Overview 

Definition and causes

Molluscum Contagiosum is a skin disease caused by a viral infection. The virus causing this is a Poxvirus called Molluscum Contagiosum Virus.^1,2

Transmission and risk factors

Transmission tends to occur through contact with infected skin or objects contaminated with the virus. A higher rate of infection tends to occur in individuals with weakened immune systems or those who are more susceptible. It is more common in children, rare in children under one year of age, and can also be present in teenagers and adults. Some studies have indicated that atopic dermatitis is a possible risk factor.^2,3

Purpose of the guide

In this article, we aim to provide information on laser therapy which is a prominent treatment option available for treating Molluscum Contagiosum.

There are various treatment approaches, based on the different opinions from the professionals. Few healthcare professionals believe/opinionated that the treatment isn't necessary as Molluscum Contagiosum is a self-limiting condition, however, treatment is indicated under a necessary condition like when the condition becomes severe resulting in superinfection of bacteria. Some doctors believe that the treatment is necessary in order to prevent the spread of infection to the different parts of the body in the affected individual, to prevent the spread of infection to others or to remove the social stigma or the discomfort experienced by the affected individual.⁴ 

Understanding molluscum contagiosum

Symptoms and diagnosis

Common signs and symptoms

The main characteristics of Molluscum Contagiosum are the papules, which measure around 2 to 5 millimetres, they appear as single or multiple lesions, these are skin coloured or pink with a central umbilication. Papules can be pediculated and sometimes have an erythematous halo.²

The location of these lesions in children can be facial, trunk, and extremities, they aren't found in the palm and sole region. The genital location of the papules in children relates to autoinoculation, these are not necessarily signs of sexual abuse. In adults, it can be in the lower abdomen, thighs, and genital area; most of the time, it is transmitted through sexual contact.³

How is molluscum contagiosum diagnosed?

Diagnosis is clinically based on the characteristics of the skin lesion. There are various diagnostic techniques available for diagnosing this condition which include:

• Dermoscopy (a technique that uses microscopy on the skin surface for deeper analysis of a lesion⁵
• Reflectance Confocal Microscopy (RCM)
• Line-field Confocal Optical Coherence Tomography
• Biopsy (limited to atypical cases)

The natural course of the disease

Typical progression

The Molluscum Contagiosum comes in contact with the skin, and it starts to reproduce in cells of the skin surface for 2 to 6 weeks, then the appearance of papules starts. It is a self-limiting condition, which means that even without treatment, the immune system will fight and destroy the virus. The difference is the time it will take; it is described as 6 to 9 months without treatment and 3 to 4 years in some patients.⁶

Possible complications

• Bacterial superinfection
• Papules greater than 1 cm in diameter in immunocompromised patients.
• Plaques of eczema around one or more of the skin lesions.

Treatment options for molluscum contagiosum

Topical treatments

• Podophyllotoxin (contraindicated in pregnant women)
• Potassium Hydroxide
• Salicylic Acid
• Benzoyl Peroxide
• Tretinoin
• Imiquimod
• Cantharidin
• And others⁷

Cryotherapy

It’s a procedure that uses extremely cold temperatures to freeze and then remove non-normal tissue.⁸

Curettage

Removal of skin with a surgical instrument with the shape of a spoon and with sharp edges known as a curette.⁹

Laser therapy

This is an additional treatment option based on a specific type of laser ray, we will provide more information.

Laser therapy for molluscum contagiosum

What is laser therapy?

Basic principles of laser treatment

The laser therapy used is Pulsed Dye Laser (PDL), which is preferred when the other treatment options fail

How laser therapy works for molluscum contagiosum

Mechanism of action

PDL induces thermal trauma on the skin, and the inflammatory response created will delete the viral antigens.¹⁰

Advantages of laser therapy

• Effectiveness and success rates
• It produces good results and a tolerable experience
• The skin does not need to be opened; therefore, it is a better option for patients with an infectious disease or immunocompromised
• The person who receives the treatment can recover in a small amount of time

Potential risks and side effects

• Redness
• Itching

Overall, we can say it is safe; studies have shown that it is a great alternative for immunocompromised patients, and from the first session, most of the papules disappear.¹¹

Preparation for laser therapy

Pre-treatment consultation

What to expect during the consultation?

Be ready to answer the health professional questions about your medical history, things related to your health, skin issues, and any medication use. It is a good moment to inform your doctor about any active infections and if you tend to scar or keloid.

Pre-treatment instructions

Skin preparation

Limit the exposure to the sun, make sure to use a sunscreen of at least Solar Protection Factor (SPF) 30 if you need to be outside exposed to sunlight.¹²

Medication considerations

Make sure you stop using medications that can increase photosensitivity, such as retinoids and antibiotics.¹²

Lifestyle adjustments

Stop using self-tanning products like sprays or lotions on the treatment area for at least two weeks before the procedure.¹²

The laser therapy procedure

Step-by-step guide to the procedure

Arrival and preparation

Upon re-examination of the body area to be treated, the patient may receive a hospital gown and the treatment area to be cleaned.

During the treatment

The laser machine was calibrated to the settings chosen by the healthcare professional, and laser light was applied to the lesions as pulses or continuous waves. The duration of the procedure depends on the number of lesions and their size.¹³

Post-treatment care

We expect it to be provided with a calming lotion or cream.

Pain management

Depending on the laser machine to be used, the number of lesions and the size, the options for pain management can vary from general anaesthesia, local anaesthesia, numbing cream or just the cooling function of the laser machine to make sure the patient feels comfortable.¹⁴

Post-treatment discomfort can be solved by using over-the-counter medications or other medication prescribed by the healthcare provider.

Aftercare and recovery

Immediate post-treatment care

Skin care tips

Be gentle with the skin, don’t use heavy makeup or perfumed creams or oils.

Signs of normal healing

Typical itching on the skin and in a few cases purpura are seen.

Long-term care and follow-up

Frequent visits and follow-ups should be done so the healthcare professional can make sure the patient is cured.

Frequently asked questions (FAQs)

What is molluscum contagiosum?

Molluscum Contagiosum is a skin disease caused by a viral infection. The virus causing this is a Poxvirus called Molluscum Contagiosum Virus.

How is molluscum contagiosum transmitted?

Transmission tends to occur through contact with infected skin or objects contaminated with the virus. It is more common in children, rare in children under one year of age, and can also be present in teenagers and adults.

What are the common symptoms of molluscum contagiosum?

The main characteristics are papules, which measure around 2 to 5 millimetres, appearing as single or multiple lesions. These are skin-coloured or pink with a central umbilication and sometimes have an erythematous halo.

How is molluscum contagiosum diagnosed?

Diagnosis is clinically based on the characteristics of the skin lesion. Techniques like dermoscopy, reflectance confocal microscopy, line-field confocal optical coherence tomography, and biopsy (for atypical cases) can also be used.

What is the natural course of molluscum contagiosum if left untreated?

It is a self-limiting condition. Even without treatment, the immune system will fight and destroy the virus, typically taking 6 to 9 months, and in some patients, 3 to 4 years.

What are the treatment options for molluscum contagiosum?

Treatment options include topical treatments (e.g., podophyllotoxin, potassium hydroxide, salicylic acid, benzoyl peroxide, tretinoin, imiquimod, and cantharidin), cryotherapy, curettage, and laser therapy.

How does laser therapy work for treating molluscum contagiosum?

The pulsed dye laser (PDL) induces thermal trauma on the skin, causing an inflammatory response that eliminates the viral antigens.

What are the advantages of laser therapy for molluscum contagiosum?

Laser therapy produces good results, is minimally invasive, and offers quick recovery. It is safe and a great alternative for immunocompromised patients.

What should I expect during the pre-treatment consultation for laser therapy?

Be prepared to answer questions about your medical history and be examined by the doctor.

Summary

In conclusion, understanding and managing Molluscum Contagiosum is essential for those affected by this skin disease. While it is a self-limiting condition, various treatment options are available to alleviate symptoms, prevent the spread of the virus, and address aesthetic concerns. Among these options, laser therapy stands out as an effective, minimally invasive treatment with quick recovery times and high success rates.

By utilizing pulsed dye laser (PDL) technology, laser therapy induces thermal trauma that triggers the body's immune response, effectively targeting and eliminating the viral antigens responsible for Molluscum Contagiosum. This method has proven particularly beneficial for immunocompromised patients and those seeking a swift resolution to their skin lesions.

It is crucial for patients to have a thorough pre-treatment consultation to discuss their medical history, skin conditions, and any medications they may be taking. Proper skin preparation and adherence to pre-treatment instructions can enhance the efficacy of the procedure and minimize potential side effects. During the treatment, patients can expect a carefully calibrated laser application tailored to their specific needs, followed by post-treatment care to ensure optimal healing.

Laser therapy offers a promising solution for those struggling with Molluscum Contagiosum, providing not only physical relief but also emotional and social benefits by addressing the visible signs of the condition. As with any medical treatment, it is important to consult with a healthcare professional to determine the most appropriate course of action based on individual circumstances.

By staying informed about the available treatment options and following the guidance of medical experts, patients can effectively manage Molluscum Contagiosum and improve their quality of life.