Symptoms
Dell’s warts are a viral and benign infectious disease of the skin or mucosa that occurs primarily in children and immunocompromised individuals. The disease manifests as single or numerous round, dome-shaped, shiny, skin-colored or white papules that usually have a central depression with a spongy core that can be squeezed. A single patient may have as many as 20, and immunosuppressed individuals as many as 100, such dell warts, which may be surrounded by redness or eczema. The size of the warts ranges from 1 mm to > 1 cm. They appear a few weeks or months after transmission and slowly expand. They do not hurt, but can cause an annoying itch. The warts rarely also occur in the mouth, on the conjunctiva, and in the genital and anal areas in cases of sexual transmission. The duration of infection varies from 6-9 months to several years. In immunosuppressed individuals, the course is more severe and lesions heal more poorly spontaneously.
Causes
Infection is caused by Molluscum contagiosum virus (MCV, Molluscipoxvirus), a 200-300 nm double-stranded DNA virus of the poxvirus family (Poxviridae). The virus occurs in several genotypes. MCV-2 is mainly transmitted sexually. The virus replicates in the skin and causes abnormal cell proliferation, hyperplasia, and hypertrophy of the epidermis.
Transmission
The infection is highly contagious. The virus is transmitted by direct close contact with infected persons or through contaminated objects. Infected people can also reinfect themselves in other places. Because the disease is so contagious, it is common for ill people to pass the virus on to family members, acquaintances, and friends.
Risk factors
Children 2 years of age and older and school-age children, immunosuppressed persons, and HIV-infected persons are commonly affected. The disease is more common in warm, tropical climates. Other possible risk factors include: Bathing or swimming together, sharing towels, certain sports with close physical contact, sexual abuse, changing sexual partners, atopic dermatitis, immunosuppressants, and living in close quarters, such as in a family.
Complications
Possible complications include local skin conditions such as eczema, abscesses, secondary infections, pain, and scarring due to treatment. Abscesses do not necessarily mean that the lesions are bacterially infected, as an immune reaction to the virus can also lead to an abscess. The skin lesions are a psychosocial and cosmetic problem. It is often the parents, rather than the children, who are concerned about the condition.
Diagnosis
Diagnosis requires medical treatment to rule out other conditions, such as vulvar warts, condyloma accuminata, chickenpox, herpes simplex, and tumors.
Prevention
Prevention of transmission is difficult. Hygienic measures are important: Do not bathe together, separate towels, no close body contact, use condoms during sexual intercourse.
Nonpharmacologic treatment
The disease is self-limiting within months to years in immunocompetent patients and heals with inflammatory processes as part of an immune response. Observational waiting is therefore an option. However, patients often and justifiably desire treatment. Whether and in which cases this is necessary is a subject of discussion. The warts can be deflated or removed by physical methods, for example in medical treatment by squeezing out the nucleus or cutting with a curette, scalpel, sharp needle or other sharp instrument. This may cause scarring, pain, local irritation and abscess formation. Beforehand, children should be given a local anesthetic to suppress pain, and after treatment the wound should be disinfected. Other options include electrocoagulation, laser treatment, tape stripping and photodynamic therapy. Recurrences are possible and may occur after months due to the long incubation period. Itching can be treated symptomatically. The various methods are outlined under the article Itching. Skin diseases and abscesses require separate treatment.
Drug treatment
For drug therapy, the usual wart agents are used, which are also used for the treatment of other warts, for example, caustics and irritants, cytostatics and immunomodulators. The effectiveness of these agents has not been sufficiently studied scientifically in this indication, but this does not mean that they may not be suitable for treatment. The same is true for non-drug treatment. It must be noted that many of the drugs mentioned are not approved in this indication in many countries and their use is off-label at the responsibility of the physician. The appropriate precautions must be observed. For the exact application, please refer to the product information and the literature, for example Hanson and Diven (2003). Caustics and keratolytics:
- Salicylic acid, chloroacetic acid, trichloroacetic acid, glacial acetic acid, nitric acid, oxalic acid, lactic acid, sodium hydroxide, potassium hydroxide (InfectoDell, Molusk), silver nitrate sticks, iodine solution, benzoyl peroxide, and tretinoin are used externally in the form of drugs at appropriate concentrations and dissolve the warts or trigger the inflammatory immune response. Cantharidin from the Spanish fly, which is highly blistering on the skin, is a popular remedy with some physicians, but is no longer commercially available as a drug in many countries. Caustics should not get on healthy skin, which should be protected with a patch or ointment.
More:
- In addition to cautery agents, cytostatics such as fluorouracil, podophyllotoxin, immunomodulators rarely cimetidine (systemic) and local antiviral agents such as cidofovir are used. The efficacy of imiquimod is controversial.
Folk and alternative medicine:
- Celandine (fresh milky juice), spurge (fresh milky juice), thuja, oak decoction, onions, garlic and numerous other remedies. See also under Thuja against warts.
