Unusual Presentations of Molluscum Contagiosum

Al-Mutairi, Nawaf

doi:10.2310/7750.2008.06003

Cited by 5 publications

(4 citation statements)

References 14 publications

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“…These atypical lesions usually occur in the setting of immunosuppression including atopic dermatitis, acquired immunodeficiency syndrome, organ transplantation, immunosuppressive therapy and leukaemia. [2][3][4] However, in our case, even though the patient had disseminated MC, she was apparently healthy. There was nothing in her history or clinical findings to suggest any risk factors for MC.…”

Section: Discussioncontrasting

confidence: 49%

Disseminated erythematous papules in a healthy 73-year-old woman

Lee

Jang

Han

et al. 2011

Clinical and Experimental Dermatology

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A 73-year-old Korean woman presented with a 1-year history of disseminated papular eruptions on the trunk, buttocks and limbs. The patient had a 3-year history of hypertension, but was not taking any medication. Her family history was unremarkable. She had cultivated vegetables on her farm for several years, where she was exposed to the sun directly on a daily basis. She had been treated with excessive topical corticosteroids (clobetasol propionate 0.05%, about 250 mL in a month) over the previous year. However, this treatment had only improved the pruritus temporarily and the lesions gradually spread to cover the entire trunk area. She denied any other medical problems and recent use of immunosuppressive drugs.On physical examination, multiple discrete erythematous to yellowish papules, 5-100 mm in diameter, with or without central umbilication, were seen, covering the entire trunk, buttocks and limbs (Fig. 1a). The lesions had gradually spread out across the upper portion of both arms, and at the time of presentation, they numbered > 100. Laboratory investigations including complete blood cell counts, blood chemistry studies, urine analysis, chest X-ray and electrocardiography were within normal limits. Results of testing for antibodies to human immunodeficiency virus were negative. A biopsy was taken from one of the lesions. Histopathological findingsOn histopathological examination, an intradermal lobulated cystic cavity containing numerous intracytoplasmic inclusion bodies, was seen, which was connected with the epidermal surface (Fig. 1b). Figure 1 (a) Multiple discrete erythematous to yellowish papules, 5-10 mm in diameter, with or without central umbilication, over the entire trunk. (b) Intradermal lobulated cystic cavity containing numerous intracytoplasmic inclusion bodies, which connected with the epidermal surface (haematoxylin and eosin, original magnification · 100).

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Section: Discussioncontrasting

confidence: 49%

Disseminated erythematous papules in a healthy 73-year-old woman

Lee

Jang

Han

et al. 2011

Clinical and Experimental Dermatology

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“…In contrast, vitamin D3 has been shown to upregulate cathelicidin peptide LL-37 in normal skin 84 and 311 nm UVB treatment increased serum LL-37 levels in patients with psoriasis. 85 To that end, calcipotriol pretreatment of non-lesional, apparently normal skin in patients with PLE significantly reduced the severity of PLE symptoms at subsequent experimental photoprovocation, 86 although the mechanism remained elusive. Similar to photosensitive rosacea, 87 in which LL-37 increases UVB-triggered inflammasome activation, this AMP may also play a role in PLE-koebnerized psoriasis as we found it to be significantly increased in blood vessels in the dermis of lesional PLE skin compared to healthy skin (Fig.…”

Section: Propsoriatic Antipsoriaticmentioning

confidence: 99%

Desired response to phototherapy vs photoaggravation in psoriasis: what makes the difference?

Wolf

Weger

Patra

et al. 2016

Experimental Dermatology

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Psoriasis commonly responds beneficially to UV radiation from natural sunlight or artificial sources. Therapeutic mechanisms include the proapoptotic and immunomodulating effects of UV, affecting many cells and involving a variety of pro-and anti-inflammatory cytokines, downregulating the Th17/IL-23 response with simultaneous induction of regulatory immune cells. However, exposure to UV radiation in a subset of psoriasis patients leads to exacerbation of the disease. We herein shed light on the predisposing factors of photosensitive psoriasis, including genetics (such as HLACw*0602 or CARD14), gender and coexisting photodermatoses such as polymorphic light eruption (PLE) in the context of potential molecular mechanisms behind therapeutic photoresponsiveness or photoaggravation. UV-induced damage/pathogenassociated molecular patterns, damage to self-coding RNA (signalling through Toll-like receptors), certain antimicrobial peptides and/or inflammasome activation may induce innate immunity, leading to psoriasis at the site of UV exposure when there is concomitant, predisposing resistance against UV-induced suppression of the adaptive immune response (like in PLE) that otherwise would act to reduce psoriasis. K E Y W O R D S

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“…Lesions that appear in immunocompetent adults are usually acquired through sexual contact and rarely spread beyond the genital region [10]. Less common sites of infection include the areola [11], eyelids [12], fingers [13], lateral canthus [14], nipple [11,15], and sole of the foot [16].…”

Section: Discussionmentioning

confidence: 99%

Molluscum contagiosum of the eyelid: case report in a man receiving methotrexate and literature review of molluscum contagiosum in patients who are immunosuppressed secondary to methotrexate or HIV infection

Beutler

Cohen²

2016

Dermatology Online Journal

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Background: Molluscum contagiosum is a benign viral infection of the skin. Lesions typically present as dome-shaped, fleshcolored, umbilicated papules that range in size from 1 to 5 millimeters in diameter. They are usually asymptomatic, but can become tender or pruritic. Children and immunocompromised adults, including individuals being treated with immunosuppressive drugs, are most susceptible to infection. Single or multiple lesions most commonly appear on the extremities, face, genitals, and trunk. However, albeit rarely, molluscum contagiosum may also develop at other sites, including the eyelids.Purpose: We describe the clinical and pathologic findings of a man who developed molluscum contagiosum of the eyelid while receiving methotrexate. We also review the characteristics of other patients with molluscum contagiosum acquired either during treatment with methotrexate or associated with human immunodeficiency virus (HIV) infection and summarize the unusual sites of presentation for the viral lesions in these individuals.Materials and methods: The features of a man receiving methotrexate who developed molluscum contagiosum of the eyelid are presented. Using PubMed, the following terms were searched and relevant citations assessed: adalimumab, contagiosum, Enbrel, etanercept, Humira, infliximab, methotrexate, molluscum, Remicade, TNF alpha, and tumor necrosis factor alpha. In addition, the literature on methotrexate treatment and molluscum contagiosum is reviewed.Results: Several small papules were observed on the eyelid of a 24-year-old man who had been receiving methotrexate and adalimumab (Humira) for the treatment of Crohn disease. The lesions were removed by shave biopsy. Microscopic examination revealed epidermal hyperplasia composed of keratinocytes filled with large eosinophilic intracytoplasmic inclusions. Based on correlation of the clinical presentation and histopathologic findings, a diagnosis of molluscum contagiosum was established. The patient applied mupirocin 2% ointment to the biopsy sites, which subsequently healed without complication or recurrence. Conclusion:Molluscum contagiosum is a benign viral papular eruption that frequently affects children and immunocompromised adults. Patients treated with immunosuppressive agents, such as methotrexate, have a heightened risk of developing molluscum contagiosum lesions. It remains to be determined whether adjunct therapy with a tumor necrosis factor alpha inhibitor increases the risk of this viral infection. Diagnosis can usually be established by clinical presentation, although a biopsy is sometimes required to exclude other conditions. Molluscum contagiosum is generally self-limiting and often resolves spontaneously within 18 months. However, topical (cantharidin) or locally destructive (curettage, cryotherapy, and/or laser) therapy may be indicated for patients who are concerned about persistent lesions and for children who are particularly susceptible to autoinoculation.

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Unusual Presentations of Molluscum Contagiosum

Abstract: A histopathologic examination may be necessary to make the diagnosis.

Cited by 5 publications

References 14 publications

Disseminated erythematous papules in a healthy 73-year-old woman

Disseminated erythematous papules in a healthy 73-year-old woman

Desired response to phototherapy vs photoaggravation in psoriasis: what makes the difference?

Molluscum contagiosum of the eyelid: case report in a man receiving methotrexate and literature review of molluscum contagiosum in patients who are immunosuppressed secondary to methotrexate or HIV infection

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