Zennure Takci  ( Department of Dermatology, Altinbas University School of Medicine, Istanbul, )
Arzu Karatas  ( Department of Dermatology, Baskent University, Ankara, )
Yalcin Bas  ( Department of Dermatology, Medical Park Hospital, Tokat, )
Ozlem Tekin  ( Department of Dermatology, Kecioren Training and Research Hospital, Ankara, )
Goknur Kalkan  ( Department of Dermatology, Yildirim Beyazit University, Ankara, )
Havva Yildiz Seckin  ( Department of Dermatology, Tokat Gaziosmanpasa University, Tokat, )
Atiye Akbayrak  ( Department of Dermatology, Tokat Gaziosmanpasa University, Tokat, )
Sercan Sezgin  ( Department of Dermatology, Mus State Hospital, Mus, )
Osman Demir  ( Department of Biostatistics, Tokat Gaziomanpasa University, Tokat, )
Sahin Takci  ( Department of Pediatrics, Ondokuz Mayis University, Samsun, Turkey. )

 

Objective: To address the gap in evidence related to molluscum contagiosum in children by focusing on demographic and clinical features as well as risk factors.

 

Method: The multicentre, prospective, clinical study was conducted at four hospitals in Ankara and Tokat cities of Turkey from August 1, 2014, to August 5, 2019, and comprised patients aged ≤18 years diagnosed with molluscum contagiosum. Data about demographics, day nursery and preschool attendance, the seasons when the disease occurred, any use of Turkish baths and swimming pools, history of personal/familial atopy, coexistence of diseases, disease duration, courses, number of lesions and anatomic localisation. Data was analysed using SPSS 19.

 

Results: Of the 286 patients, 130(45.5%) were girls and 156(54.5%) were boys. The overall mean age was 5.94±3.95 years. The median duration of the disease was 5 weeks (interquartile range: 3.00-12.00 weeks). There was a significant number of cases with family history 18(48.6%) in the 0-3 age group (p=0.027). History of personal atopy was significantly high in the winter season (p<0.05). Patients with >20 lesions had used swimming pools significantly more frequently than the rest (p=0.042). The trunk was the most commonly involved region 162(56.6%).

 

Conclusion: Providing prospective data about demographics, clinical characteristics and risk factors of molluscum contagiosum in children will lead to appropriate preventive and therapeutic measures.

 

Keywords: Children, Molluscum contagiosum, Epidemiology. (JPMA 72: 2375; 2022)

 

DOI: https://doi.org/10.47391/JPMA.4829

 

Introduction

Molluscum contagiosum (MC) is a common, benign viral skin infection characterised by flesh-coloured, discrete, usually asymptomatic dome-shaped pearly papules with a central dell from which a grey-white cheesy material can be extruded. It is common in children, with a prevalence of 5.1% to 11.5%.1,2 MC is caused by a double-stranded deoxyribonucleic acid (DNA) MC virus (MCV) that is part of the poxviridae family. Since the eradication of smallpox, MCV has been the only remaining pox virus infection specifically affecting humans.1 The virus is contagious through direct skin-to-skin contact and autoinoculation, or indirectly via fomites on towels, shared baths, bath sponges, clothing, bedding and swimming pools.1,3 There is limited data on the epidemiology and clinical features of the paediatric population with MC. The current study was planned to fill the gap in evidence by conducting by focussing on demographic and clinical features as well as risk factors.

 

Patients and Methods

The multicentre, prospective, clinical study was conducted at dermatology and venerology clinics of four hospitals in Ankara and Tokat cities of Turkey from August 1, 2014, to August 5, 2019, after approval from ethics review committee.The four participating hospitals were Health Science University Kecioren Education and Training Hospital, Ankara Occupational Diseases Hospital, Tokat Gaziosmanpasa University Health Research and Practice Hospital, and the Tokat State Hospital.The study comprised patients who had been diagnosed with MC and were under the age of 18 years. Written informed consent for data and photographs was obtained from the parents of all the enrolled subjects. Children with an uncertain diagnosis of MC and a lack of informed consent were excluded from the study. Data recorded was age, gender, the season when the disease occurred, day nursery or preschool attendance, disease duration at the time of diagnosis, family history of MC, history of personal atopy, like allergic rhinitis, allergic conjunctivitis, atopic dermatitis (AD), active AD, and asthma, familial atopy, use of swimming pools and Turkish baths in the preceding six months, concomitant verruca vulgaris, numbers and anatomic locations of the lesions, systemic diseases, and concomitant use of topical and/or systemic immunosuppressive medications.The patients were divided into 3 age subgroups: 0-3 years, 4-6 years, and 7-18 years. The course of the disorder was considered to be either acute or chronic. Acute cases were defined as patients in whom the disorder had emerged for the first time and lasted <8 weeks. Chronic cases were defined as patients in whom the disease lasted >8 weeks.The cases were also categorised into 3 subgroups according to the number of MC lesions: <10, 11-19 and >20. The cases were further categorised into 6 subgroups according to the anatomical locations of the lesions: face, trunk, extremities, trunk and extremities, genital area, and whole body. The spread of the lesions was also grouped as 1 region involvement and >1 region involvement. Curettage, cryotherapy, 10% potassium hydroxide (KOH) solution, and tea tree oil were used in the treatment of the patients, depending on age, the extent of the lesions, and the children's ability to tolerate the treatment. Detailed investigation of treatment, molluscum eczema, or bacterial superinfection were outside the scope of the study.

Data was analysed using SPSS 19. Categorical variables were expressed as frequencies and percentages, normally distributed continuous variables as mean ± standard deviation, and non-normally distributed continuous variables as medians with interquartile range (IQR) and minimum-maximum range. Independent sample t-test was used to compare the continuous normally distributed data between various groups. Mann Whitney U test was used to compare the continuous non-normally distributed data between the groups. Pearson's chi-squared test was used to compare the categorical data between the groups. P<0.05 was considered statistically significant.

 

Results

Of the 286 patients, 130(45.5%) were girls and 156(54.5%) were boys. The overall mean age was 5.94±3.95 years. No cases were observed in children aged <1 year. Detailed demographic and clinical data of all the subjects was noted (Table-1).

 

 

 

Family history of MC was found in 37(13%) patients, and a significant number of cases with family history 18(48.6%) was in the 0-3 years age group (p=0.027). In terms of family history, no significant differences were found in relation to gender, season of occurrence, personal history of atopy, family history of atopy, numbers of lesions, and localisations of the lesions (p<0.05 each). None of the patients was doing close-contact sports.

History of personal atopy was found in 69(24.1%) patients (Table-2) and the history of familial atopy was found in 39(13.6%) (Table-3). There was a significant difference between personal/familial atopy and the season of occurrence (p<0.05). History of personal atopy was found to be higher in those who developed MC during the winter season 29(42%) (p=0.037). Also, the history of familial atopy was higher in the autumn season 8(27.6%) (p=0.040).

 

The median disease duration at the time of diagnosis was 5 weeks (IQR: 3.00-12.00 weeks, range: 1-108 weeks). The disease duration was >1 year in 10(3.5%) patients. There was no significant difference between the acute and chronic stages of the disease in terms of age, gender, season, family history, day nursery, Turkish bath, swimming pool, history of personal/familial atopy, number of lesions, and lesion localisation (p>0.05 each)

Further, 147(51.4%) patients had <10 lesions. Swimming pool use was found in 9(6.1%) patients of those with <10 lesions, 4(4.3%) with 10-20 lesions, and 7(15.6%) with >20 lesions (p=0.042). There was no significant difference between the number of lesions and factors, like age, gender, season, nursery, Turkish bath, concomitant verruca vulgaris, and lesion localisation (p>0.05 each). Trunk localisation was the most commonly involved region. There were no significant differences between anatomic localisations with respect to age, gender, season, nursery, Turkish bath and swimming pool (p>0.05 each). Overall, 10(3.5%) patients had lesions on the face with eyelash bottom involvement; 9(90%) of them had umbilicated and/or minimally inflamed papules, and 1(10%) patient had inflamed erythematous nodular papule accompanied by conjunctivitis (Figure).