A 35-year-old woman comes to the office for evaluation of a rash on her face. The rash started 3 weeks ago and has slowly worsened. There is no pruritus. The patient has no significant past medical history and no history of tobacco or alcohol use.
Vital signs are within normal limits. Her BMI is 27 kg/m². Skin examination findings are shown in the image below. There is no warmth or tenderness around the skin lesions. The remainder of her physical examination is normal.

Which of the following is the best next step in management of this patient?

Question

A 35-year-old woman comes to the office for evaluation of a rash on her face. The rash started 3 weeks ago and has slowly worsened. There is no pruritus. The patient has no significant past medical history and no history of tobacco or alcohol use.
Vital signs are within normal limits. Her BMI is 27 kg/m². Skin examination findings are shown in the image below. There is no warmth or tenderness around the skin lesions. The remainder of her physical examination is normal.

Which of the following is the best next step in management of this patient?

Quizplus · Accepted Answer

This patient has skin lesions consistent with molluscum contagiosum (MC), a self-limited and localized skin infection due to a poxvirus. MC is more common in children but can occur in adults and adolescents, usually through direct skin-to-skin contact with lesions (eg, sexual relations, contact sports) or contaminated fomites. MC is also more common in patients who have immunosuppressive conditions (eg, HIV) or are taking immunosuppressants. Patients typically develop a firm, dome-shaped papule with a shiny surface and central indentation or umbilication anywhere on the body (except palms or soles). Some patients can also develop pruritus or inflamed lesions with surrounding erythematous patches or plaques. Those with multiple lesions, widespread disease, or facial involvement should undergo HIV testing as MC can be more severe in these patients. The diagnosis is made clinically and can be confirmed with biopsy showing keratinocytes containing eosinophilic, cytoplasmic inclusion bodies (molluscum bodies). Treatment (if desired) can include cryotherapy, curettage, cantharidin, or podophyllotoxin. (Choices A and D) Disseminated histoplasmosis can have a varied presentation with erythematous papules, plaques, ulcers, vesicles, pustules, or generalized dermatitis. Secondary syphilis is characterized by a diffuse rash (usually macular or papular) involving the entire body (including palms and soles). However, there is usually no significant central umbilication with these conditions. Secondary syphilis (Choice C) Disseminated Cryptococcus can occasionally cause papules, plaques, ulcers, or cellulitis. Lesions can resemble MC with central umbilication, but they are usually multiple and more widespread than seen in this patient. (Choice E) Varicella typically presents with a viral prodrome (eg, fever, pharyngitis, malaise) followed by a diffuse macular rash that can progress to papules and vesicles. Patients usually have different stages of rash development, often with crusting. Varicella Educational objective: Molluscum contagiosum is due to a poxvirus and can present as a firm, dome-shaped papule with a shiny surface and central indentation or umbilication. Patients with multiple lesions, widespread disease, or facial involvement should undergo HIV testing. __________ References: Molluscum contagiosum eyelid lesions in an HIV-patient. (http://www.ncbi.nlm.nih.gov/pubmed/23374952) An overview of molluscum contagiosum: a viral skin condition. (http://www.ncbi.nlm.nih.gov/pubmed/18616033)

A 35-Year-Old Woman Comes to the Office for Evaluation of a Rash