Dermoscopy of Molluscum

Molluscum is a worldwide epidemic mainly afflicting children in Papua, New Guinea and Fiji. The molluscum contagiosum virus (MCV) is a DNA virus member of the poxviridae family and is one of human beings’ biggest pathogenic weapons. Dermoscopy, which can magnify and display the lesion morphology in detail (including fine structure such as waxy sheen, peripheral halo or central umbilicus of lesions that suggest Molluscum). These morphologic features become more apparent on dermoscopy and may assist in diagnosis confirmation.

What Is Molluscum?
MCV causes Molluscum, a self-limiting and benign cutaneous infection. Typically, a 2 to 8 mm diameter papule, solitary or multiple; round or hemispherical with waxy luster; central umbilicus concave. Molluscum is transmitted by direct contact, and it may also be spread through autologous inoculation or sexual transmission. Sexual transmission is rampant amongst sexually active youth and often linked with intercourse so that it happens to be considered as a STI.
The disease occurs mainly in children between the ages of 1 and 10 and in people with weakened immune systems, such as those who have leukemia, HIV, or are being treated for cancer. Skin damage can induce viral infection, the virus is easy to enter the human body through the broken skin to become infected. Sharing items with virus carriers in places such as public baths and swimming pools also increases the risk of infection.

How To Identify Molluscum?
Molluscum is caused by a DNA poxvirus called MCV, it does not have an animal host and can only affect humans. It is classified as four types depending on the MCV type, MCV-1 to MCV-4. MCV-1 is the most common type and MCV-2 (found in adults) are typically spread sexually.
Molluscum lesions generally are hemispherical papules, gray or pearly in color, with a waxy surface that has the characteristic central indentation filled with whitish cheese-like grumous material of molluscumor; It is a common skin condition, and because of its symptoms mimic other notable skin conditions such as ordinary warts or papular urticaria or tellest sweat duct tumors.
Numerous combinations of diagnostic approaches for molluscum contagiosum have been developed. We can use dermoscopy to diagnose by a suspected lesion based on typical molluscum contagiosum features first. Histopathological examination can also be used. In the case of a molluscum contagiosum, a centrally depressed dome-shaped cyst filled with keratin is visible beneath the stratum corneum. The presence of molluscum contagiosum can be directly identified and confirmed by gently scraping the cuticle at the tip of the mollusc using a cotton swab and sending the sample to a laboratory to be analyzed for the presence of molluscum contagiosum vesicles.

Dermoscopic Features of Molluscum
On dermoscopy molluscum shows a central umbilication and the surrounding white to yellow amorphous or multilobulated structures . At the periphery of the lesion, a network of linear or branching blood vessels can be clearly visualized in a distinctive “red crown” pattern, providing a key visual clue to the diagnosis of molluscum contagiosum.

Differences between Molluscum and Other Skin Lesions
Using high-definition magnification with dermoscopy, molluscum contagiosum is easily discriminable from those other lesions of the skin. Central craters and multilobe white to yellowish amorphous structures were common dermoscopic features seen in molluscum contagiosum. The dermoscopic characteristics in basal cell carcinoma include a white structureless background, branching blood vessels and blue-gray dots. Dermoscopic features of keratoacanthoma typically consist of hemispherical or crateriform lesions with a central plug filled by keratin, and often an advancing growth at the margin.

Dermoscopy in the Treatment of Molluscum
Dermoscopy enables real-time observation of changes in molluscum during treatment, including subtle changes in its shape, size and color. For example, molluscum usually appears dermoscopically as an apical depression with a waxy sheen, which may diminish or disappear as treatment progresses, reflecting the effectiveness of the treatment. Furthermore, dermoscopy is a non-invasive procedure that requires no additional pain or discomfort for the patient. This makes it even more popular for monitoring the response to molluscum contagiosum treatment and evaluating efficacy.

Clinical and Dermoscopic Images of Molluscum
Molluscum contagiosum often presents clinically as a single or multiple translucent papules of varying sizes, mostly skin-colored or slightly whitish, sometimes with an umbilicus at the tip.
Dermoscopically, molluscum contagiosum lesions often appear as yellowish-white or white amorphous areas, due to the presence of viral particles and keratinized material within the lesions. The lesions are often surrounded by elongated vascular structures, which tend to be crowned or linear, and sometimes punctate.
Dermoscopy clearly shows the fine structure of the lesions and helps the doctor to make an accurate diagnosis. When molluscum contagiosum lesions are atypical or similar to other diseases, dermoscopic images allow doctors to differentiate molluscum contagiosum from other similar diseases (e.g., folliculitis, itchy rashes, sebaceous hyperplasia, etc.), thus avoiding misdiagnosis and underdiagnosis.

Treatment and Management of Molluscum
Common treatments for molluscum contagiosum are divided into two main categories: localized and systemic treatments.
Localized treatments include scraping, freezing and laser treatment. The first step is to use tweezers to scrape or pinch off the warts. The cold treatment is the use of liquid nitrogen’s low temperature effect to make the mollusc tissue necrosis and fall off. Laser treatment uses laser energy to vaporize or carbonize molluscum contagiosum and remove it. The prognosis of all four treatments is also affected by the patient’s immunity, the number and depth of treatments, and post-operative care.
Systemic treatment for molluscum contagiosum focuses primarily on improving the patient’s overall immunity and helping the body to naturally clear the virus. Commonly used immune-modulating drugs for this process include imiquimod cream and recombinant human interferon α2b. Systemic therapy focuses not only on the fading of the lesions, but also on improving the overall health of the patient. By improving the patient’s immunity, systemic therapy can reduce other complications caused by the disease and improve the patient’s quality of life.