What are the common misconceptions about shellfish allergies. How can you distinguish between shellfish allergy and intolerance. What are the key symptoms of a shellfish allergy to watch out for. Is it safe for people with shellfish allergies to receive iodine-based medical procedures.

Understanding Shellfish Allergies: Causes and Prevalence

Shellfish allergies occur when the immune system overreacts to specific proteins found in shellfish. This type of food allergy is more common in adults than children, likely due to differences in eating habits and exposure. While shellfish are often praised for their nutritional benefits, they can pose serious health risks for those with allergies.

Why are shellfish allergies more prevalent in adults? The answer lies in dietary patterns. Since young children typically don’t consume shellfish regularly, the allergy may not become apparent until later in life when shellfish consumption increases.

Types of Shellfish Allergies

Shellfish allergies can be broadly categorized into two main groups:

• Crustacean allergies (e.g., shrimp, crab, lobster)
• Mollusk allergies (e.g., clams, mussels, scallops)

Is it possible to be allergic to one type of shellfish and not the other? While it’s possible, most individuals with a shellfish allergy are sensitive to multiple species within the same class. For instance, someone allergic to crab is likely to react to other crustaceans like lobster and shrimp.

Symptoms of Shellfish Allergies: What to Watch For

Recognizing the symptoms of a shellfish allergy is crucial for proper management and prompt treatment. The severity of reactions can vary widely between individuals and even between episodes for the same person.

Common symptoms of shellfish allergies include:

• Hives or itchy skin
• Swelling of the lips, face, tongue, or throat
• Wheezing or difficulty breathing
• Abdominal pain, nausea, or vomiting
• Dizziness or lightheadedness

In severe cases, shellfish allergies can trigger anaphylaxis, a potentially life-threatening reaction that requires immediate medical attention. Symptoms of anaphylaxis may include:

• Rapid pulse
• Drop in blood pressure
• Constriction of airways
• Loss of consciousness

Can shellfish allergy symptoms appear immediately after exposure? Yes, allergic reactions to shellfish can occur within minutes of consumption or contact. However, in some cases, symptoms may not appear for several hours.

Debunking the Iodine Myth: Shellfish Allergies and Medical Procedures

A persistent myth surrounding shellfish allergies is the belief that individuals with this allergy cannot safely undergo medical procedures involving iodine-based contrast dyes. This misconception has led to unnecessary anxiety and potential delays in important diagnostic tests.

Is there a connection between shellfish allergies and iodine sensitivity? The short answer is no. This myth originated from a 1970s survey where 15% of patients who reported reactions to contrast media also stated they had shellfish allergies. However, this correlation was not scientifically validated.

Key facts to understand about shellfish allergies and iodine:

• Iodine is not an allergen and is too small to trigger an allergic reaction
• Shellfish allergies are caused by muscle proteins called tropomyosin, not iodine
• People with shellfish allergies can typically safely receive iodine-based contrast dyes

Does this mean all shellfish-allergic individuals can safely undergo procedures with iodine contrast? While the shellfish allergy itself doesn’t pose a risk, it’s important to note that some individuals may have separate allergies to contrast media. Always consult with a healthcare provider before any medical procedure.

Shellfish Allergy vs. Intolerance: Understanding the Difference

Many people who believe they have a shellfish allergy may actually be experiencing shellfish intolerance. While both conditions can cause discomfort, the underlying mechanisms and potential risks are quite different.

How can you distinguish between shellfish allergy and intolerance?

While shellfish intolerance can cause discomfort, it does not carry the risk of anaphylaxis associated with true shellfish allergies. However, it’s crucial to get a proper diagnosis from an allergist or immunologist to determine whether you have an allergy or intolerance.

Managing Shellfish Allergies: Prevention and Treatment

For individuals with shellfish allergies, the primary management strategy is avoidance. This involves carefully reading food labels, asking about ingredients when dining out, and being cautious of cross-contamination in food preparation areas.

What steps can be taken to manage shellfish allergies?

1. Strict avoidance of all shellfish and products containing shellfish
2. Carrying an epinephrine auto-injector (such as an EpiPen) at all times
3. Wearing a medical alert bracelet or necklace
4. Educating family, friends, and coworkers about the allergy
5. Having an emergency action plan in case of accidental exposure

Is there a cure for shellfish allergies? Currently, there is no cure for shellfish allergies. However, some individuals may outgrow their allergy over time. Regular follow-ups with an allergist can help monitor the allergy and adjust management strategies as needed.

Cross-Reactivity and Related Allergies

Understanding cross-reactivity is crucial for individuals with shellfish allergies. Cross-reactivity occurs when the immune system mistakes proteins in one food for similar proteins in another food, triggering an allergic response.

Are all shellfish allergies related? While there is often cross-reactivity within the same class of shellfish (crustaceans or mollusks), it’s less common to be allergic to both classes. However, it’s important to exercise caution and consult with an allergist before consuming any type of shellfish if you have a known allergy.

Other considerations regarding cross-reactivity:

• Fish allergies are separate from shellfish allergies, but some individuals may be allergic to both
• Some people with shellfish allergies may also react to chitosan, a substance derived from shellfish shells used in some supplements
• There is no established cross-reactivity between shellfish and iodine-containing substances

Misconceptions About Shellfish Allergies and Supplements

Another common misconception surrounds the safety of certain supplements for individuals with shellfish allergies. One such supplement is glucosamine, which is often derived from the shells of crustaceans.

Can people with shellfish allergies safely take glucosamine supplements? In most cases, yes. Glucosamine is made from the shells of shellfish, not the protein that causes allergic reactions. The allergens in shellfish are found in the flesh, not the shell. However, as with any supplement, it’s always best to consult with a healthcare provider before use, especially if you have a history of severe allergic reactions.

Other misconceptions to be aware of:

• Calcium supplements derived from oyster shells are typically safe for those with shellfish allergies
• Carrageenan, a food additive derived from seaweed, is not related to shellfish and should not cause reactions in shellfish-allergic individuals
• Fish oil supplements are usually safe for those with shellfish allergies, as fish are not related to shellfish

The Role of Allergy Testing and Diagnosis

Proper diagnosis of shellfish allergies is crucial for effective management and prevention of severe reactions. Allergy testing can help confirm a suspected shellfish allergy and identify which specific types of shellfish may trigger a reaction.

What methods are used to diagnose shellfish allergies?

1. Skin prick tests: A small amount of shellfish extract is placed on the skin, which is then pricked. A raised bump indicates a possible allergy.
2. Blood tests: These measure the levels of specific antibodies (IgE) to shellfish proteins in the blood.
3. Oral food challenges: Under medical supervision, small amounts of shellfish are consumed to observe any allergic reactions.
4. Medical history: A detailed account of past reactions and symptoms helps in diagnosis.

Is allergy testing always accurate? While allergy tests are valuable diagnostic tools, they are not 100% accurate. False positives and false negatives can occur. That’s why a comprehensive approach, combining test results with medical history and sometimes oral food challenges, is often necessary for a definitive diagnosis.

When to See an Allergist

It’s important to consult an allergist or immunologist if you suspect a shellfish allergy. Seek professional help if:

• You’ve experienced symptoms after eating shellfish
• You’re unsure whether you have an allergy or intolerance
• You need guidance on managing your diet and avoiding shellfish
• You want to explore the possibility of outgrowing your allergy

An allergist can provide a proper diagnosis, develop a management plan, and offer education on avoiding allergens and handling emergencies.

Living with Shellfish Allergies: Practical Tips and Considerations

Managing a shellfish allergy requires vigilance and careful planning, but it doesn’t have to significantly limit your lifestyle. Here are some practical tips for living with a shellfish allergy:

Reading Food Labels

Always check ingredient lists carefully. In the United States, shellfish is one of the eight major allergens that must be clearly labeled on food packages. Look for terms like:

• Shellfish
• Crustacean
• Specific shellfish names (e.g., shrimp, crab, lobster)

Be aware that shellfish can be found in unexpected products, such as some Asian cuisines, Worcestershire sauce, and even some pet foods.

Dining Out Safely

Eating at restaurants can be challenging for those with shellfish allergies. Tips for safer dining include:

• Informing the server and chef about your allergy
• Asking about ingredients and preparation methods
• Being cautious of cross-contamination, especially in seafood restaurants
• Considering bringing your own food to social gatherings

Traveling with a Shellfish Allergy

Traveling requires extra preparation when you have a shellfish allergy:

• Research local cuisines and common ingredients in your destination
• Learn how to communicate your allergy in the local language
• Carry translation cards explaining your allergy
• Pack safe snacks and consider bringing cooking supplies
• Research local medical facilities and emergency services

Educating Others

Helping friends, family, and colleagues understand your shellfish allergy is crucial:

• Explain the severity of your allergy and potential reactions
• Teach them how to use an epinephrine auto-injector
• Provide a list of safe foods and those to avoid
• Encourage them to ask questions if they’re unsure about a food’s safety

By taking these precautions and educating those around you, you can effectively manage your shellfish allergy while maintaining a full and active lifestyle.

Emerging Research and Future Treatments

While there is currently no cure for shellfish allergies, ongoing research is exploring new treatment options and improved diagnostic methods. Some areas of active investigation include:

Immunotherapy

Oral immunotherapy and sublingual immunotherapy are being studied as potential treatments for food allergies, including shellfish allergies. These approaches involve gradually exposing the immune system to small amounts of the allergen to build tolerance over time.

Improved Diagnostic Tools

Researchers are working on developing more accurate and comprehensive diagnostic tests for food allergies. This includes component-resolved diagnostics, which can identify specific proteins within shellfish that trigger allergic reactions.

Gene Therapy

Early-stage research is exploring the potential of gene therapy to modify the immune response in individuals with food allergies. While this is still in its infancy, it represents a promising avenue for future treatment.

Biologics

Monoclonal antibody treatments, such as those used for other allergic conditions, are being investigated for their potential in treating food allergies, including shellfish allergies.

What does the future hold for shellfish allergy treatment? While current management focuses on avoidance and emergency preparedness, ongoing research offers hope for more targeted treatments and potentially even a cure in the future. However, it’s important to note that the development and approval of new treatments can take many years.

In the meantime, individuals with shellfish allergies should continue to work closely with their allergists to manage their condition effectively and stay informed about the latest developments in allergy research and treatment.

Shellfish allergy | AAAAI

Shellfish, including shrimp, lobster, oysters and more, are often touted for their health benefits. But for millions of Americans with shellfish allergy, a tiny bite of these foods can cause a severe reaction. If you have a food allergy such as shellfish, your immune system overreacts to a particular protein found in that shellfish.

Most people with one shellfish allergy are allergic to other species within the same class. For example, if you are allergic to crab, you may also be allergic to lobster, shrimp and other crustaceans. Likewise, if you are allergic to clams, you may also be allergic to other mollusks, such as mussels or scallops.

It is a myth that shellfish allergy means it is unsafe to receive iodine dyes. If you have a shellfish allergy, you can most likely safely get radiocontrast medical procedures, unless you have a separate allergy to them.

This myth originated in the 1970s from a survey of patients who reported prior reactions to contrast media. Among those who replied that they had a reaction, 15% also stated they were allergic to shellfish. It is important to note that this was not confirmed with any testing. After that report, physicians tried to make the connection and hypothesized that iodine was the reason for this suspected cross reactivity. However, iodine is not an allergen. It is present inside our bodies and too small to start an allergic reaction on the allergy cells in the body. Interestingly, iodine is also not the cause of allergic reactions to shellfish, which is caused by muscle proteins called tropomyosin. So, concern for allergic reactions to contrast media in people with shellfish allergy has been a myth all along, but unfortunately one that continues to impact physicians and patients alike to this day.

Another misconception is that shellfish-allergic patients cannot take glucosamine. Glucosamine is normally safe to consume because it is made from shells, not the protein that causes allergy to shellfish.

Shellfish allergy is more common in adults than children. This is probably due to our eating habits. Because young children don’t typically eat shellfish, this allergy may not be apparent until later in life.

As with other food allergies, avoiding contact with shellfish is the only sure way to manage your symptoms.

Many people who think they are allergic to shellfish may actually be intolerant to it. Some of the symptoms of food intolerance and food allergy are similar, but the differences between the two are very important. An intolerance to shellfish can make you feel miserable. An allergy to shellfish can result in symptoms of anaphylaxis (an-a-fi-LAK-sis), a life-threatening allergic reaction.

An allergist / immunologist has advanced training and experience to determine if you are intolerant or allergic to shellfish and help you manage your condition.

Find out more about food allergies.

Reviewed: 9/28/20

The relationship of radiocontrast, iodine, and seafood allergies: a medical myth exposed

Review

. 2010 Nov;39(5):701-7.

doi: 10.1016/j.jemermed.2009.10.014.

Epub 2010 Jan 4.

Esteban Schabelman 
¹
, Michael Witting

Affiliations

Affiliation

• ¹ Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.

• PMID:

  20045605

• DOI:

  10. 1016/j.jemermed.2009.10.014

Review

Esteban Schabelman et al.

J Emerg Med.

2010 Nov.

. 2010 Nov;39(5):701-7.

doi: 10.1016/j.jemermed.2009.10.014.

Epub 2010 Jan 4.

Authors

Esteban Schabelman 
¹
, Michael Witting

Affiliation

• ¹ Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.

• PMID:

  20045605

• DOI:

  10.1016/j.jemermed.2009.10.014

Abstract

Background:

Radiocontrast agents are some of the most commonly used medications in the emergency department. However, both physicians and patients misunderstand the role that allergies play in reactions to radiocontrast media, especially with regards to shellfish and iodine.

Objectives:

We sought to review the literature describing rates of contrast reactions and risk of contrast administration to patients with iodine allergy, shellfish or seafood allergies, or prior reactions to intravenous iodinated contrast.

Method:

Both authors independently performed literature reviews, including position statements of stakeholder organizations, to gain perspective on important issues. They subsequently performed a systematic search for articles that estimated the risk of administration of iodinated contrast to those with a prior history of contrast reaction, “iodine allergy,” or reaction to seafood or shellfish.

Results:

The risk of reactions to contrast ranges from 0. 2-17%, depending on the type of contrast used, the severity of reaction considered, and the prior history of any allergy. The risk of reaction in patients with a seafood allergy is similar to that in patients with other food allergies or asthma. A history of prior reaction to contrast increases the risk of mild reactions to as high as 7-17%, but has not been shown to increase the rate of severe reactions. Severe reactions occur in 0.02-0.5% and deaths in 0.0006-0.006%; neither have been related to “iodine allergy,” seafood allergy, or prior contrast reaction. Low-osmolality contrast media became available in 1988, and many of the higher risk estimates were from the era before it was widely available.

Conclusions:

Iodine is not an allergen. Atopy, in general, confers an increased risk of reaction to contrast administration, but the risk of contrast administration is low, even in patients with a history of “iodine allergy,” seafood allergy, or prior contrast reaction. Allergies to shellfish, in particular, do not increase the risk of reaction to intravenous contrast any more that of other allergies.

Copyright © 2010 Elsevier Inc. All rights reserved.

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old problem – new solutions

Viral skin infections are common diseases in the practice of a dermatologist. Infections are most commonly caused by herpesviruses, human papillomaviruses, and molluscum contagiosum (MCV). Among viral infections, a special place is occupied by the incidence of molluscum contagiosum (CM) due to its high prevalence in childhood. Thus, according to S. Seo [1, 2], infection of school-age children with ECM is 2–8%. According to K. Kyriakis [3], the overall relative incidence among 162 outpatient children is 3.2%, with the main part being children aged 3 to 5 years.

Dermatotropic poxvirus is a large (200-300 nm), rectangular, double-stranded DNA virus that replicates in the cytoplasm of infected epithelial cells. There are at least four genotypes (MCV 1-4), the most common of which is type 1 worldwide. Moreover, in children, CM, as a rule, is provoked by type 1 orthopoxvirus (MCV-1), and in adults, by type 2 virus (MCV-2). This situation is due to the fact that the type 1 virus is transmitted mainly by contact and indirectly, through common objects, and the type 2 virus is transmitted through sexual contact. However, all types of the virus cause the same clinical manifestations [4–6]. There are several noteworthy characteristics of ECM that make it unique compared to well-studied members of the orthopoxvirus genus. First, ECM causes a chronic infection with minimal or no signs of inflammation. In contrast, monkeypox virus and varicella-zoster virus cause acute illnesses that have significantly higher morbidity and mortality rates compared to MT. Secondly, ECM infects and persists only in keratinocytes, while viruses of various types of pox infect other types of cells and tissues. Third, the molecules encoded by ECM are different from those encoded by members of the orthopoxvirus genus. This difference in the molecules they produce probably reflects the difference in tissue tropism of these viruses and the phenotypic variety of the diseases they cause. VKM is the only virus, unlike the viruses of various smallpox species, that is pathogenic exclusively to humans. In connection with the victory over the variola virus, vaccination against this disease was eliminated from the vaccination vaccination schedule; thus, ECM remains the only circulating poxvirus infecting humans worldwide. At the same time, ECM has properties inherent in poxviruses, manifested in high contagiousness and pathogenicity [7].

Thus, A. Kawahar and M. Yoshida [8] detected ECM DNA using polymerase chain reaction (PCR) in skin samples without rashes in 17 out of 20 patients studied, which indicates the transmission of the virus from infected foci of apparently unaffected skin. Infection is also possible through clothing, towels, toys that the patient touches. In 10 patients, virus DNA was found in the skin of the fingers of both hands. Also, the results of the studies confirmed the indirect route of transmission through other objects: viral DNA was found on a desk, closet, toy box and tap, which was in common use by children at school.

ECM is well known to have adapted in terms of growth and resistance to local immune systems in human skin. It affects only the skin and less often the mucous membranes [9].

The virus “developed” an effective growth mechanism in a differentiating cell of the human epidermis and adapted well to the human body. By not crossing the basement membrane, the virus evades immune surveillance; it does not elicit a systemic immune response during most of the infection period; it causes only a local reaction, which leads to seroconversion. Understanding and studying how ECM evades the skin’s immune defenses and why ECM infection is limited to human keratinocytes could be of great benefit to virology. Probably, we are talking about the identification of new mechanisms of evasion from the immune system, as well as the features of viral tropism. These data would improve our understanding of the immune processes occurring during this infection, and the study of viral proteins in the immune evasion system would help identify new cellular mechanisms that regulate signaling pathways critical for immune system activation [5–7].

The clinical picture of this disease was described almost 200 years ago, many clinical and fundamental studies have been carried out, and the negative impact on the patient’s quality of life has been assessed. CM is a viral infection with a benign course, characterized by the formation of waxy, flesh-colored, dome-shaped papules, averaging 3–5 mm in diameter [10].

Papules contain a waxy material that consists of cellular debris and numerous virus particles. Elements of K.M. usually located in groups in one or two skin regions, but they also occur in a scattered form, rarely affecting the palms and soles, mucous membranes, for example, lips, cheeks, conjunctiva. The disease can develop at any age, but in most cases in children and young adults. Most immunocompetent patients usually have fewer than 20 papules, but some may have up to several hundred. Lesions are usually asymptomatic, but sometimes they cause itching, and an inflammatory reaction may develop around them [11].

Impairment of the skin barrier may explain the increase in the prevalence and high number of rashes in patients with atopic dermatitis [12, 13]. In patients with atopic dermatitis, due to dry skin and disruption of the epidermal barrier, disseminated forms of the disease often occur [14]. The use of topical corticosteroids and calcineurin inhibitors due to their immunosuppressive effect is one of the provoking factors in the development of the disease in patients with atopic dermatitis [15].

The phenomenon of inflammation around the lesions is the result of the host response to the virus. However, the associated itching can also facilitate the spread and introduction of viruses through broken skin. Localized dermatitis around papules usually regresses spontaneously.

The diagnosis of this disease usually does not cause difficulties, is established clinically and does not require special diagnostic methods. Histological examination reveals a viral acanthoma, and eosinophilic inclusion bodies (Henderson-Paterson bodies) in the cytoplasm of keratinocytes [14]. The disease is characterized by a benign course, high contagiousness, and a limited duration of the course [16–18]. Some patients spontaneously involute within 6–9months, but lesions can often persist for years [16]. The affected areas have an unaesthetic appearance, causing a heightened perception of rashes by others and the child’s parents [18].

Healing usually occurs without scarring. In the vast majority of cases, the disease affects schoolchildren under 12 years of age [17]. This is especially true for the southern regions, where up to 10% of schoolchildren suffer from CM, and close physical contact, tight-fitting clothing, and poor hygiene can be considered as factors contributing to the disease [18].

Despite numerous treatment options, there is still no specific antiviral therapy for CM. One of the most common methods of treatment is the removal of mollusks using a curette or tweezers [19], but with significant dissemination of molluscs and their unfavorable localization (for example, on the face, neck or genital area), as well as in the case of a young child, great difficulties arise. in applying this method. Thanks to percutaneous anesthesia with lidocaine-prilocaine ointment [19], applied 30-60 minutes before surgery, painless removal of mollusks is sometimes possible, but in many cases, and especially if the child is restless, it is not possible to do without sedation or general anesthesia. Pre-oiling the skin with ointment before removing the molluscs also significantly complicates mechanical manipulations, since the tweezers slide off the elements of the mollusk, which makes it difficult to technically complete the task.

Cryotherapy with liquid nitrogen, although less painful, requires more time than removing molluscs with a curette or tweezers, and rarely achieves the effect in one application – several procedures are required [20].

Sometimes used pulsed carbon dioxide lasers [21], as well as electrocoagulators, do not have clear advantages in terms of practicality and portability. In the presence of recommended conservative therapies, there are numerous alternative therapies, each of which requires a high degree of loyalty as well as patience on the part of the parents of the child being treated.

The latest Cochrane review of CM treatment was published in 2009. It reviewed 11 randomized controlled trials with 495 participants [22]. The review did not include patients with STIs and HIV. There is little evidence for the effectiveness of the following drugs: sodium nitrite in combination with salicylic acid versus salicylic acid, Australian lemon myrtle oil versus olive oil, and benzoyl peroxide cream versus tretinoin cream [22]. Most of the commonly used procedures (eg curettage) were excluded from the Cochrane review. Hanna’s prospective randomized trial was excluded because it showed very little improvement after multiple visits and did not provide information about when the visit occurred [23]. Three randomized trials have been published in a Cochrane review and one is still ongoing [24]. The test results showed no significant difference between ablative and immunomodulating therapy, as well as chemical methods.

Salicylic acid in the form of a patch [25] or retinoic acid (tretinoin) [26] are sometimes successfully used, but can lead to significant irritation of the skin located on the periphery of the lesion. In addition, these funds are not available in Russia.

The effectiveness of topical application of the immune modulator imiquimod is not well understood, the drug is not approved for use in children, the question of the necessary duration of treatment is not well understood, and the cost of therapy is extremely high [27].

N. Al-Mutairi et al. [28] in a 16-week study of 37 patients showed that there were no significant differences between cryotherapy and applications of imiquimod 5% cream (34 of 37, or 92%). S. Seo et al. [29] compared the effect of 10% potassium hydroxide solution with that of 5% imiquimod cream; both procedures were effective (57 and 77%, respectively), but the authors observed a high incidence of local side effects associated with the irritant effect of 10% potassium hydroxide solution.

Further conservative therapies, with varying success, include topical application of podophyllotoxin [30], cantharidin [31], trichloroacetic acid, phenol, silver nitrate [31], or iodine [25]. It should be assumed that some of the chemicals used, by damaging the epidermis and inducing an immune response due to this, cause the destruction of the virus [32].

There have also been reports of success achieved with the use of oral cimetidine therapy, and it was assumed that the substance had immunomodulatory properties (blocking the suppressor function of lymphocytes and improving T-cell immunity) [33].

There is now ample evidence that potassium hydroxide is suitable for treating childhood CM. So, R. Romiti et al. [34] described the topical application of a 10% potassium hydroxide solution, which is used for the manufacture of mycological native preparations, for the treatment of BM infection in children. At the same time, the same task force showed that, with 5% potassium hydroxide, also applied twice daily, 20 children with CM achieved comparable treatment outcomes (median over 6 weeks) with a significantly reduced treatment profile. side effects [32, 35].

B. Mahajan et al. [36] report the use of a 20% potassium hydroxide solution in the treatment of 27 children aged 8 months to 14 years.

D. Hinostroza-Da-Conceicao et al. [37] studied the effect of 15% potassium hydroxide applied every evening on 46 patients of various ages.

In England, K. Short et al. recently presented the first double-blind, placebo-controlled trial of 10% potassium hydroxide solution in children aged 2 to 12 years [32].

However, in all the studies described above, a rather high incidence of side effects in the form of burning, ulceration of the elements, the appearance of pigmentation and scarring was observed.

F. Neri et al. [38] tried to reduce the incidence of side effects and tested 5% potassium hydroxide solution. There was no or minimal burning sensation during treatment, and no pigmentation disorders were observed at the end of this study. The main conclusion from this study was that 5% aqueous potassium hydroxide solution was as effective as 10% potassium hydroxide solution, but caused less irritation. This study also highlights the efficacy of 5% potassium hydroxide in the treatment of CM by protecting children from more aggressive physical treatments [32] .

In a study on the efficacy and safety of 5% potassium hydroxide, T. Jansen et al. [39] enrolled 21 children, with 14 patients having atopic dermatitis and 3 patients having atopic eczema. The most common side effect observed in 76.2% of patients was a temporary slight burning sensation immediately after topical application. Two patients developed post-inflammatory hyperpigmentation, which resolved after 1–3 months [32].

Talk

Currently, there are many different methods of treating CM, such as curettage, mechanical removal, electrocoagulation or cryotherapy, applications of salicylic acid and tretinoin, which are often painful and cause a fairly large number of side effects in the form of an inflammatory reaction, scarring and hyperpigmentation.

Potassium hydroxide 5% stabilized has been well documented in numerous studies and is as effective as potassium hydroxide at higher concentrations, yet 5% has no side effects when used correctly.

In Russia, a 5% solution of potassium hydroxide is registered as a medical device, class 1, under the trademark Molutrex (manufactured by the Dermatological laboratory “ASM”, France). The production technology of Molutrex allows the solution to be stabilized so that the activity and pH of the solution remain constant for 1 month after opening the package, which distinguishes this product from a simply prepared solution of 5% potassium hydroxide.

This 5% potassium hydroxide solution should be gently applied using a brush or a thin applicator (included) in the morning and evening only to the KM elements, while avoiding contact with healthy skin. The product should not be washed off – it must dry. It is recommended to apply a 5% potassium hydroxide solution until redness (inflammation) of the KM papules occurs, after which the use of the solution should be discontinued (reddening usually occurs within a period of 2 to 10 days of use). Reddened elements indicate that CM formations will disappear in the near future approximately within 2-6 weeks after redness. You can not use a 5% solution of potassium hydroxide for more than 14 days, apply to inflamed elements of the KM and other skin formations (warts, papillomas, etc.).

Terminals

Thus, the data of numerous clinical studies confirm the high efficacy and good tolerability of a stabilized 5% solution of potassium hydroxide ( Molutrex ) in the treatment of children suffering from CM, including patients with atopic dermatitis. Ease of use, safety, and pharmacoeconomic characteristics allow it to be used at home as a first-line treatment for molluscum contagiosum.

The authors declare no conflict of interest.

Molluscum contagiosum – Diagnosis and treatment of skin diseases

Molluscum contagiosum – is a viral infection transmitted from person to person by direct contact. They belong to the smallpox group, as they have a very similar structure and cause absolutely similar clinical symptoms.

Molluscum contagiosum is a skin disease caused by a poxvirus of the MCV genus, namely a member of the family, transmitted during close contact, that is, contact with a sick person, or through various objects that an infected person has used.

In adults, the disease manifests itself in the form of small red blisters on the abdomen, genitals, inner thighs and pubic area. As for children, most often mollusks are located on the face or upper limbs. Such skin rashes are usually not accompanied by other ailments. Occasionally, a person may experience itching at their place of residence.

This disease is commonly called nodule mollusk, that is, the main element, similar to the shell of a mollusk, which can be seen during the microscopy process. The content in the nodule is a white mass, which includes epithelial keratinized cells and outstanding microscopic bodies.

Types and subtypes of molluscum contagiosum

In modern times, two types and four subtypes of molluscum contagiosum are known to science:

1. MCV I is considered to be the most common;
2. II MCV;
3. MCV III;
4. IV MCV.

Each of the subtypes is capable of causing clinical manifestations in the genital area and extra-genitally.

Signs of molluscum contagiosum

The usual element of molluscum contagiosum is a compacted pink or flesh-colored papule (nodule) of a round or oval shape. In the case of palpation, an acute painful sensation appears. Molluscum contagiosum has standard sizes from two to ten millimeters. Of course, there are also cases of the appearance of huge nodes with sizes up to several centimeters. Often, nodules can combine and form conglomerates. Such formations merge into groups and can actively continue to spread throughout the human body.

The surface of the nodules is shiny and even. It has an umbilical depression. When pressed, a white curdled liquid begins to flow out of it. Such secretions in medicine are called horny masses.

Forms of molluscum contagiosum

There are several types of molluscum contagiosum:

• The typical form has the appearance of several collected elements that are located very close to each other, namely in the area of ​​one anatomically infected area;
• The generalized form is determined by the localization of nodular rashes on various parts of the human body;
• Complicated form manifests itself during the connection of any bacterial infection. Redness, pus and soreness is a typical form of the disease in people with a sexually transmitted infection. Another feature of the manifestation of molluscum contagiosum in HIV patients is active localization in the facial region of the nasolabial area and chin.

Similarity to other diseases

Molluscum contagiosum is composed of a huge number of elements. That is why it is very easy to confuse it with other skin diseases.

These include:

• Genital warts;
• Flat warts;
• Micropapillomatosis of the vulva;
• Hyperplasia of sebaceous glands;
• Pearly papules of the penis;
• Syringiomas.

In case of detection of a single large element, differential diagnosis with keratoacanthoma, basal cell and squamous cell skin cancer is carried out.

Course of the disease

In most cases, predominantly in childhood, molluscum contagiosum disappears spontaneously after a maximum of six months. In rare cases, a recurrent form may appear, that is, the appearance of new elements of the rash. In principle, molluscum contagiosum is not a threat to life. Moreover, it can be attributed to a general cosmetic problem.

More attention should be paid to complicated, generalized and recurrent forms. In such cases, it is necessary to consult a specialist – an immunologist and give an immunogram with further testing for HIV infection.

During mechanical damage to the loose elements, that is, cuts, scratches, extrusion or shaving, autoinoculation may occur. Autoinoculation is a strong spread of this infection.

Treatment of molluscum contagiosum

Most often, specialists take into account the propensity for the independent and spontaneous disappearance of the elements that have appeared. That is why treatment can not always be prescribed.

In cases of localization in open areas of the body, on the face, genitals in adults, the removal of molluscs occurs at a cosmetic level. It is possible to use both mechanical and physical methods. This can be simple extrusion with tweezers, careful scraping with a curette, elimination using liquid nitrogen, that is, cryotherapy. Removal by cryotherapy is carried out by laser technology or electrocoagulation.

Destroying a mollusk, a person does not get the confidence that the virus that causes the reaction also leaves the body. Treatment of molluscum contagiosum should be strictly under the supervision of professional specialists in this field.

Self-medication is strictly prohibited. Otherwise, this disease can often be confused with a malignant skin tumor. Accordingly, making a decision alone may not only not help, but also aggravate this disease, causing serious health problems.

In order to start treatment, first of all, it is necessary to undergo a special examination prescribed by a doctor. After the diagnosis is made, outpatient treatment begins with a dermatologist. All elements of the molluscum contagiosum are scrupulously destroyed with surgical tweezers using electrocoagulation or scraping with a Volkmann spoon. Then the lesions are necessarily lubricated with an alcoholized solution of iodine and a very saturated solution of potassium permanganate.

Many specialists, in order to speed up the healing process, prescribe to their patients various anti-viral creams and ointments, specially designed for specific shellfish extermination, for treatment. In some more complicated cases, it is necessary to undergo strict therapy with antibiotics in addition.

For preventive purposes, each sick person must observe all necessary hygiene rules. And this applies not only to the personal, but also to the domestic sphere.

To protect yourself from the possible spread of this infection, you need to isolate yourself from society. If we are talking about children, then visiting kindergartens and schools is strictly prohibited. Moreover, these institutions must be checked.

In the home of a person infected with molluscum contagiosum, it is urgent to conduct a medical examination of all family members in order to prevent further development and spread of the disease.