Eyelids & the Anterior Segment:
                    Case sixteen

This 30 year-old man presented with a left chronic follicular conjunctivitis and this facial appearance. Despite excision, the skin lesions recurred and multiplied.

a. What is the diagnosis?

Molluscum contagiosum.

It is caused by a DNA poxvirus and appears as discrete umbilicated papule which can vary in size from 1 to 5 mm in diameter. When occurring near the lid margin, it can cause chronic follicular conjunctivitis.

b. What further investigation should be considered?

Recurrence and progression of molluscum contagiosum despite treatment should raise the suspicion of immunosuppression. This patient was found to be HIV positive.

Molluscum contagiosum occurs in 10% of HIV patient with advanced immunodeficiency and is therefore an AIDS defining sign. Its progressive nature can cause significant cosmetic disfigurement.

c. How can the lesions be treated?

The lesions may be removed by the following methods:
  • shave excision and curretage followed by cauterization
  • simple excision
  • cryotherapy
  • use of chemical applications such as phenol or trichloroacetic acid
The recurrence rate decreases when the patient is started on antiretroviral therapy with zidovudine.
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