteristic, but the household route of transmission in adults is not excluded.There is a high probability of getting infected when using personal belongings of a sick person, personal belongings, towels, bed linen. In children, the rash, on the contrary, is localized in open areas of the body, this is the face, arms, trunk. For children, infection is characteristic during close household contacts, in a team, in a swimming pool, through contaminated toys, and handshakes.

    Invisible small pimples.

    Although molluscum contagiosum is characterized by specific eruptions, it often goes unnoticed.Many people do not pay attention to them, considering them just pimples , and do not consider the need for treatment. At the same time, they are a source of infection and infect others and loved ones. Therefore, it is possible to identify molluscum contagiosum with a careful medical examination.

    Molluscum contagiosum – AIDS associated infection.

    There were cases when molluscum contagiosum was confused with both benign neoplasms and malignant tumors, warts and other skin diseases, some of which, if untreated, are dangerous to humans.Note that molluscum contagiosum is an AIDS-associated infection, and is often detected in patients with HIV. Therefore, each patient must contact a dermatologist – venereologist and be tested for sexually transmitted diseases.

    What Causes Molluscum Contagiosum?

    Molluscum contagiosum disease occurs only in humans. The causative agent is a special virus Molluscipoxvirus from the smallpox family. The disease is widely reported around the world. Contagious molluscum in Kharkov is also detected and quite often.The disease is highly contagious. Often we are faced with outbreaks in children’s groups, as well as in both sexual partners or during medical examinations.

    How to avoid the appearance of new rashes?

    The disease is characterized by a chronic, recurrent course. However, relapses can be completely avoided. In this case, the patient needs to be regularly monitored by a dermatologist, be sure to remove molluscum contagiosum and not forget about strengthening overall health.Since the occurrence of relapses of the disease is facilitated by a reduced immune defense. Sometimes molluscum contagiosum may resolve spontaneously without treatment. But in most of the sick, the rash persists for quite a long time. In this case, you need to consult a dermatologist.

    Molluscum contagiosum – treatment.

    The main method of treatment is cryotherapy – treatment of molluscum contagiosum with liquid nitrogen. The procedure is painless, no injections are required.After treatment, traces and scars are not formed.

    What about sex life?

    Since molluscum contagiosum can be transmitted through sexual intercourse, sex can only be continued after treatment and removal of all molluscs on the skin.

    Molluscum contagiosum – prophylaxis.

    Be sure to follow the rules of personal hygiene. A person who has been diagnosed with mollusks on the skin must be isolated from the team. Obligatory change of underwear and bed linen.Only personal belongings, towels, washcloths, etc. should be used. It is necessary to take a shower every day and especially after a bath, sauna, swimming pool, sexual intercourse.

    In the Anonymous Center you can consult a dermatologist and undergo treatment for molluscum contagiosum and, if necessary, remove it.

    Stopmollux solution for local application 5% 5ml for removing molluscum contagiosum

    Composition

    5% potassium hydroxide

    Form of issue

    Solution 5 ml

    Pharmacological action

    Molluscum contagiosum is a benign viral skin disease characterized by the appearance on the skin, less often on the mucous membranes of hemispherical nodules ranging in size from a pinhead to a pea with a central umbilical depression.

    The causative agent is the contagious molluscum virus (Molluscum contagiosum virus).

    The disease is ubiquitous and affects a person at any age (in the overwhelming majority of cases, the disease affects children under 12 years of age).

    Infection occurs through direct contact with a sick person or a virus carrier, or indirectly through personal and household items.

    The incubation period is 2 weeks to 6 months.

    The prevalence of the disease in various countries is from 1.2% to 22% of the population.

    In older children, infection occurs when visiting a swimming pool or engaging in contact sports.

    Children suffering from eczema or atopic dermatitis who are treated with GCS are more likely to get sick.

    In young people, BM infection often occurs through sexual contact.

    In middle-aged and elderly people, long-term use of glucocorticosteroid drugs, cytostatics, immunosuppressive drugs can be a provoking factor in the development of the disease.

    CM elements can be located on any part of the skin.

    These are nodules 0.1–0.2 cm of a hemispherical or flattened shape, dense, painless, normal skin color or pale pink, with a waxy sheen, with an umbilical depression in the center.

    Nodules rapidly increase in size up to 0.5–0.7 cm and are isolated on unchanged skin.

    When the nodules are squeezed from the sides, a white, crumbly (mushy) mass is released from the central opening, consisting of degenerative epithelial cells and virus particles.

    The number of elements of the rash is different: from 5-10 to several dozen or more.

    Children have a long history of CM (from 6 months to 5 years) as a result of autoinoculation of the causative agent of the disease.

    Molluscum contagiosum is an infectious disease of viral etiology.

    And it can disappear spontaneously, but there is always a danger of transmitting the infection to other people, so all patients require treatment!

    Despite numerous treatment options, there is still no specific antiviral therapy for molluscum contagiosum.

    Destruction of molluscum contagious elements is the main direction of therapy in the Russian Federation at the present time. Suggested methods of destruction: curettage, cryotherapy, evisceration (husking), laser therapy, electrocoagulation. These methods are usually painful, can leave scarring and lead to relapses.

    Taking into account the possibility of autoinoculation, it is necessary to remove all elements of molluscum contagiosum, for which, before the therapy, the entire surface of the patient’s skin should be examined, paying attention to the folds of the skin.

    Indication for use

    Solution for removing molluscum contagiosum STOPMULLUSK is intended for application to the surface of skin lesions caused by molluscum contagiosum.

    Methods of administration and dosage

    1. Open the bottle by pushing down on the cap and turning the cap counterclockwise. Remove excess solution from the applicator on the edge of the bottle neck to prevent drops of solution from falling. 2.Using the applicator, apply a small amount of the solution to the area affected by molluscum contagiosum, avoiding excess on healthy skin.Let the solution soak and dry for 1-2 minutes. The applicator should be re-immersed in the solution after every 2-3 applications (applications). Be sure to close the cover securely after each use. 3. Apply the solution using the applicator 1-2 times a day (morning and evening) to areas affected by molluscum contagiosum for several days, until inflammation (redness) appears on these areas. This usually takes 2 to 10 days. After the appearance of inflammation (redness), stop applying the STOPMOLLUSK solution.Inflammation indicates that the molluscum contagiosum will disappear after 2-6 weeks. A tingling sensation is often felt when applying the solution. If more pronounced symptoms of burning or irritation of healthy skin tissues (around the lesion caused by molluscum contagiosum) appear, stop using STOPMOLLUSK solution and seek medical advice. Before applying the solution to many areas affected by molluscum contagiosum, it is recommended to first apply the solution to 2-3 areas to check the skin response.4.Do not apply the product to areas affected by molluscum contagiosum with signs of inflammation or secondary infection. 5. It is forbidden to apply the solution to the same area affected by contagious molluscum for a period exceeding 14 days. If the positive results of treatment do not appear, see your doctor.

    Contraindications

    It is forbidden to use the solution in the following cases: – for children under the age of 2 years; – on the mucous membranes or around the eyes; – if you are allergic to any of the components of the solution; – on areas of the skin affected by molluscum contagiosum with signs of secondary infection and inflammation; – on common warts or other skin lesions.If you have any doubts or questions, seek the advice of your doctor. Warnings and precautions for use: This medical device may irritate healthy skin tissues if misused. The solution should be applied exclusively to the skin area affected by molluscum contagiosum. Do not let the solution come into contact with healthy skin! It is forbidden to apply the solution to the mucous membranes or to the areas around the eyes. We strongly recommend that nursing mothers do not apply the solution to areas of the body that may come into contact with the baby’s skin.It is not recommended to use the solution by patients suffering from acute atopic eczema, as well as those with defects in the immune system. If the solution comes in contact with the skin around molluscum contagiosum, flush the skin with water. In case of contact with eyes, rinse with plenty of water and seek medical attention. If on fingers, do not touch eyes or mucous membranes. Wash your hands immediately.

    Side effects

    Like all chemically active products, this solution can cause side effects of varying degrees, in particular a burning sensation or temporary irritation.After the disappearance of molluscum contagiosum, hyperpigmentation or hypopigmentation may occur. These phenomena disappear over time. Be sure to inform your doctor about any side effects or irritants not listed in this leaflet.

    Storage conditions

    Store the solution bottle upright. Use the solution within a month after opening the bottle. Store the solution at 15 to 25 ° C.

    Stopmollusk solution for local approx.to remove contagious shellfish fl. 5ml

    The first available remedy for the removal of molluscum contagiosum without pain and scarring
    – Can be used from 2 years old
    – Provides effective destruction of molluscum contagiosum rashes in 2 to 10 days
    – Suitable for home use
    – Healing of elements proceeds without scarring even with atopic dermatitis
    – Easy to use for multiple rashes
    – Minimum relapses
    – The shape of the applicator allows you to apply the solution to small elements of rashes
    – Available at the price of

    Roster

    Like all chemically active products, this solution can cause side effects of varying degrees, in particular, a burning sensation or temporary irritation.
    After the disappearance of molluscum contagiosum, hyperpigmentation or hypopigmentation may occur. These phenomena disappear over time. Be sure to inform your doctor about any side effects or irritants not listed in this leaflet.

    1. Point delivery of KOH to the center of the papule of molluscum contagiosum (chemical exposure).
    2. Development of local inflammation.
    3. Destruction of the protein and lipid envelope of the virus.
    4. In response to inflammation, a local immune response is stimulated, which leads to the natural disappearance of molluscum contagiosum.
    Potential consumers of a medical device are patients with skin lesions caused by molluscum contagiosum over the age of 2 years.

    solution for removal of contagious molluscum STOPMULLUSK is intended for application to the surface of skin lesions caused by contagious molluscum.

    1. Open the bottle by pushing down on the cap and turning the cap counterclockwise. Remove excess solution from the applicator on the edge of the bottle neck to prevent drops of solution from falling.2.Using the applicator, apply a small amount of the solution to the area affected by molluscum contagiosum, avoiding excess on healthy skin. Let the solution soak and dry for 1-2 minutes. The applicator should be re-immersed in the solution after every 2-3 applications (applications). Be sure to close the cover securely after each use.
    3. Apply the solution using the applicator 1-2 times a day (morning and evening), to areas affected by molluscum contagiosum, for several days, until inflammation (redness) appears on these areas.This usually takes 2 to 10 days. After the appearance of inflammation (redness), stop applying the STOPMOLLUSK solution. Inflammation indicates that the molluscum contagiosum will disappear after 2-6 weeks. A tingling sensation is often felt when applying the solution. If more pronounced symptoms of burning or irritation of healthy skin tissues (around the lesion caused by molluscum contagiosum) appear, stop using STOPMOLLUSK solution and seek medical advice. Before applying the solution to many areas affected by molluscum contagiosum, it is recommended to first apply the solution to 2-3 areas to check the skin response.
    4. Do not apply the product to areas affected by molluscum contagiosum with signs of inflammation or secondary infection.
    5. It is forbidden to apply the solution to the same area affected by contagious molluscum for a period exceeding 14 days. If the positive results of treatment do not appear, see your doctor.

    Like all chemically active products, this solution can cause side effects of varying degrees, in particular, a burning sensation or temporary irritation.
    After the disappearance of molluscum contagiosum, hyperpigmentation or hypopigmentation may occur. These phenomena disappear over time. Be sure to inform your doctor about any side effects or irritants not listed in this leaflet.

    it is prohibited to use the solution in the following cases:
    – for children under the age of 2 years;
    – on mucous membranes or around the eyes;
    – if you are allergic to any of the components of the solution;
    – on areas of the skin affected by molluscum contagiosum with signs of secondary infection and inflammation;
    – on common warts or other skin lesions.

    If you have any doubts or questions, seek the advice of your doctor.

    Warnings and precautions for use:

    • This medical device, if used incorrectly, may irritate healthy skin tissues. The solution should be applied exclusively to the skin area affected by molluscum contagiosum.
    • Do not let the solution come into contact with healthy skin!
    • It is forbidden to apply the solution to the mucous membranes or to the areas around the eyes.
    • We strongly recommend that nursing mothers do not apply the solution to areas of the body that may come into contact with the baby’s skin. It is not recommended to use the solution by patients suffering from acute atopic eczema, as well as those with defects in the immune system.
    • If solution comes in contact with the skin around molluscum contagiosum, flush skin with water.
    • In case of contact with eyes, rinse with plenty of water and seek medical advice.
    • In case of contact with fingers, do not touch eyes or mucous membranes.Wash your hands immediately.

    In order to avoid unwanted interactions with other drugs, be sure to inform your doctor or pharmacist about other drugs you are using.

    class = “h4-mobile”>

    Store the solution bottle upright. Use the solution within a month after opening the bottle. Store the solution at 15 to 25 ° C. Shelf life: the solution is 2 years.

    List of surgical operations

    Service code Name of operation Difficulty
    Skin, subcutaneous fat, skin appendages
    A11.01.001 Skin biopsy 1
    A11.01.005 Biopsy of nodules, tofus 1
    A16.01.001 Removal of superficial foreign bodies 1
    A16.01.002 Opening panaritium 3
    A16.01.003 Necrectomy 2
    A16.01.004 Surgical debridement of a wound or infected tissue 3
    A16.01.005 Excision of skin lesions 2
    A16.01.006 Excision of the affected subcutaneous fat 2
    A16.01.008 Suturing skin and subcutaneous tissue 3
    A16.01.009 Suturing an open wound (without skin grafting) 3
    A16.01.010 Skin grafting for wound closure 3
    A16.01.011 Lancing of a boil (carbuncle) 3
    A16.01.012 Lancing and drainage of phlegmon (abscess) 2
    A16.01.013 Removal of cavernous angioma 3
    A16.01.014 Removal of stellate angioma 3
    A16.01.015 Removal of telangiectasias 2
    A16.01.016 Removal of atheroma 3
    A16.01.017 Removal of benign skin neoplasms 3
    A16.01.018 Removal of benign neoplasms of subcutaneous fat 3
    A16.01.019 Opening of the infiltrate (acne) of the skin and subcutaneous fat 1
    A16.01.020 Removal of contagious molluscs 2
    A16.01.022 Dermabrasion 2
    A16.01.023 Scar excision 3
    A16.01.026 Intradermal contour plastic 3
    A16.01.027 Removal of nail plates 2
    A16.01.028 Callus removal 3
    A16.01.031.006 Excision of soft tissue neoplasms under local anesthesia 3
    Muscular system
    A16.02.001 Incision of muscle, fascia tendon and bursa 3
    A16.02.002 Removal of muscle growth 3
    A16.02.003 Removal of tendon neoplasm 3
    A16.02.008 Release of tendons from scars and adhesions (tenolysis) 3
    A16.02.009 Muscle and tendon repair 3
    A16.02.010 Dissection of odontoid, annular ligaments 3
    Skeletal system
    A11.03.002 Puncture of sinuses 1
    A16.03.006 Correction of a fracture of the nasal bone 3
    A16.03.013 Bone drainage 3
    A16.03.014 Removal of foreign body bone 3
    A16.03.015 Removal of sequestration 3
    A16.03.016 Excision of the affected bone 2
    A16.03.017 Partial ostectomy 3
    A16.03.020 Internal fixation of the bone (without fracture correction) 3
    A16.03.021 Removing the internal fixing device 3
    A16.03.022 Bone joint 3
    A16.03.026 Closed reduction of the fracture with internal fixation 3
    A16.03.027 Open fracture treatment (without internal fixation) 2
    A16.03.029 Closed correction of the separated pineal gland 2
    A16.03.030 Open correction of the separated pineal gland 3
    A16.03.031 Treatment of an open fracture site 3
    A16.03.034 Reposition of bone fragments in fractures 2
    A16.03.036 Revascularizing osteoperforation 3
    A16.03.082 Amputation of one or more fingers 3
    Joints
    A11.04.001 Biopsy of joint tissues 1
    A16.04.001 Open treatment of joint dislocation 3
    A16.04.002 Therapeutic joint aspiration 2
    A16.04.003 Removal of free or foreign body of the joint 3
    A16.04.006 Excision of joint damage 3
    A16.04.018 Reduction of joint dislocation 2
    A16.04.022 Reduction 2
    A16.04.024 Meniscectomy 3
    Hematopoietic system and blood
    A11.05.002 Obtaining a cytological preparation of bone marrow by puncture 3
    A11.05.003 Obtaining a histological preparation of bone marrow 3
    Immune system
    A11.06.002 Lymph node biopsy 1
    A16.06.002 Lymph node extirpation 3
    Oral cavity and teeth
    A11.07.001 Biopsy of the oral mucosa 1
    A11.07.002 Tongue biopsy 1
    A11.07.003 Biopsy of tonsil, pharynx and adenoids 1
    A11.07.004 Biopsy of the pharynx, gums and uvula 1
    A11.07.007 Biopsy of lip tissues 1
    Upper respiratory tract
    A11.08.001 Biopsy of the mucous membrane of the larynx 1
    A11.08.002 Biopsy of the mucous membrane of the nasal cavity 1
    A11.08.003 Biopsy of the nasopharyngeal mucosa 1
    A11.08.004 Puncture of the paranasal sinuses 1
    A11.08.008 Biopsy of the laryngopharyngeal mucosa 1
    A16.08.001 Tonsilectomy 3
    A16.08.002 Adenoidectomy 3
    A16.08.003 Placement of temporary tracheostomy 3
    A16.08.004 Placement of a permanent tracheostomy 3
    A16.08.005 Laryngotomy 3
    A16.08.006 Mechanical stopping of bleeding (anterior and posterior nasal tamponade) 3
    A16.08.007 Removal of a foreign body from the pharynx or larynx 3
    A16.08.009 Removal of polyps of the nasal passages, larynx 3
    A16.08.010 Resection of nasal concha 3
    A16.08.011 Removal of a foreign body from the nose 3
    A16.08.012 Lancing of the paratonsillar abscess 3
    A16.08.013 Submucous nasal septum correction 3
    A16.08.014 Reposition of the nasal bones 3
    A16.08.015 Electroplating of the inferior turbinates 3
    A16.08.016 Washing tonsil lacunae 2
    A16.08.017 Radical sinus surgery 3
    A16.08.018 Nasal boil lancing 2
    A16.08.019 Changing the tracheostomy tube 1
    A16.08.020 Closure of the tracheostomy 3
    A16.08.021 Tracheotomy 3
    A16.08.022 Coniotomy 2
    A16.08.023 Washing the maxillary sinus 2
    Lower respiratory tract and lung tissue
    A11.09.002 Lung biopsy during bronchoscopy 1
    A16.09.001 Thoracocentesis 3
    Mediastinum
    A11.11.003 Transpleural puncture 1
    Large blood vessels
    A16.12.006 Incision, excision and closure of the veins of the lower limb 3
    A16.12.012 Ligation and exposure of varicose veins 3
    Esophagus, stomach, duodenum 12
    A11.16.001 Esophageal biopsy with endoscopy 1
    A11.16.002 Gastric biopsy by endoscopy 1
    A11.16.003 Biopsy of the duodenum using endoscopy 1
    A16.16.029 Removal of a benign tumor of the esophagus 3
    Small intestine
    A11.17.002 Endoscopic small intestine biopsy 1
    Large intestine
    A11.18.001 Endoscopic colon biopsy 1
    Sigmoid and rectum
    A11.19.001 Sigmoid colon biopsy with endoscopy 1
    A11.19.002 Rectal biopsy using endoscopy 1
    A11.19.003 Biopsy of the anus and perianal region 1
    A16.19.002 Cauterization of the rectal mucosa 2
    A16.19.003 Excision of the rectal mucosa 3
    A16.19.008 Incision or excision of perrectal tissue 3
    A16.19.011 Incision or excision of the perianal tissue 3
    A16.19.012 Drainage of rectal abscess 3
    A16.19.014 Separation of the anal sphincter 3
    A16.19.016 Evacuation of thrombosed hemorrhoids 2
    A16.19.017 Removal of the polyp of the anal canal and rectum 3
    A16.19.018 Removal of rectal foreign body without incision 2
    Female genital organs
    A11.20.004 Vaginal biopsy 1
    A11.20.006 Biopsy of the Bartholin gland hole 1
    A11.20.008 Separate diagnostic curettage of the uterine cavity and cervical canal 1
    A11.20.010 Breast biopsy, percutaneous 1
    A11.20.011 Cervical biopsy 1
    A16.20.020 Drainage of female genital abscess 3
    A16.20.021 Hymen dissection 3
    A16.20.036 Surgical treatment of cervical diseases using different energies 3
    A16.20.037 Artificial termination of pregnancy (early abortion) 3
    A16.20.038 Operation for infertility on the uterine appendages (blowing the fallopian tubes, fertiloscopy) 3
    A16.20.059 Removal of a foreign body from the vagina 3
    Male genital organs
    A11.21.002 Biopsy of testis, epididymis and spermatic cord 1
    A11.21.005 Prostate biopsy 1
    A16.21.008 Stopping bleeding (male genital organs) 3
    A16.21.026 Male sterilization 3
    Endocrine glands
    A11.22.001 Biopsy of the thyroid or parathyroid gland 1
    A16.22.012 Removal of stones from the ducts of the salivary glands 2
    Peripheral nervous system
    A16.24.001 Separation or excision of a nerve 3
    A16.24.002 Nerve stapling 3
    Hearing organ
    A16.25.001 Outer ear boil drainage 2
    A16.25.002 Curettage of the outer ear 2
    A16.25.003 Primary surgical debridement of the outer ear wound 3
    A16.25.005 Outer ear stitching 3
    A16.25.006 Reconstruction of the external auditory canal 3
    A16.25.008 Removal of a foreign body from the ear canal 2
    A16.25.009 Myringoplasty 3
    A16.25.010 Revision of tympanoplasty 3
    A16.25.011 Myringotomy 3
    A16.25.015 Primary surgical debridement of ear wounds 3
    A16.25.016 Revision of the tympanic cavity, removal of the neoplasm of the outer ear 3
    A16.25.017 Dissection of scars in the tympanic cavity 3
    A16.25.018 Radical ear surgery 3
    A16.25.021 Elimination of the defect of the auricle 2
    Organ of vision
    A16.26.001 Incision of the lacrimal gland 2
    A16.26.002 Removal of a foreign body or neoplasm of the lacrimal gland 3
    A16.26.003 Excision of the lacrimal gland 3
    A16.26.006 Opening of the phlegmon of the lacrimal sac, incision of the lacrimal openings and lacrimal tubules 2
    A16.26.007 Plastics of the lacrimal openings and lacrimal tubules 2
    A16.26.011 Probing of the nasolacrimal canal 2
    A16.26.012 Blepharotomy, canthotomy 2
    A16.26.013 Excision of chalazion 2
    A16.26.014 Lancing of barley, abscess of the century 2
    A16.26.015 Excision of the calcified meibomian gland 2
    A16.26.016 Excision, reposition of the base of the eyelashes 2
    A16.26.018 Eyelash epilation 1
    A16.26.020 Correction of ectropion or entropion 3
    A16.26.024 Blepharorrhaphy 3
    A16.26.025 Removal of a foreign body or neoplasm of the eyelids 3
    A16.26.026 Suturing eyelid wound 3
    A16.26.033 Conjunctivotomy 2
    A16.26.034 Removal of a foreign body of the conjunctiva 1
    A16.26.035 Suturing conjunctival wound 2
    A16.26.036 Expression (extrusion) and curettage of conjunctival follicles 3
    A16.26.038 Simblepharon Dissection 3
    A16.26.041 Plastic surgery of the conjunctival cavity 3
    A16.26.043 Pinguecula excision 2
    A16.26.044 Excision of the pterygium 2
    A16.26.051 Removal of corneal foreign body 2
    A16.26.070 Sinustrabeculectomy 3
    A16.26.071 Decompression of the optic nerve 2
    A16.26.076 Suturing scleral wound 2
    A16.26.077 Removal of a foreign body from the sclera 3
    A16.26.092 Lens extraction 3
    A16.26.094 Intraocular lens implantation 3
    A16.26.098 Enucleation of the eyeball 3
    A16.26.103 Orbitotomy 3
    A16.26.112 Other penetrating antiglaucomatous operations 3
    A16.26.118 Other non-penetrating antiglaucomatous operations 3
    Organ of smell
    A16.27.002 Ethmoidotomy 3
    Kidney and urinary tract
    A11.28.002 Bladder biopsy 1
    A16.28.024 Cystotomy 3
    A16.28.037 Urethral meatotomy 3
    A16.28.043 Puncture of paravesical abscess 3
    A16.28.058 Reduction of paraphimosis 1
    Other
    A11.30.001 Paracentesis 1
    A16.30.001 Surgical treatment of inguinal-femoral hernia 3
    A16.30.003 Surgical treatment of peri-umbilical hernia 3
    A16.

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