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Five-year-old presenting with Molluscum contagiosum.

Presenting Complaint

Five year old "John" was brought in by his mother as his doctor had diagnosed him with Molluscum contagiosum (MC). This was causing him social problems as it was embarrassing for him and his mother had been informed by the school that each papule must be covered. He was also not permitted to attend swimming lessons.

MC is a pox viral infection characterised by numerous small papules which can appear anywhere on the skin. It is a common infection in children and occurs when a child comes into direct contact with a lesion. It usually disappears spontaneously after several months. It is frequently seen on the face, neck, armpit, arms and hands but may occur anywhere on the body except the palms and soles (Beers & Berkow, 1999).

Medical history

John was generally in very good health and his medical history was unremarkable. He had had MC for one year.

Physical Examination

John presented with papules and nodules on his torso, legs and arms. He had scratched them, causing several of them to become irritated and red. On school days, he had to be covered in Band-Aids, resulting in teasing.

Treatment

The focus of treatment was to reduce inflammation and viral loading. To this end it was suggested he take fish oil for its anti-inflammatory action (Calder 2002). His mother had 1g capsules at home and said she would squeeze some out for him twice daily, giving an approximate daily dose of 1g. We also spoke about improving his diet although was already on the better side of average with few fast foods or snacks.

A herb mix was made up of:
Herb                                       Total

Hypericum perforatum   1:2 non-alcoholic   40mL
Glycyrrhiza glabra     1:1 non-alcoholic   40mL
Uncaria tormentosa            1:1          20mL
TOTAL                                      100mL


Dose: 2ml twice daily (three times daily not suitable for a school child)

Discussion

Licorice (Glycyrrhiza glabra) was used as the glycyrrhizin inhibits viral growth and inactivates viral particles (Jeong & Kim, 2002, Asl & Hosseinzadeh, 2008). Although to date there is no data pertaining to its efficacy for MC, many in vitro and in vivo studies have demonstrated widespread anti-viral activity against herpes simplex virus, hepatitis B and C, encephalitis, influenza A, Epstein-Barr virus, coronavirus, arbovirus and respiratory syncytial virus (Braun & Cohen, 2010). Licorice also has anti-inflammatory properties, largely due to the activity of glycyrrhetinic acid (Teelucksingh et al. 1990).

St John's wort (Hypericum perforatum) was used for its anti-viral activity (Birt et al. 2009)--as a precaution it was explained to his mother that he might be more sensitive to the sun when taking it (Braun and Cohen 2010) even though the dose was low.

Cat's claw (Uncaria tormentosa) was used traditionally as a tonic and restorative and is often used in modern herbalism as an anti-viral; however, to date there is no evidence to back up this usage. Hopefully this research will be done in the future.

Non-alcoholic extracts were chosen where available due to the John's tender age. They are also more palatable for children resulting in improved compliance. Although there were times when she forgot to give John the herb mix, his mother reported that the MC symptoms started to decrease within a month and "disappeared after a few more weeks". Unfortunately, his older brother, aged 9, has now contracted MC and has started taking the same mix.

References

Asl MN, Hosseinzadeh H. 2008. Review of pharmacological effects of Glycyrrhiza sp. and its bioactive compounds. Phytother Res. 22:6;709-724

Beers MH, Berkow R. 1999. The Merck Manual of Diagnosis and Therapy, Merck Research Laboratories, NJ

Birt DF, Widrlechner MP, Hammer KD, Hillwig ML, Wei J, Kraus GA et al. 2009. Hypericum in infection: Identification of anti-viral and anti-inflammatory constituents. Pharmaceutical Biology, 47:8;774-782.

Braun L, Cohen M. 2010. Herbs and Natural Supplements, An Evidence-based Guide, Elsevier, Marrickville, Australia

Calder PC. 2002. Dietary modification of inflammation with lipids. Proc Nutr Sco 61:3;345-358

Jeong HG, Kim JY. 2002. Induction of inducible nitric oxide synthase expression by 18b-glycyrrhetnic acid in macrophages. FEBS Lett 513;208-212

Teelucksingh S, Mackie AD, Burt D, McIntyre MA, Brett L, Edwards CR. 1990. Potentiation of hydrocortisone activity in skin by glycyrrhetinic acid. Lancet. 335:8697;1060-1063.

Sarah Harvey MHSc (Herbal Med), BHSc (Hons), ND

All Health Clinic, 37a Rohini St, Turramurra 2074

Tel: 02-9440 1631
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Title Annotation:Case Study
Author:Harvey, Sarah
Publication:Australian Journal of Herbal Medicine
Article Type:Report
Geographic Code:8AUST
Date:Jan 1, 2013
Words:718
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