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AIDS Treatment Update

TREATING MOLLUSCUM: An overview of therapies for this common skin infection




 

AIDS TREATMENT UPDATE, Issue 42, June 1996

Molluscum contagiosum are skin lesions caused by a common pox virus. The lesions can occur in HIV-negative people, but among people with HIV who are exposed to the virus or have previously been infected, they can spread widely over the skin.

The lesions are small, dome-shaped bumps a few millimetres across. They are the same colour as normal skin, but have a pearly or waxy appearance. The lesions each have a hard white central core, and they may have a dent (known as an umbilication) in the middle.

They are particularly common on the face, where they can be spread by wet shaving with a blade. This is thought to occur when a lesion is nicked by the razor. Some doctors suggest that using an iodine skin disinfecting lotion such as Betadine before shaving and soaking the razor blade in it afterwards, or using an electric razor instead, may help to prevent the spread; however, it is unclear whether these measures really make a difference.

Although Molluscum doesn't have any harmful effects on your physical health, the lesions can be very disfiguring, causing psychological distress. Some people feel perfectly confident living with a few lesions, but others want to have them removed immediately. If they are affecting your quality of life you should not hesitate to ask your doctor for treatment.

Molluscum can be treated by various means, and different clinics may recommend different approaches. However, the common aim of the various treatments is simply to remove the lesions. Destroying the hard core of each lesions seems to be essential for successful treatment.

The commonest method is cryotherapy - freezing the lesions one by one using liquid nitrogen applied in a spray or using a cotton-tipped swab. Dr Ian Williams of the Mortimer Market Centre argues that it is important to be aggressive with this treatment, repeating it at least weekly until the lesions are under control.

Another approach is to apply a chemical such as trichloroacetic acid to each lesion to kill the cells, or to use other corrosive chemicals such as anti-wart solutions containing podophyllin or phenol, such as Warticon. These treatments can be painful, and they can't be used on sensitive skin or on lesions close to the eyes.

Some doctors have reported good results from a surgical approach, where each lesions is scooped out using a blunt instrument. At some clinics the preferred treatment is to burn off the lesions using electricity. Both of these methods can be painful, so you should be offered pain-killers or a local anaesthetic such as a lignocaine injection. There is also a significant risk that you will be left with scars.

A less common treatment uses the anti-acne drugs tretinoin (brand name Retin-A) or isotretinoin (Roaccutane). Tretinoin comes in the form of ointment which is applied to individual lesions, while isotretinoin can also be taken as tablets. These drugs are retinoids, which work by reducing the production of natural oils in the skin, encouraging the top layer to dry out and peel. The skin may become reddened and sore while these treatments are being used.

Since the lesions are caused by a virus, an American trial is assessing an experimental approach using the anti-viral drug cidofovir in a cream formulation.

TRIAL The Kobler Centre, which generally treats Molluscum with cryotherapy, is currently offering a study to see whether using additional Warticon anti-wart cream improves the success of the treatment. All participants will have their Molluscum frozen with liquid nitrogen every two weeks, but half of them will also be given a tube of Warticon cream to apply to any new lesions that occur between clinic visits. The researchers will assess whether this approach is more successful at reducing the number of lesions or clearing Molluscum altogether.

For more information call Sandra Davies on 0181-746 8000 bleep 0388.



 


Copy rights reserved to ATN 1996 AIDS Treatment News (ATN), the world's first treatment newsletter for people with HIV, reports on mainstream and alternative treatment, access to care, Web resources, public policy, and political action.



Information in this article was accurate in June 1, 1996. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.