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Patient Story
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An 8-year-old girl is brought to the office because of an outbreak of bumps on her face for the past 3 months (Figure 115-1). Occasionally she scratches them, but she is otherwise asymptomatic. The mother and child are unhappy with the appearance of the molluscum contagiosum and chose to try topical imiquimod 5 percent cream. Fortunately, her health insurance covered this expensive treatment. A topical treatment was chosen to avoid the risk of hypopigmentation that can occur in dark-skinned individuals with cryotherapy.

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FIGURE 115-1

Molluscum contagiosum on the face of an 8-year-old girl. (Used with permission from Richard P. Usatine, MD.)

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An 11-year-old girl was also seen with molluscum on her face. The child and her mother decided to try cryotherapy as her treatment. She very bravely tolerated the treatment with liquid nitrogen in a Cryogun (Figure 115-2). The molluscum disappeared without scarring or hypopigmentation after 2 treatments.

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FIGURE 115-2

Cryotherapy of molluscum on the face of an 11-year-old girl. The central umbilication is easily seen in the 2 papules that were just frozen. (Used with permission from Richard P. Usatine, MD.)

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Introduction
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Molluscum contagiosum is a viral skin infection that produces pearly papules that often have a central umbilication. It is seen most commonly in children, but can also be transmitted sexually among adults.

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Epidemiology
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  • Molluscum contagiosum infection has been reported worldwide. An Australian seroepidemiology study found a seropositivity rate of 23 percent.1

  • Up to 5 percent of children in the US have clinical evidence of molluscum contagiosum infection.2 It is a common, nonsexually transmitted condition in children (see Figures 115-1 to 115-4).

  • The number of cases in US adults increased in the 1980s probably as a result of the HIV/AIDS epidemic. Since the introduction of highly active antiretroviral therapy (HAART), the number of molluscum contagiosum cases in HIV/AIDS patients has decreased substantially.3 However, the prevalence of molluscum contagiosum in patients who are HIV-positive may still be as high as 5 to 18 percent (Figure 115-5).4,5

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FIGURE 115-3

A group of molluscum contagiosum lesions on the abdomen of a 4-year-old boy. (Used with permission from Richard P. Usatine, MD.)

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FIGURE 115-4

Molluscum contagiosum under the eye of a young girl with central umbilication. (Used with permission from Richard P. Usatine, MD.)

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FIGURE 115-5

Extensive molluscum contagiosum on the face of a young girl who has perinatally-acquired HIV infection. (Used ...

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