DERMATOPATHOLOGY CASES: Self-Assessment Cases: Editor - Dr Sampurna Roy MD

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Wednesday, December 30, 2009

Answer of Dermatopathology Case 28

Molluscum Contagiosum

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Mollusca contagiosa. From paediatric dermatology to sexually transmitted infection.Hautarzt. 2009 Jun;60(6):472-6.
Molluscum contagiosum (MC) is a common cutaneous infection caused by the molluscipox virus (MCV) and can affect both children and adults. Molluscum contagiosum is relatively frequent in children aged 1-5 years old and can be localized almost anywhere on the body, but in adults it is regarded as a sexually transmitted infection (STI). MCV can be transmitted directly from person to person or by autoinoculation. MC in adults characteristically involves the genital area but extragenital appearance can be more typically seen in patients with immunosuppressive conditions, especially in HIV/AIDS. The onset of MC inHIV-positive individuals can be regarded as a part of the immune reconstitution inflammatory syndrome (IRIS). MC probably affects both sexes equally in children, whereas it seems that in adults the incidence is more prevalent in males. Therapy is controversial but may be considerably beneficial in preventing transmission or autoinoculation. At present there is no aetiological treatment of MC and most treatment options are mechanical sometimes causing discomfort or are not sufficiently evidence-based. Attention should be given to the extragenital site of involvement in adults and HIV testing should be recommended. Both children and adults with MC should be educated to avoid scratching and skin contact with others to prevent transmission and autoinoculation. Adult patients with MC shouldbe carefully screened for other STIs and appropriately counseled.

Molluscum contagiosum and dental caries: A pertinent combination. J Indian Soc Pedod Prev Dent. 2009 Oct-Dec;27(4):197-201.
Background: In recent decades, there has been a tremendous surge of interest inissues related to child health. The present study was carried out to reveal theDMFT/deft status of children in the age group of 1-12 years, residing inorphanages from Pune, India. Aims and Objectives: To explore the DMFT/deft status in various orphanages from Pune (India). To find out differences, if any, betweenthe DMFT/deft status in orphanages from Pune, India, and the general population of children below 12 years of age in Maharashtra state, India as well as all over India. Results: DMFT/deft of the orphanages was found to be 2.58 in the age group1-5 years and 2.5 in the age group 6-12 years with caries prevalence in 70.27% of the children. An incidental finding of Molluscum contagiosum was observed in asignificant percentage of children. The total percentage of children afflicted by Molluscum contagiosum was found to be 24.32%. Conclusion: The higher incidence of Molluscum contagiosum in children residing in orphanages as compared to thenormal population of the same age group was reflected in the higher incidence of DMFT/deft in orphanages as compared to the normal population.

Molluscum contagiosum: Descriptive study. An Pediatr (Barc). 2009 Oct 30.
INTRODUCTION: Molluscum contagiosum is a cutaneous viral infection that often requires assistance. The aim of our study is to review the cases admitted in our clinic, evaluate the epidemiological features and the treatment prescribed. PATIENTS AND METHODS: We conducted a descriptive survey of the patients diagnosed of molluscum contagiosum in our clinic (Complexo Hospitalario Arquitecto Marcide-Novoa Santos, Ferrol, Spain) between June 16th 2008 and January 15th 2009. The following dates were recorded in all cases: age, sex, personal history of atopy, swimming pool attendance, number of lesions and treatment prescribed.RESULTS: 140 cases of molluscum contagiosum were included in the study. Average age was 10.7 years. 51.43% of patients had a personal history of atopy and 72.1% used to attendance swimming-pool. Average number of lesions was 13.3, with a higher number of them in males, atopic and swimming-pool attendants. Curettage was the treatment performed in 86.4% of cases. CONCLUSIONS: Atopic dermatitis and swimming-pool attendance were associated in our study with a higher frequency andnumber of molluscum contagiosum. Although different therapeutic options must be evaluated depending on the patient and clinical skills, curettage is the most frequent treatment performed by dermatologists.

Molluscum contagiosum: immunomorphological aspects of keratinocytes markers of differentiation and adhesion. J Cutan Pathol. 2009 Dec;36(12):1279-85.
BACKGROUND: Molluscum contagiosum (MC) is a Molluscipox virus infection of keratinocytes with hyperplasia and intracytoplasmic inclusions - the molluscumbodies (MBs). Few papers address cytokeratins (K) profile in MC, mainly focusing terminal keratinization process. METHODS: Forty-one MC lesions were subjected to immunohistochemical technique to verify K1, K10, K14, K16, involucrin, filaggrin,E-cadherin and p63 expression. MC immunolabeling pattern was compared to adjacent normal appearing epidermis (ANAE). RESULTS: In MC and ANAE, K1/K10 were expressedin suprabasal layers, K14 was expressed in basal and suprabasal layers and K16 was expressed through all spinous layer. Involucrin and filaggrin were observed in granular, spinous and in basal layer of ANAE and MC. E-cadherin was present upto the first layers of MC while ANAE exhibited E-cadherin labeling at basal andspinous layers. Basal and spinous layers keratinocytes nuclei, in both MC and ANAE, express p63. CONCLUSION: Infection by Molluscipox virus alters keratinocyte differentiation status. The presence of K14 and p63 in spinous layer, as well as early expression of involucrin and filaggrin, associated to a hyperproliferative state disclosed by K16 expression, may be a result of disruption in keratinocytes maturation process. The changes observed at ANAE may represent early events in keratinization disturbance.