Molluscum contagiosum and its homoeopathic management

Dr Rajasree Nambiar

ABSTRACT
Molluscum contagiosum is a viral infection  of skin caused by molluscum contagiosum virus(MCV) which leads to single or multiple raised pearl like papules on skin.This affect mostly the children. The virus spread through direct skin to skin contact, through fomites or sexual contact with affected partner. This article discusses the epidemiology, pathogenesis, clinical features, diagnosis and homoeopathic management of molluscum contagiosum.

OBJECTIVES

• To understand the epidemiology, pathogenesis, clinical features diagnosis and treatment aspects of molluscum contagiosum.
• To understand homoeopathic management of molluscum contagiosum with the help of repertory and materia medica.

Keywords :Molluscum contagiosum, molluscum contagiosum virus (MCV), homoeopathy medicines

INTRODUCTION
Molluscum contagiosum is a viral infection of the skin caused by molluscum contagiosum virus(MCV) a DNA virus belonging to the Pox viridae family and the genera of mollusci pox virus.

HISTORY

• In 1814-Bateman differentiated it from molluscum fibrosum.
• In 1841-Henderson and Patterson independently described MCV intracytoplasmic inclusion bodies.
• In 1905-Julisberg established the viral etiology of molluscum contagiosum.

EPIDEMIOLOGY

• It is a universally occurring infection usually affecting children and sexually active adults as well as immunocompromised individuals.
• Infection occurs either by direct skin to skin contact or indirectly by means of fomites.
• Incidence rate of molluscum contagiosum in those who are 14 years or younger are large.
• Local outbreak of molluscum contagiosum occur and have been reported in children attending swimming pools, In hot countries , where children are dressed lightly and in close contact with one another and where personal hygiene may be poor, spread within a household is not uncommon.
• Genital lesions in adults are probably transmitted through sexual contact.
• It rarely occurs before age of 1 perhaps because of less direct contact with other children. This can also be explained by maternally transmitted immunity to infants or a prolonged incubation period.

HIGH RATES OF MOLLUSCUM CONTAGIOSUM CAN BE ASSOCIATED WITH

• Age
• Living in close proximity
• Skin to skin contact
• Residence in topical climate
• Swimming pool
• Child sex  has no relation or association to disease state

PATHOGENESIS 

•  Virus
•  Basal keratinocytes
•  Increase in cell turnover that extend to suprabasal region
•  In stratum spinosum mitotic rate decreases and viral DNA synthesis increases
•  Proliferating cells in follicular epithelium form lobulated epithelial mass compressing dermal papillae
•  Cytoplasmic aggregation of viral material appear as large hyaline bodies (molluscum bodies)
•  Eventually destroys cell particularly at center of each lobule
• In fully developed lesion a cavity develop with large number of molluscum bodies with little inflammatory infiltrate at adjacent dermis

CLINICAL FEATURES

• Incubation period 2 weeks to 6 months.
• Pink/Pearly white or yellow white 1-6mm discrete papule with central umbilification.
• Lesions may extrude their contents through central umbilification.
• Lesion larger than 6mm may become red and purulent healing with a slightly depressed scar.
• In infants and toddlers lesions are usually observed around eyes, axilla, and proximal extremities.
• Growth occur over several weeks and spontaneous remission will ensue which is headed by inflammation, suppuration and crusting which destroy lesion leaving a small scar.

DIAGNOSIS

• This is generally straight forward, but large solitary lesion in adult may occasionally be mistaken for basal cell carcinoma.
• Expression of large cheesy like substance by lateral pressure with forceps is characteristic.
• Other techniques include

1. 10% KOH smear-Simple light microscopy

               Shows papules with pseudosaccules gathered symmetrically around central pore.

2. Real time polymerase chain reaction of swab sample.

DIFFERENTIAL DIAGNOSIS

• Warts
• Closed comedones
• Tiny epidermal cyst

Ruling out-Central umbilification and microscopic examination will differentiate skin condition from other papules.

PATIENT EDUCATION

• The highly contagious nature of molluscum should be emphasized.
• The lesions are benign and patient should not be unduly concerned.
• Children with lesion covered by clothing have very low risk of spreading to others.
• Families should be advised not to have siblings bathe together if an infected child have active lesion.

TREATMENT

• Destructive method
• Immune modulating  treatment

HOMOEOPATHIC MANAGEMENT

Homoeopathy is able to succeed in many clinical conditions because of the standard principles upon which it is strongly built.

Mollucsum contagiosum can also be cured effectively with homoeopathic medicines and it also prevents the recurrence.

In a study conducted by Swamy Shraddhmamaynanda and Ashok Kumar Pradhan on Early remission of molluscum contagiosum under homoeopathic treatment  at Ramakrishna Mission Medical Unit,West Bengal,100 cases of molluscum contagiosum were treated with single homoeopathic medicine Dulcamara along with a control group of 10 cases treated with placebo.Out of 100 cases 90 cases showed remission within 15 days and most of them were cured with in 2-3 months.No remission was seen in control group within 3 months and 4 cases showed little improvement after 6 months and 2 cases were cured after 18 months.This study indicate a definite role of homoeopathic medicine in the early resolution of molluscum contagiosum.

A randomized controlled trial on the effectiveness of a variety of homoeopathic drugs(thuja,ruta,calcarea carb,causticum) for the treatment of warts and molluscum contagiosum (Manchanda et al.1997) compared  with placebo with 124 people showed 81% improvement in homoeopathy group and 19% improvement in placebo group

RUBRIC SELECTION

1.MURPHY R-HOMOEOPATHIC MEDICAL REPERTORY

Diseases-MOLLUSCUM contagiosum :Brom. bry. calc. Calc-ar. kali-i. lyc. merc. merc-sul. Nat-m. Sil. sulph. teucr. Thuj.   

2.BOERICKE W-POCKET MANUAL OF HOMOEOPATHIC MATERIA MEDICA  WITH INDIAN MEDICINE AND REPERTORY

Skin-molluscum : Brom. bry. calc. Calc-ar. kali-i. lyc. merc. merc-sul. nat-m. sil. sulph. teucr.

3.SHROYENS F-SYNTHESIS REPERTORY TREASURE EDITION

SKIN-ERUPTIONS-molluscum-contagiosum;molluscum :calc. carc. Kali-i. lyc. Merc. phos. sep. sil. sulph. Thuj.

SKIN – ERUPTIONS – umbilicated ant-t. kali-bi.

SKIN – ERUPTIONS – papular
Acon. allox. anthraco. aur. bac. beryl. Bry. Calc. caps. Caust. cham. cycl. Dulc. galeoc-c-h. gels. Grin. hippoz. Hydrc. Iod. Kali-bi. Kali-c. KALI-I. kali-s. kerose. lat-m. loxo-lae. loxo-recl. lyc. Merc. morb. narc-ps. nat-f. petr-ra. Petr. phos. pic-ac. psor. Sep. sil. suis-hep. sulfa. Sulph. Syph. tere-la. thiop. toxo-g. x-ray zinc.

4.S K TIWARI-HOMOEOPATHY CHILDCARE THERAPEUTICS,CHILD TYPES,REPERTORY

MOLLUSCUM CONTAGIOSUM :Ambr, ARS, calc, calc-p, caust, con, dulc, graph, hep, kali-i, lyc, MERC, NAT-M, nit-ac, phos-ac, phos, PULS, rhus-t, SIL, staph, SULPH, thuj

5.VAN ZANDVOORT-COMPLETE REPERTORY

SKIN-ERUPTIONS-molluscum-contagiosum;molluscum : BROM. bry. calc. CALC-AR. carc. germ-met. Jug-c. kali-i. lepr. Lyc. merc. nat-m. sacch-a. sil. SULPH. Teucr.THUJ.

6.CLARKE JH-A CLINICAL REPERTORY TO THE DICTIONARY OF MATERIA MEDICA

Clinical-molluscum-molluscum contagiosum :Calc.sil

THERAPEUTICS

CALCAREA CARB

• Molluscum contagiosum.
• Unhealthy readily ulcerating flaccid skin.
• Glands swollen.
• Better in cold air.
• Easy relapses,interrupted convalescence.
• Children crave egg and eat dirt and other indigestible things.

SILICEA

• Every little injury suppurates.
• Delicate pale waxy skin.
• Rose colored blotches,umbilicated eruptions with offensive pus.
• Scars suddenly become painful.
• Eruptions itch only in daytime and evening.
• Patient chilly and want plenty of warm clothing.
• Rachitic children with large head, open fontanelles and sutures,distented abdomen.

SULPHUR

• Indicated in all sorts of skin eruptions vesicular,pustular etc especially in those who have been treated by medicated soaps and washes and suppressed by ointment and local medication.
• Dirty filthy look of skin with filthy odour.
• Dry scaly unhealthy skin.
• Aggravation warmth of bed,covering,night.
• Amelioration open air,uncovering.

THUJA

• Eruptions on covered parts and worse after scratching.
• Left sided affection,chilly patient.
• Perspiration sweetish and strong.
• Wart like eruption on anogenital region.
• Has fixed ideas

NATRUM MUR

• Oily,dry,harsh yellow unhealthy skin.
• Dry eruptions on margins of hair.
• Redness of old scars.
• Scars painful.
• Emaciation most notable in neck.

BROMIUM

• Acne,boils ,pustular.
• Boils on arms and face.
• Aggravation evening till midnight,sitting in warm room.

KALI- IOD

• Acne,small boils.
• Worse any covering, heat of body intense.
• Purple spots worse on legs.
• Tendancy to oedematous swellings of eyelids, mouth, uvula etc.

LYCOPODIUM

• Skin thick and indurated.
• Violent itching.
• Offensive secretions.
• Worse warmth.

DULCAMARA

• Eruptions scaly,thick,crusty,moist,bleeding.
• Warts large smooth,fleshy,flat.
• Pruritis.
• Thick crust all over body.
• Small furuncle on places hurt.

RANUNCULUS BULBOSUS

• Vesiular and pustular eruption.
• Burning and intense itching.
• Worse contact
• Hard excrescences.
• Itching in palms.
• Blister like eruption in palms.

CAUSTICUM

• Warts seedy,jagged,bleeding easily ulcerating on tips of fingers,nose,lids,brows.
• Itching.
• Soreness of folds of skin.
• Children slow to walk.
• Skin dirty, white, sallow.
• Skin prone to intertrigo during dentition.

CONCLUSION
Homoeopathy has got a wide range of remedies in the treatment of molluscum contagiosum. we must conduct more evidence-based studies to show its effectiveness in the treatment of molluscum contagiosum.

REFERENCES

1. Thomas P Habif.Clinical dermatology,a color guide to diagnosis and therapy.fifth edition.elsevier Ltd.2009
2. Harper’s textbook of pediatric dermatology,Volume 1,third edition;blackwell publishing Ltd.2011
3. William Boericke .Pocket manual of homoeopathic material medica and repertory;B jain publishers.New Delhi,India;2011
4. JH Clarke.A clinical repertory to the dictionary of material medica.B jain publishers,New Delhi.India;2007
5. SK Tiwari .Homoeopathy and childcare –principles,therapeutics,childrens type,repertory.B jain publishers,New Delhi,India;2010
6. Murphy repertory.synthesis repertory.complete repertory.RADAR software
7. Swamy Shraddamayananda,Ashok  Kumar Pradhan.Early remission of Molluscum Contagiosum under Homoeopahic treatment :An observation in 100 cases.World Journal of  Pharmaceutical Research.Vol 4,Issue 7,2015
8. Effectiveness of homoeopathy for clinical conditions:Evaluation of the evidence.Review of literature from public submission by ARCH.Nov 2014

Dr.Rajasree Nambiar
PG scholar, Department of Organon of medicine and homoeopathic philosophy,
Government homoeopathic medical college & hospital,
Bengaluru.