Perhaps the biggest misconception about molluscum contagiosum is that it's really a spell or hex from the Harry Potter series of books for young adults. It may roll off the tongue with the same wand-twirling drama of "petrificus totalus," but sadly it has nothing to do with wizards. It's actually an infection, part of the pox family of viruses. Think chickenpox, but without the fever or discomfort.
Words like "benign" and "mild" tend to get thrown around when health experts describe molluscum contagiosum, or MC. They also use words like "rare." When we contacted the Centers for Disease Control and Prevention for more details on MC, a representative asked why we were interested in this "relatively obscure bug?" Whitney High, a professor of dermatology at the University of Colorado School of Medicine, isn't so dismissive, telling us he's seen MC in healthy adults "with my own eyes." When an STD is discussed with the same language you might use for a Bigfoot sighting—"I swear I saw it!"—you know you're dealing with something a little uncommon. What is molluscum contagiosum, and should we care? We've got the answers to all your burning questions.
What makes the rash and lesions of molluscum contagiosum distinctive? Would we immediately know from looking at it that it's not something else?
They're definitely hard to miss. The MC lesions tend to be pink or flesh-colored, and between 2 and 5 millimeters in diameter. Adam Friedman, an associate professor of dermatology at George Washington School of Medicine and Health Sciences, says molluscum "look a little like whiteheads, though the center of the white papule is umbilicated," like a donut with a hole in the middle. They often appear in clusters, usually near the genitals, butt, or (on women) breasts, and can occasionally become itchy or swollen but are more typically painless.
This is a kind of pox, right? I thought only kids got that. How is this an STD?
There are actually two types of molluscum contagiosum. The first and most common is MCV type 1, which is predominantly found in children between the ages of one and ten. Then there's MCV type 2, which is sexually transmitted and occurs almost entirely in adults.
So I can only get it by having sex with somebody who's infected?
Well, no. It's spread by skin-to-skin contact, so sex is probably the most direct way to get it, as there tends to be a lot of bare skin touching during sexual intimacy. But according to the CDC, MCV 2 "might be" spread by sharing swimming pools, baths, and saunas, although they admit there isn't any solid medical evidence to back this up. You can also re-infect yourself, spreading the virus by touching or scratching a lesion and then touching another part of your body. But is it more prone to happen when the lesions are intact or after they've burst? When are lesions more or less infectious? Nobody knows! There's frankly not a lot of research on this, and the CDC claims that "conflicting reports make it unclear."
There was a study a few years ago that suggested removing pubic hair could lead to an increased risk of getting molluscum contagiosum. Is that true?
If we can borrow a phrase from the magic 8 ball, signs point to yes. "By shaving, you could potentially 'open up' the pores, and more easily spread the virus," High says. "Just like it is well known that so-called 'flat warts'—a form of HPV, not molluscum, but still a viral infection of the skin—is also spread by shaving, and this has been been known for decades." Friedman agrees, saying that abrasive grooming techniques can "damage the skin barrier as well as unroof the moll scum papule, allowing for the virus to pass through the skin barrier." So, to recap: Condom = ineffective in protecting against MC. Having a full bush = well, it doesn't hurt.
What are the long-term health consequences of contracting molluscum contagiosum? Is it dangerous?
Not so much dangerous as super annoying. Because it's so highly contagious and can spread so easily, Friedman says, it can be an incredible nuisance. Especially when we know so little about how it's spread and under what conditions. The worst repercussion is probably scarring, but that's only if you pick or scratch the infected area. "By picking or scratching at them, not only do you increase the risk of further spreading them, but also you open yourself to bacterial skin infections given the barrier is broken and open to the nasty world we live in," Friedman says.
But here's the really hilariously bizarre and ironic part. As it turns out, it's not just health professionals who aren't all that concerned about molluscum contagiosum. Our own immune systems barely care enough to fight it. "We can sometimes see an eczema-like rash that can develop around the molluscum called 'molluscum dermatitis,' which indicates the immune system is on the attack," Friedman says. "However, in most cases, because this viral infection is so superficial in the skin and lives inside the skin cells, it often goes unnoticed by the immune system." And that's what causes the infection to spread and keep spreading. Not because the infection is so strong, but because our own immune systems are like, "Meh, whatever."
How do you treat it?
Let's just put it this way: None of them are fun. Treatments include everything from cutting, freezing, and even burning lesions with acid.
Wait, what? Acid? You're kidding, right?
Relax—it's just salicylic acid, which is used in skin-care products to treat acne, corns, and warts. "All of these treatments intend to destroy the skin, ridding the infected cells and hopefully with new, non-infected cells growing in," High says. There are less aggressive ways to treat the problem, he says, like a topical imiquimod cream, which stimulates the immune system to come in and fight off the infection. "Sometimes it works, sometimes it doesn't," High says. "There is no vaccine, like there is for HPV."
Another option is cantharidin, "a liquid derived from the blister beetle," Friedman says, "that can, as the name infers, create blisters when applied to the skin." It's an odorless and painless liquid that he says is "certainly less painful than liquid nitrogen," the method used to freeze off the MC lesions. "I have asked patients which is more painful, liquid nitrogen or curettage, a small circular blade that is used to scrape them away," Friedman says, "and most say curettage is less painful."
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