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
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.
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