Firm, shiny papules: can you diagnose the skin disease?

NEWS/ QUIZ

2 MIN QUIZ

Diagnose It: firm, shiny papules

A 45-year-old woman presents with the chief complaint of “itchy bumps” on her lower abdomen. Upon examination, her dermatologist notes the lesions are firm, skin-colored, shiny papules. Medical history reveals she recently received a kidney transplant and does not have a history of atopic dermatitis. She reports that the lesions appeared recently and, due to her medical history, she quickly made an appointment for an examination. Dermoscopy is used to examine the lesion, showing white/yellow polylobular structures and crown vessels.

Molluscum-dermatoscopy

Source: Derm Net NZ

What is the diagnosis?

Select the correct answer

A) Basal cell carcinoma

B) Molluscum contagiosum

C) Verruca vulgaris

D) Histoplasmosis

CORRECT

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INCORRECT

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Answer is: B

Molluscum contagiosum (MC) is an infection caused by the molluscum contagiosum virus, a member of the Poxviridae family.^1,2While MC is often seen in children aged 2 to 5 years, it can also affect older children, adolescents, sexually active adults, and immunocompromised individuals, with no difference in incidence between males and females.^1,2MC is rare in children younger than 1 year old.¹ Studies of the prevalence of MC in the United States (US) are rare.^1,2 In children in the US, the estimated prevalence is less than 5%.¹ Between 1990 and 1999, the number of office visits due to MC was estimated to be 280,000 per year.² There is limited data on the prevalence of MC in adults.

MC lesions present as firm, round, umbilicated, pearly papules. Papules are white, pink, or skin-colored and are typically 2 to 5 mm in diameter in nonimmunocompromised individuals. Lesions can be single or form multiple lesions or clusters. Lesions can also be pediculated, and pruritus may be present.^1,2 MC in children is mainly found on exposed skin, such as the trunk, extremities, and face, and, rarely, on the soles of the hands or feet. The location of lesions is different in adults, mainly occurring on the lower abdomen, genitals and perianal area, and thighs. In immunocompromised patients, lesions can be found in atypical locations and may be larger (>1 cm in diameter) and more numerous.¹ MC can be transmitted through contact with infected skin (nonsexual, sexual, or autoinoculation) but can also be passed via infected objects (eg, clothing, towels). In adults, most cases of MC are transmitted through sexual contact.¹ Congenital transmission can also occur.¹ Atopic dermatitis (AD) may be a risk factor for MC; however, some studies have found no correlation between AD and MC, so more research is needed.¹

The characteristics of the lesions will inform diagnosis of MC. Using dermoscopy, presence of umbilication (or central pore) will be clear. White or yellow polylobular structures and peripheral crown vessels will also be seen. When viewed under polarized light, lesions can also have rosettes.¹

In most cases, MC resolves with no scarring and in most cases is self-limiting, lasting only a period of 6 to 9 months. However, in some cases, the lesions may persist for 3 to 4 years.^2,3 Pruritis may result in scratching, which can lead to scarring. The most common complication is secondary infection of the lesions, which is especially problematic in immunocompromised individuals.³ There are limited data on the natural history of disease in this population.²

References:

1. Meza-Romero R, Navarrete-Dechent C, Downey C. Molluscum contagiosum: an update and review of new perspectives in etiology, diagnosis, and treatment. Clin Cosmet Investig Dermatol. 2019;12:373-381. doi:10.2147/CCID.S187224

2. van der Wouden JC, van der Sande R, Kruithof EJ, Sollie A, van Suijlekom-Smit LW, Koning S. Interventions for cutaneous molluscum contagiosum. Cochrane Database Syst Rev. 2017;5(5):CD004767. doi:10.1002/14651858.CD004767.pub4

3. Molluscum contagiosum: long-term effects. Centers for Disease Control and Prevention. Accessed October 4, 2022. https://www.cdc.gov/poxvirus/molluscum-contagiosum/long-term-effects.html

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