Photo Rounds

Growths on face and scalp

A 40-year-old woman with human immunodeficiency virus (HIV) presented to her family physician (FP) with growths on her face and scalp. The growths had developed 3 months earlier and were itchy—but didn’t hurt. She indicated that she’d missed a few appointments with her HIV doctor and had not always taken her antiretroviral medicine, as prescribed.

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The FP diagnosed molluscum contagiosum and recognized that some of the larger lesions on the scalp were related to the patient’s altered immune status. Molluscum contagiosum is a viral skin infection that produces pearly papules that often have central umbilication. This skin infection is most commonly seen in children, but can also be transmitted sexually among adults. The number of cases in adults increased in the 1980s in the United States, probably as a result of the HIV/AIDS epidemic. Since the introduction of highly active antiretroviral therapy (HAART), the number of molluscum contagiosum cases in HIV/AIDS patients has decreased substantially. However, the prevalence of molluscum contagiosum in patients who are HIV-positive may still be as high as 5% to 18%.

The FP encouraged the patient to take her antiretroviral medication as prescribed and suggested that she return to her HIV specialist to see if her therapeutic regimen required any adjustments. He also offered her cryotherapy, with a follow-up appointment one month later. The patient agreed to the cryotherapy, which was performed with a cryogun using a bent tip spray. The patient’s eye was protected using a tongue depressor, while her eyelid was sprayed with liquid nitrogen.

At the follow-up visit, the molluscum lesions had improved and a second round of cryotherapy was performed. Although it was not offered to this patient, topical imiquimod is another treatment option for molluscum contagiosum. This treatment has not, however, been approved by the Food and Drug Administration for this diagnosis.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Mayeaux, EJ. Molluscum contagiosum. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:743-748.

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