Eczema Molluscatum

Disseminated eruption of molluscum contagiosum virus (MCV) in an AD patient is known as EM. It is mostly a disease of children. The relatively small, skin-coloured frequently umbilicated papules vary in size (Figure 6.1). Though most papules are confined to the eczematous lesions of the underlying AD, autoinoculation of the virus may cause aberrant papules in other body regions. There is no fever, no malaise, and no general symptoms associated with EM.

MCV was found to have unique genes not found in variola virus, that encode proteins which help the virus avoid immune detection, and 59 MCV genes are

Spongiotic Dermatitis
Figure 6.1 Eczema molluscatum. A disseminated eruption of whitish, umbilicated papules on eczematous skin which show considerable variation in size.

predicted to encode previously uncharacterized proteins, including MHC class I, chemokine, and glutathione per-oxidase homologues, which may be linked with MCV pathogenesis and provide considerable insights into how viruses can evade antiviral defence mechanisms.1

The soluble interleukin (IL)-18 binding protein (IL-18BP) of poxviruses represents a new immune escape strategy. As IL-18 is a proinflammatory cytokine that can enhance both the innate and acquired immunity, the poxvirus-encoded IL-18BPs binding to IL-18 with high affinity and inhibiting IL-18 mediated IFN-y induction interrupts the normal immune response to MCV antigens.2

Treatment of EM greatly depends on the physician's personal opinion and experience. Patients pretreated with topical steroids or topical immunomodulators are usually taken off these drugs for a few weeks to allow mounting of a natural immune response against the virus.3 In addition, a smaller number of lesions may be expressed with a suitably shaped forceps. Half an hour's pretreatment with a cream containing a eutec-tic mixture of local anaesthetics will both reduce pain and soften the lesion for easier removal. Topical application of imiquimod or other topical immunostimula-tory drugs shows promising results and may become a future treatment option.4 As the virus is easily spread by a scratching hand, we recommend the application of gauze dressings to cover the affected areas.

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