tretinoin and Molluscum-Contagiosum

Warts and molluscum contagiosum are common skin diseases in children and are usually self-limiting. The decision of whether to treat children with molluscum or warts should be individualized to the patient and his or her family. Considerations include how symptomatic the lesions are, the extent and duration of disease, the ability of the child and the parents to tolerate and comply with treatment recommendations, and any underlying medical conditions (Table, see page 219). Recurrences of molluscum contagiosum and especially warts are common, and realistic expectations regarding the potential for treatment failure and recurrence should be discussed with the child and his or her family prior to initiating any therapy. As pediatric practitioners, we all remain acutely aware of our patients' physical and psychological development and the potential for any intervention to influence this development. Although various treatment modalities now exist for the treatment of these viral diseases, any intervention should be balanced against these considerations.

Topics: Adhesives; Adjuvants, Immunologic; Administration, Topical; Aminoquinolines; Cantharidin; Child; Cimetidine; Cryotherapy; Curettage; Fluorouracil; Hot Temperature; Humans; Imiquimod; Immunotherapy; Irritants; Keratolytic Agents; Laser Therapy; Molluscum Contagiosum; Occlusive Dressings; Pediatrics; Podophyllin; Salicylic Acid; Tretinoin; Warts

Molluscum contagiosum is an infection caused by a poxvirus that gives rise to small, benign, white, pink, or flesh-colored, umbilicated, raised papules or nodules located in the epidermal layer of the skin. The disease can be transmitted by direct bodily contact including sexual activity, fomites, or self-inoculation. There has been continued debate about whether physicians should actively treat molluscum contagiosum. Many dermatologists recommend treatment to reduce the incidence of contagious transfer and reduce self-inoculation. Furthermore, individuals with weakened immune systems (eg, patients with human immunodeficiency virus infection) not only are at greater risk for secondary inflammation and bacterial infection but also are prone to lesions that typically persist for prolonged periods. In addition to the commonly administered treatments (ie, physical and chemical destruction), novel treatment opportunities exist, including immunomodulated therapy with imiquimod.

Topics: Administration, Cutaneous; Aminoquinolines; Humans; Imiquimod; Keratolytic Agents; Molluscum Contagiosum; Randomized Controlled Trials as Topic; Tretinoin

Topical vitamin A acid (VAA) has various mechanisms of action which may be responsible for its therapeutic success in many different disorders. Although the absorption, metabolism, and excretion of VAA are not completely understood, VAA appears to remain mainly on the skin surface. The question of carcinogenicity is unresolved, and more research is needed to clarify this problem. This article reviews the literature regarding the therapeutic uses of VAA and summarizes various investigators' experiences with VAA.

Topics: Acne Vulgaris; Animals; Callosities; Cocarcinogenesis; Fox-Fordyce Disease; Humans; Ichthyosis; Keloid; Keratoacanthoma; Keratosis; Lichen Planus; Melanoma; Melanosis; Molluscum Contagiosum; Nevus; Psoriasis; Skin Absorption; Skin Diseases; Skin Neoplasms; Tretinoin

Topics: Humans; Molluscum Contagiosum; Needles; Tretinoin

A case of molluscum contagiosum arising on the face and neck of a woman using topical tacrolimus over a period of 6 weeks for the treatment of atopic dermatitis is presented. Of particular note, these lesions remained confined to areas treated with tacrolimus and did not extend to adjacent regions treated with topical corticosteroids.

Topics: Administration, Topical; Adult; Betamethasone Valerate; Dermatitis, Atopic; Female; Humans; Immunosuppressive Agents; Molluscum Contagiosum; Ointments; Tacrolimus; Treatment Outcome; Tretinoin

Molluscum contagiosum is a viral disease frequently observed in children and adolescents with atopic dermatitis, in whom it poses a special therapeutic challenge. A 3-year-old girl presented with atopic eczema and disseminated molluscum contagiosum on her buttocks and upper legs. Topical application of 0.05% tretinoin resulted in a steady regression of the lesions. Other therapeutic options include topical anti-viral agents, cryosurgery, laser treatment, and curettage. Further, the therapeutic outcome is highly dependent on an adequate therapy of the concomitant atopic eczema.

Topics: Administration, Oral; Administration, Topical; Child, Preschool; Dermatitis, Atopic; Drug Therapy, Combination; Female; Humans; Molluscum Contagiosum; Prednisolone; Superinfection; Tretinoin

Topics: Asthma; Child; Cimetidine; Cryotherapy; Curettage; Diagnosis, Differential; Eczema; Female; Histamine H2 Antagonists; Humans; Keratolytic Agents; Molluscum Contagiosum; Nurse Practitioners; Primary Health Care; Recurrence; Referral and Consultation; Tretinoin

Human immunodeficiency virus (HIV) causes disease by infecting lymphocytes and progressively destroying critical regulatory and effector cells of the immune system, leaving patients vulnerable to a number of bacterial, fungal, and viral infections. Facial herpes (herpes simplex virus-1 [HSV-1]), genital herpes (HSV-2), herpes zoster (varicella zoster virus), oral hairy leukoplakia (Epstein-Barr virus), Kaposi's sarcoma (HHV-8), molluscum contagiosum, condyloma acuminata (human papillomavirus [HPV-6, HPV-11]), plantar warts (HPV-1), and facial warts and flat warts (HPV-5) are some of the cutaneous viral diseases most commonly seen in HIV-infected patients. Two immunomodulatory agents, imiquimod (Aldara), shown to be safe and effective in the management of genital warts, and alitretinoin gel, shown to be safe and effective in the treatment of Kaposi's sarcoma, may offer a new therapeutic approach to treatment of cutaneous viral diseases. There is a strong scientific rationale to suggest that imiquimod and alitretinoin gel may be useful in the treatment of a variety of cutaneous viral diseases that have been shown to respond to immunomodulatory drugs. This represents a new approach in the therapeutic treatment paradigm for treatment of cutaneous viral diseases at their site of infection.

Topics: Adjuvants, Immunologic; AIDS-Related Opportunistic Infections; Alitretinoin; Aminoquinolines; Antiviral Agents; Condylomata Acuminata; Gels; Humans; Imiquimod; Molluscum Contagiosum; Skin Diseases, Viral; Tretinoin

Topics: Administration, Topical; Adolescent; Adult; Age Factors; Child; Child, Preschool; Cryosurgery; Curettage; Diagnosis, Differential; Female; Humans; Molluscum Contagiosum; Tretinoin

Topics: Administration, Topical; Cryosurgery; Curettage; Electrocoagulation; Humans; Molluscum Contagiosum; Nitrogen; Tretinoin

Topics: Adolescent; Adult; Child; Humans; Molluscum Contagiosum; Molluscum contagiosum virus; Remission, Spontaneous; Tretinoin

Topics: Child, Preschool; Humans; Immunologic Deficiency Syndromes; Male; Molluscum Contagiosum; Tretinoin

Molluscum contagiosum spread by sexual contact may be mistaken for other venereal diseases. The occurrence of a penile lesion resembling herpes progenitalis, and successful therapy of genital mollusca with topical tretinoin (vitamin A acid) is described.

Topics: Adult; Female; Humans; Male; Molluscum Contagiosum; Penis; Sexually Transmitted Diseases; Tretinoin; Vitamin A

Topics: Child, Preschool; Hemophilia A; Humans; Male; Molluscum Contagiosum; Tretinoin; Vitamin A