A 23-year-old woman comes to the physician with skin lesions. She noticed a small papule 2 weeks ago and now has additional similar lesions. There is no associated pain. The patient has had no systemic symptoms except 1 day of diarrhea that resolved 3 weeks ago. She has no previous medical problems and works as an assistant at a veterinary facility. The patient has been sexually active with a new partner. She drinks alcohol socially, but does not use tobacco or illicit drugs. Her vital signs are normal. Physical examination is normal except for the lesions as shown below. Which of the following is the most likely cause of her skin lesions?

Question

A 23-year-old woman comes to the physician with skin lesions.  She noticed a small papule 2 weeks ago and now has additional similar lesions.  There is no associated pain.  The patient has had no systemic symptoms except 1 day of diarrhea that resolved 3 weeks ago.  She has no previous medical problems and works as an assistant at a veterinary facility.  The patient has been sexually active with a new partner.  She drinks alcohol socially, but does not use tobacco or illicit drugs.  Her vital signs are normal.  Physical examination is normal except for the lesions as shown below.  Which of the following is the most likely cause of her skin lesions?

Quizplus · Accepted Answer

Explanation: Molluscum contagiosum (MC) is a self-limited, localized skin infection caused by a poxvirus. It is characterized by small skin-colored papules with indented centers that may occur anywhere except the palms and soles. The lesions may be accompanied by pruritus and surrounding dermatitis. Children are most commonly affected, but adolescents, adults, and immunocompromised individuals can also develop MC. Transmission is through skin-to-skin contact or contact with contaminated fomites. MC is often transmitted through sexual contact and may be seen in association with other sexually-transmitted diseases. It is also frequently seen in patients with HIV and may be more widely disseminated and persistent in these patients. HIV testing should be considered in patients with MC, especially for lesions that are widespread or involve the face. MC diagnosis is clinical and based on characteristic findings. The condition is typically self-limited, but treatment may be considered to prevent further spread, reduce symptoms, or improve cosmesis. There are a number of techniques to remove lesions including physical destruction via curettage/cryotherapy or chemical removal with topical agents (eg, podophyllotoxin). (Choice A) Gottron's papules are red/purple papules or plaques associated with dermatomyositis. These typically involve the dorsal and radial surfaces of the metacarpophalangeal joints, proximal interphalangeal joints, and proximal phalanx. Gottron's papules (Choice B) Extrapulmonary blastomycosis is an uncommon cause of skin papules that may be seen with or without an acute pulmonary syndrome. Lesions are typically wart-like or pustular. Blastomycosis follows a characteristic geographic distribution. Sporotrichosis causes ulcerating nodular lesions that are most commonly seen on the hands or arms. geographic distribution Sporotrichosis (Choice C) Common cutaneous signs of insulin resistance include skin tags, acanthosis nigricans, and xanthelasma. skin tags acanthosis nigricans xanthelasma (Choice D) Contagious ecthyma (orf) is caused by a poxvirus of sheep and goats and begins as a single erythematous papule on the hand. Milker's nodules are maculopapular/vesicular lesions caused by a parapoxvirus of cows. Both of these conditions are self-limited and very uncommon. Educational objective: Molluscum contagiosum (MC) causes single or multiple skin-colored, small papules with indented centers and is transmitted via skin-to-skin contact. The lesions can be either asymptomatic or pruritic and can occasionally be accompanied by surrounding dermatitis. Treatment is usually conservative. HIV testing should be considered in patients with MC, especially if they have lesions involving the face. References: Molluscum contagiosum virus infection. (http://www.ncbi.nlm.nih.gov/pubmed/23972567)

A 23-Year-Old Woman Comes to the Physician with Skin Lesions