Molluscum Contagiosum Lesions Research Articles

Association between filaggrin gene mutations and the clinical features of molluscum contagiosum: The Yamanashi Adjunct Study of the Japan Environment and Children's Study.

Previous studies have reported swimming, atopic dermatitis, and filaggrin (FLG) gene mutations as risk factors for molluscum contagiosum (MC) infection. FLG gene mutations impair skin barrier function. The aim of this study was to determine the impact of FLG mutations on the incidence and clinical features of MC. We used data from 2036 children who participated in the Yamanashi Adjunct Study of the Japan Environment and Children's Study, a prospective, birth cohort study. A questionnaire for caregivers (when children were 4 and 8 years of age) asked about clinical features including previous MC incidence and treatment, number of MC lesions at first visit, and time to resolution. Participants underwent genotyping to detect six FLG mutations that are common in the Japanese population. A logistic regression model was used to analyze the association between MC incidence and FLG mutations, adjusted for potential confounders. The cumulative incidence of MC at age 8 years was 47.1%. Among participants with a history of MC, 67.6% had undergone curettage. FLG mutation was a significant risk factor for MC incidence (adjusted odds ratio [aOR] 1.69, 95% confidence interval [CI] 1.18-2.42). Swimming and atopic dermatitis were also significant risk factors for MC. There was no significant association between FLG mutation and the number of MC lesions at the first visit or the time to resolution of lesions. FLG mutation is a risk factor for MC incidence; however, FLG mutations do not affect the number of MC lesions at presentation or the time to resolution.

Berdazimer gel for molluscum contagiosum in patients with atopic dermatitis.

Controlling molluscum contagiosum (MC) infections is critical in atopic dermatitis (AD) management. This post hoc analysis assessed the efficacy and safety of berdazimer gel, 10.3% (topical, antiviral, nitric oxide-releasing medication) versus vehicle in MC patients with or without AD. Three Phase 3, multicenter, randomized, double-blind, vehicle-controlled, parallel-group trials (B-SIMPLE[berdazimer sodium in molluscum patients with lesions]1, -2, -4) enrolled patients 6 months and older with 3-70 mollusca. Berdazimer or vehicle was applied once daily to all MC lesions for 12 weeks. Data from three Phase 3 studies were integrated for subgroup efficacy and safety assessments using several weighted meta-analysis approaches. Patients with concurrent AD or a history of AD/eczema were categorized as AD+ subgroup (AD- when absent). Primary efficacy endpoint: complete lesion clearance at Week 12. Safety endpoints included adverse events (AEs) through Week 24 and local skin reactions through Week 12. Of 1598 enrolled patients, 209 (13.1%) were AD+. Baseline mean lesion counts were greater in AD+ (26.4) than AD- (19.3). Complete clearance rates were higher at Week 12 for berdazimer compared with vehicle in AD+ (n = 209; 35.0% vs. 27.4%; odds ratio [OR], 1.3; 95% CI, 0.7-2.5) and AD- (n = 1389; 29.1% vs. 18.9%; OR 1.8; 95% CI 1.4-2.4) subgroups. AEs in AD+ were application-site pain (21.6% with berdazimer vs. 11.9% with vehicle), dermatitis (12.8% vs. 2.4%), and erythema (9.6% vs. 7.1%). Berdazimer gel showed favorable efficacy regardless of AD status. Berdazimer-induced erythema may be indistinguishable from AD symptoms or with inflammatory response upon resolution of molluscum.

Berdazimer gel for molluscum contagiosum: An integrated analysis of 3 randomized controlled trials

An out-of-office therapeutic agent indicated for molluscum contagiosum is needed. To assess the efficacy and safety of berdazimer gel, 10.3% (a topical, antiviral, nitric oxide-releasing medication) versus vehicle. Berdazimer gel, 10.3% or vehicle was applied once daily to all molluscum contagiosum lesions for 12weeks in patients ≥6months with 3-70 mollusca. Efficacy assessment: complete lesion clearance and partial clearance at week 12. Safety and tolerability assessment: adverse events through week 24 and local skin reactions through week 12. There were 1598 patients enrolled (n=917 berdazimer, n=681 vehicle). Berdazimer was superior to vehicle at week 12 in complete clearance rates, 30.0% versus 19.8% (odds ratio, 1.75; 95% CI, 1.38-2.23, P<.001). Subgroup analyses of primary efficacy showed consistent favorable efficacy for berdazimer across most subgroups, including age, sex, baseline lesion count, and disease duration. Berdazimer provided favorable outcome for partial clearance. Application-site pain (18.7% vs 4.8% in berdazimer vs vehicle) and erythema (11.7% vs 1.3%), mostly mild to moderate, were the most common local skin reactions. Berdazimer sodium in molluscum patients with lesions (B-SIMPLE) trials enrolled only US patients; no efficacy assessments beyond week 12. Berdazimer gel, 10.3% showed favorable efficacy and safety across subgroups.

Safety and efficacy of topical nitric oxide-releasing berdazimer gel for molluscum contagiosum clearance: A systematic review and meta-analysis of randomized controlled trials.

Molluscum contagiosum (MC) is a contagious infection that, although benign, can become an aesthetic burden and lead to other opportunistic infections, secondary dermatitis, and self-isolation. Currently, several treatment options are available for MC, including the newly investigated nitric oxide-releasing berdazimer gel, leading this review to evaluate randomized controlled trials (RCT) comparing berdazimer gel with a vehicle for treating MC. The meta-analysis included three reports and four RCT involving 1854 patients, with 1106 (59.6%) randomized to receive berdazimer. Our findings suggest that berdazimer is effective in the management of MC lesions, but the increased clearance of lesions and reduction of scarring must be weighed against the potential for topical adverse effects, particularly when considering the use of this therapy in pediatric patients.

Giant Molluscum Contagiosum Opportunistic Infection in a HIV/AIDS Patient

Atypical types of molluscum contagiosum (MC), which are present in immunocompromised patients and show substantial weakening of cellular immunity, can be difficult to diagnose. Low CD4 cell counts are associated with MC lesions, which are most frequently seen in HIV patients. We report MC lesions in the trunk and lower extremities in a 40-year-old HIV-positive female patient. A 75 cells/mm CD4 count was present in the patient. To rule out more dangerous disorders including dimorphic fungal infections, a skin biopsy was performed. The hypogastrum of the trunk and vulva were affected by the lesions which were painless, flesh-colored papules and nodules. Syphilis and hepatitis B virus testing came out negative, while serological tests for HIV-1 were positive. Intracytoplasmic molluscum bodies were detected in the skin biopsy. However, the opportunity for an early diagnosis in our case was lost.

Open-Label Observational Study of a Topical Formulation of Calcium Spirulan Contained in a Defined Extract of the Microalga Spirulina platensis in the Treatment of Children with Molluscum Contagiosum.

Molluscum contagiosum (MC) is a common viral skin infection primarily affecting children which is difficult to treat using available therapeutic approaches. The sulfated polysaccharide named calcium spirulan (Ca-SP) has demonstrated antiviral effects against herpes simplex virus in keratinocytes in vitro, and a cream containing 1.5% Ca-SP and 1% of a defined microalgae extract (Spiralin®) effectively prevented herpes labialis in a trial with susceptible individuals. This observational study aimed to show antiviral effects of a similar formulation (Spirularin® VS) against MC in children. Children with active MC lesions were treated with Spirularin® VS cream twice daily on affected skin over several months and asked to return for follow-up visits after 1 to 3 months. Clinical status of MC infection was documented at baseline and follow-up visits. Of the 31 children enrolled in the study, 26 completed treatment and returned for control visits. Spirularin® VS cream was applied twice daily over a period of 1 to 9 months (mean treatment duration 3.9 months). 19/26 (73.1%) children achieved complete clearance of MC lesions with no clinical evidence of bacterial skin infection during treatment. No irritative skin reactions or unpleasant symptoms were observed or reported. This open-label observational study suggests that a cream formulation containing 1.5% Ca-SP and 1% Spiralin® may be an effective and safe treatment option for children with active MC lesions. The high rate of complete clearance of MC lesions and lack of adverse reactions warrant further investigation in larger, controlled trials.

Comparative efficacy of treatments for molluscum contagiosum: A systematic review and network meta-analysis.

Various interventions have been applied to treat molluscum contagiosum, but benefits and efficacy remain unclear. To assess the comparative efficacy and safety of interventions for molluscum contagiosum, a network meta-analysis was performed. Embase, PubMed, and the Cochrane Library were searched for articles published between January 1, 1990, and November 31, 2020. Eligible studies were randomized clinical trials (RCTs) of interventions in immunocompetent children and adults with genital/non-genital molluscum contagiosum lesions. Twelve interventions from 25 RCTs including 2,123 participants were assessed. Compared with the placebo, ingenol mebutate had the most significant effect on complete clearance (odds ratio [OR] 117.42, 95% confidence interval [CI] 6.37-2164.88), followed by cryotherapy (OR 16.81, 95% CI 4.13-68.54), podophyllotoxin (OR 10.24, 95% CI 3.36-31.21), and potassium hydroxide (KOH) (OR 10.02, 95% CI 4.64-21.64). Data on adverse effects were too scarce for quantitative synthesis. Ingenol mebutate, cryotherapy, podophyllotoxin, and KOH were more effective than the other interventions in achieving complete clearance, but safety concerns regarding ingenol mebutate have recently been reported. Due to the possibility of spontaneous resolution, observation is also justified for asymptomatic infection. Factors including adverse effects, cost, patient preference, and medical accessibility should be considered.

Atypical Cutaneous Viral Infections Reveal an Inborn Error of Immunity in 8 Patients.

Unusual viral skin infections might be the first clinical manifestation in children with an inborn error of immunity (IEI). We performed a prospective study from 1 October 2017 to 30 September 2021, at the Department of Pediatric Infectious Diseases and Clinical Immunity of Ibn Rochd University Hospital-Casablanca. During this period, on 591 patients newly diagnosed with a probable IEI, eight of them (1.3%), from six independent families, had isolated or syndromic unusual viral skin infections, which were either profuse, chronic or recurrent infections, and resistant to any treatment. The median age of disease onset was nine years old and all patients were born from a first-degree consanguineous marriage. By combining clinical, immunological and genetic investigations, we identified GATA2 deficiency in one patient with recalcitrant profuse verrucous lesions and monocytopenia (1/8) and STK4 deficiency in two families with HPV lesions, either flat or common warts, and lymphopenia (2/8), as previously reported. We also identified COPA deficiency in twin sisters with chronic profuse Molluscum contagiosum lesions, pulmonary diseases and microcytic hypochromic anemia (2/8). Finally, we also found one patient with chronic profuse MC lesions and hyper IgE syndrome, (1/8) and two patients with either recalcitrant profuse verrucous lesions or recurrent post-herpetic erythema multiforme and a combined immunodeficiency (2/8) with no genetic defect identified yet. Raising clinicians awareness that infectious skin diseases might be the consequence of an inborn error of immunity would allow for optimized diagnosis, prevention and treatment of patients and their families.

An Unexpected Diagnosis of MAGT1 Deficiency in a Patient with CVID-like Features, Molluscum Contagiosum and Atopy

Case DescriptionA 6-year-old boy presented to the immunology clinic with recurrent infections. He started to have recurrent otitis media at the age of 18 months. He also had multiple sinus infections and 3–4 episodes of pneumonia. Immunologic evaluation revealed an IgG of 498 (ref 608–1229 mg/dL), an IgA of 20.8 (ref 33–200 mg/dL) and an impaired response to the Streptococcus pneumoniae vaccine. T and B lymphocyte counts were normal. He was started on subcutaneous immunoglobulin replacement therapy after which his IgG level normalized and his frequency of sinopulmonary infections improved. He also has a history of eczema, chronic cough and environmental allergies for which he receives allergen-specific subcutaneous immunotherapy in addition to treatment with an inhaled corticosteroid and omalizumab. The patient also had persistent skin warts on his hands and extensive molluscum contagiosum lesions. He underwent targeted genetic testing for a primary immunodeficiency which revealed a hemizygous pathogenic variant in the magnesium transporter 1 (MAGT1) gene (c.580dup; p.Ser194Phefs*3). This variant is a duplication at nucleotide position 580 that creates a premature stop codon 3 amino acids downstream from this location. The patient subsequently underwent a carbohydrate deficient transferrin test (CDT) for congenital disorders of glycosylation (CDG) that revealed moderately elevated transferrin mono-oligosaccharide to di-oligosaccharide and Apo CIII-1/Apo CIII-2 ratios, consistent with the diagnosis of MAGT1-CDG (XMEN; X-linked immunodeficiency with magnesium defect, EBV infection, and neoplasia). Additionally, NKG2D surface expression was reduced by ~90% on the CD8T cells, and by ~85% on the NK cells in the patient sample compared to the control sample assessed in parallel. The patient continues to test negative for EBV infection by PCR. ConclusionXMEN disease (OMIM number 300853) is a rare, combined immunodeficiency resulting from a mutation in the magnesium transporter 1 gene (MAGT1) located on the X chromosome. Only 36 patients have been reported to have this disease thus far. While the clinical phenotype is variable, the disease is often associated with EBV infection. This case is unique in that the patient was diagnosed due to a history of severe warts, atopy, and hypogammaglobulinemia in the absence of EBV infection.

Clinical study to evaluate the efficacy of autoinoculation in genital molluscum contagiosum in reproductive age group.

Molluscum contagiosum (MC) typically presents as asymptomatic or itchy, discrete, smooth, flesh-colored, dome-shaped papules with central umbilication. Lesions on the genitals are often sexually transmitted and tend to be seen in young adults. Homologous auto implantation is a simple technique which helps in inducing a cell-mediated immune response to the antigens, aiding clearance of both local and distant lesions. The aim of the study is to evaluate the efficacy and side effect of the technique of autoinoculation for the treatment of genital MC in terms of reduction in number of lesions. Thirty-one patients having >5 genital molluscum attending skin outpatient department were enrolled out of which 30 remain. A well-defined mc lesion was approached using an insulin syringe (30 G) and pierced from a site just adjacent to the lesion. Results were assessed every 2 weeks for 2 months. 60% (n = 18) patients showed excellent response, 20% (n = 6) patients showed very good response, 6.6% (n = 2) patients showed good response and 13.3% (n = 4) showed poor response at the end of the study. The autoinoculation technique is an effective technique in terms of excellent clearance of MC lesions with fewer chances of recurrence, side effects, and shorter duration taken to achieve a complete response to distant lesions.

Dedicator of Cytokinesis 8 Immunodeficiency Syndrome Presenting as Extensive and Giant Lesions of Molluscum Contagiosum in a Child

Dedicator of Cytokinesis 8 Immunodeficiency Syndrome Presenting as Extensive and Giant Lesions of Molluscum Contagiosum in a Child

Pharmacokinetic Profile, Safety, and Tolerability of Topical Berdazimer Gel, 10.3% in Patients With Molluscum Contagiosum.

Berdazimer (SB206), gel 10.3% is a novel, topical, nitric oxide&ndash;releasing agent intended for molluscum contagiosum (MC) treatment. A 12-week, open-label, multicenter trial evaluated the safety, tolerability, and pharmacokinetic (PK) parameters of berdazimer gel, 10.3% applied topically once daily for the treatment of MC. Patients were aged &ge;6 months with &gt;20 molluscum lesions. The primary endpoint was the PK profile of the hydrolyzed N-methylaminopropyl-trimethoxysilane (hMAP3) monomer and nitrate during a 2-week period of once-daily berdazimer gel, 10.3% application (PK period) under maximal use conditions. Safety and tolerability were evaluated throughout the 12-week study period. Half of the 34 enrolled patients (17) were female and most (97.1% [33/34]) were white. Patients were 2 to 12 years old (mean, 5.3 years) with a mean of 50 MC lesions at baseline (mean time since MC awareness, 12.4 months). No patients had quantifiable plasma hMAP3 concentrations on day 1. On day 15, 2 patients had quantifiable plasma hMAP3 concentrations; however, the maximum concentration (33.9 ng/mL) was &gt;10-fold lower than the no observed adverse effect level (NOAEL) in an animal toxicology study. Mean nitrate concentration&ndash;time profiles were similar on days 1 and 15 and remained flat for all patients throughout the 2-week PK period. The highest plasma methemoglobin level observed was 3.2%. Application-site pain (13/34 [38.2%]) and application-site erythema (6/34 [17.6%]) were the most frequent treatment-emergent adverse events (TEAEs), and most TEAEs were mild or moderate. Once-daily berdazimer gel, 10.3% was well-tolerated with minimal systemic absorption. J Drugs Dermatol. 2022;21(10):1104-1110. doi:10.36849/JDD.6938.

Interventions for molluscum contagiosum: A systematic review and network meta-analysis with normalized entropy assessment

To the Editor: Molluscum contagiosum (MC) is a poxvirus infection affecting around 3% of children. MC lesions may persist for >24 months if left untreated, and transmission to other people may occur. Various therapies for MC have been proposed, but their comparative efficacy and safety are unclear. To evaluate the comparative effects of different interventions for MC, we conducted a systematic review and random-effects model network meta-analysis. We searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases on June 21, 2022 (search strategy listed in Supplementary Table I, available via Mendeley at https://data.mendeley.com/v1/datasets/shvph7b6t3.8).

294 Berdazimer 10.3% gel, a nitric oxide-releasing topical medication for molluscum contagiosum, triggers BOTE (Beginning Of The End) inflammation and accelerates resolution

The beginning-of-the-end “BOTE” sign describes the inflammation (with intense erythema and variable crust, pustule, scale) that predicts imminent resolution of molluscum contagiosum (MC). Posthoc analyses of 2 phase 3, 12-week, randomized, double-blind vehicle-controlled studies, B-Simple1&2, provided initial evidence that SB206 (berdazimer 10.3% gel) may trigger BOTE and shorten MC duration. We conducted a similar, larger phase 3 study, B-Simple4, and prospectively stratified patients based on baseline (BL) BOTE status (BOTE+ vs BOTE-). A pre-defined analysis of the association between the presence of BL BOTE+ lesion and MC lesion reduction including complete clearance is presented. Treatment assignment was well balanced within BL BOTE status: of 447 patients randomized to vehicle, 50.3% were BOTE+ and 49.7% were BOTE-; of 444 patients randomized to berdazimer (active), 49.3% were BOTE+ and 50.7% were BOTE-. MC lesion counts at Week 12 decreased from BL in both treatment groups at a higher level for BOTE+ vs BOTE- patients (mean±SE); vehicle arm: 44.5±4.5% BOTE+ vs 21.2±4.6% BOTE- (p<0.0001), active arm: 65.6±4.2% BOTE+ vs 59.9±4.2% BOTE- (p=0.2325). At Week 12, a similar pattern was observed for patients achieving complete clearance; vehicle arm: 56 (25.0%) BOTE+ vs 32 (14.3%) BOTE- (p=0.0043), active arm: 85 (38.8%) BOTE+ vs 59 (26.2%) BOTE- (p=0.0043). Of all patients that were BOTE- at BL, a higher proportion of patients in the active arm became BOTE+ by Week 2 vs the vehicle arm: 141 (33.8%) vs 75 (18%). Further, a higher proportion of patients failed to initiate BOTE during the study in the vehicle arm vs the active arm; 73 (16.3%) vs 33 (7.4%). Median Kaplan-Meier estimates of time to complete clearance (days) was 93 (active) vs 100 (vehicle) (p<0.0001). This study suggests that BOTE is an indicator of MC resolution and that berdazimer 10.3% gel promotes earlier BOTE initiation, resulting in faster MC resolution. ClinicalTrials.gov: NCTNCT04535531

Efficacy and Safety of Topical Nitric Oxide−Releasing Berdazimer Gel in Patients With Molluscum Contagiosum

Molluscum contagiosum (MC) is a highly contagious skin condition. Lesions may persist for months to years, and no US Food and Drug Administration-approved medications are currently available in the US. To assess the efficacy and safety of berdazimer gel, 10.3%, a novel topical nitric oxide-releasing medication, in the treatment of MC. This was a multicenter, vehicle-controlled, double-blind, phase 3 randomized clinical trial (B-SIMPLE4) conducted in 55 clinics (mostly dermatology and pediatric) in the US from September 1, 2020, to July 21, 2021. Eligible participants were 6 months or older and had from 3 to 70 raised MC lesions. Patients with sexually transmitted MC or with MC only in the periocular area were excluded. Patients were randomized to treatment with berdazimer gel, 10.3%, or vehicle gel, applied as a thin layer to all lesions once daily for 12 weeks. The primary efficacy end point was complete clearance of all MC lesions at week 12. Safety and tolerability measures included adverse event frequency and severity, and assessment of local skin reactions and scarring. Data analyses were performed from August 31, 2021, to September 14, 2021. A total of 891 participants were randomized, 444 to berdazimer, 10.3% (mean [range] age, 6.6 [0.9-47.5] years; 228 [51.4%] male; 387 [87.2%] White individuals), and 447 to vehicle (mean [range] age, 6.5 [1.3-49.0] years; 234 [52.3%] female; 382 [85.5%] White individuals). In the intention-to-treat population, 88.5% (393 patients) in the berdazimer group and 88.8% (397 patients) in the vehicle group had a lesion count performed at week 12. At week 12, 32.4% (144 patients) in the berdazimer group achieved complete clearance of MC lesions compared with 19.7% (88 patients) in the vehicle group (absolute difference, 12.7%; odds ratio, 2.0; 95% CI, 1.5-2.8; P < .001) with 14.4% (64 patients) of the berdazimer group discontinuing treatment because of MC clearance compared with 8.9% (40 patients) of the vehicle group. Adverse event rates were low. The most common adverse events were application-site pain and erythema, mostly mild in severity. Adverse events leading to discontinuation affected 4.1% (18 patients) of the berdazimer group and 0.7% (3 patients) of the vehicle group. The most common local skin reaction was mild to moderate erythema. Use of berdazimer gel, 10.3%, for MC appears to demonstrate favorable efficacy and safety with low adverse event rates. ClinicalTrials.gov Identifier: NCT04535531.

Reflectance confocal microscopy findings in a case of molluscum contagiosum

We present the case of a 74-year-old man who presented for his annual skin check and had a new suspicious lesion on his left cheek consistent with a pink-white papule showing a mixed vascular pattern (Fig 1). The patient had a medical history of 2 previously treated basal cell carcinomas on his face. The lesion was clinically suspicious for a new-onset basal cell carcinoma. The patient was referred for reflectance confocal microscopy to confirm the nature of the lesion. Nonpolarized contact dermatoscopy revealed a pink and yellow to white, relatively well-demarcated papule with a central clod-like, very faintly polylobular, white-to-yellow, amorphous structure (Fig 2). This central area corresponded to the round-to-oval lobules seen on confocal microscopy and to the central lobulated endophytic hyperplasia seen on histopathology (Fig 3).Fig 3Molluscum contagiosum - reflectance confocal microscopy, zoomed in. Higher magnification into the central lobular area revealed hyper-refractive cell outlines with hyporefractive central areas within these lobules. Note the slightly grainy cytoplasm of these cells, corresponding to Henderson-Paterson(molluscum) bodies. It was necessary to alter the brightness and contrast in the reporting software (Vivanet) to better visualize the individual cell outlines (Vivascope 1500, Caliber I.D.; Imaging & Diagnostics, Inc).View Large Image Figure ViewerDownload Hi-res image Download (PPT) The vascular pattern was mixed, with a few focal crown-like vessels and multiple prominent circumferentially arranged radial blood vessels, some exhibiting a branching pattern. Shiny white structures were not readily appreciated. The dermatoscopic differentials by a panel of experts at consensus included a possible sebaceous neoplasm given the polylobular appearance and focal crown vessels or a basal cell carcinoma with atypical dermatoscopic features given the radial blood vessels with some arborizing features. Confocal microscopy (Vivascope 1500, Caliber I.D.; Imaging & Diagnostics, Inc) revealed a well-circumscribed lesion with central, relatively uniform, hyporefractive, round-to-oval lobules forming a central polylobular structure (Fig 4). This central polylobular area corresponded to the central yellow-to-white clod seen on dermatoscopy. Higher power confocal microscopy views of the individual lobules revealed multiple slightly hyperrefractive cells within each lobule. The individual cells with large, round, hyperreflective intracytoplasmic inclusions corresponded to the Henderson-Paterson bodies observed on histology. Because of the fact that the authors were unfamiliar with the confocal findings, biopsy was performed to rule out possible sebaceous neoplasm or an atypical basal cell carcinoma. The hyporefractive lobules in the central section of the lesion exhibited the typical histopathology of molluscum contagiosum (MC) with a central area displaying lobules and endophytic hyperplasia (Fig 5). At the microscopic single-cell level, hyper-refractive round-to-oval cells within each lobule observed at reflectance confocal microscopy corresponded histologically to the individual enlarged keratinocytes containing intracytoplasmic eosinophilic, hyalinized viral inclusions that displaced the nucleus peripherally (Henderson-Paterson bodies), a typical finding of MC. MC usually has a typical clinical and dermatoscopic appearance on which most diagnoses are based. Some lesions, however, may have an unusual morphology, making clinical or dermatoscopic evaluation challenging or equivocal. This may sometimes lead to suspicion for neoplasm, necessitating biopsy and histopathologic evaluation. In this case, an evaluation of the findings and currently available literature appears to suggest that the reflectance confocal microscopy findings of MC are very characteristic and reproducible, even when MC lesions appear atypical clinically or on dermatoscopy.1Broggi G. Verzì A.E. Micali G. Caltabiano R. Lacarrubba F. Horizontal histopathology correlates with in vivo reflectance confocal microscopy features of molluscum contagiosum: a case series.J Cutan Pathol. 2021; 48: 1430-1431https://doi.org/10.1111/cup.14106Crossref PubMed Scopus (2) Google Scholar,2Cinotti E. Perrot J.L. Labeille B. Cambazard F. Reflectance confocal microscopy for cutaneous infections and infestations.J Eur Acad Dermatol Venereol. 2016; 30: 754-763https://doi.org/10.1111/jdv.13254Crossref PubMed Scopus (38) Google Scholar Awareness of the confocal findings of MC among new confocal microscopists could avoid unnecessary biopsies for these benign lesions. None disclosed.

Viral Cutaneous Infections in Swimmers: A Preliminary Study

Molluscum contagiosum (MC) and warts are common viral infections of the skin. Data regarding the prevalence of MC and verruca in swimmers are very poor and lacking in the literature. The purpose of this study was to determine the incidence of Molluscum Contagiosum (MC) and warts cases among young competitive swimmers participating in Greek swimming clubs. Of 244 swimmers enrolled in this study, 12.3% reported MC and 43% warts, during their swimming career, diagnosed and treated by dermatologists. There was no difference between sexes for MC but diagnoses of warts were higher in females. Axillae and trunk were the most common sites of primary infection for MC but warts mainly appeared on the soles. The incidence of MC and warts in swimmers who use outdoor facilities was higher. In our study, the incidence of warts and MC in Greek swimmers is considered high. Moist walking surfaces, placing towels on locker room benches, and sharing equipment are behaviors that cause infections. An early diagnosis of warts and MC lesions must be implemented in every swimmer through dermatological examination. Taking proper measures for reducing the risk of warts and MC transmission in Greek swimmers is mandatory.

Pilomatrixoma and its Imitators.

Introduction: Pilomatrixomas are benign neoplasms derived from hair follicle matrix cells. They are among the most common soft tissue head and neck tumors of childhood. Pilomatrixomas are typically isolated, slow-growing, firm, nontender masses that are adherent to the epidermis but mobile in the subcutaneous plane. This clinical presentation is so characteristic that many experienced surgeons will excise suspected pilomatrixomas without prior imaging. We reviewed the results of this approach to determine whether physical examination alone differentiates pilomatrixomas from other similar soft tissue lesions of the pediatric head and neck. Methods: Computerized review of all pilomatrixomas over a 20-year period in a single academic pediatric otolaryngology practice. Results: 18 patients presented to our pediatric otolaryngology practice between 2001 and 2021 with historical and physical findings consistent with pilomatrixoma. Of the 18 patients, 7 were male and 11 were female. Ages ranged from 1.5 to 14years, with a mean of 7.5years. Most of the lesions (12) were located in the head and face, while the rest (6) were found in the neck. All patients were treated with complete surgical excision. Pathology confirmed pilomatrixoma in 15 patients. The remaining 3 children were found to have an epidermal inclusion cyst, a ruptured trichilemmal cyst, and a giant molluscum contagiosum lesion, respectively. One additional patient presented with a small lesion of the auricular helix that was thought to be a dermoid cyst, but proved to be a pilomatrixoma on histologic examination. Discussion: As pilomatrixomas are common and have a very characteristic presentation, surgical excision without prior diagnostic imaging will lead to correct treatment in the majority of cases. High resolution ultrasonography can help to confirm the diagnosis preoperatively, but is not definitive in large case series. Most of the cystic lesions that imitate pilomatrixoma will ultimately require surgical excision.

Is molluscum contagiosum related to zinc deficiency in children? Effectiveness of oral zinc sulfate therapy in lesion regression

Objectives: Molluscum contagiosum (MC) is viral skin infection that is most commonly observed in children. Zinc homeostasis is essential for proper immune function, especially in host–virus interactions. This study aimed to investigate the effectiveness of oral zinc sulfate treatment in children with MC.Methods: The subjects included 23 children with MC and 30 age/sex-matched healthy children as controls. Children with MC received oral zinc sulfate for 2 mo, and serum zinc levels were measured before and after the treatment period. Patients were examined every 4 wk for evidence of partial or complete lesion regression. Lesion numbers were recorded before treatment and during follow up.Results: The mean serum zinc levels in children with MC did not differ from those in controls (80.57 ± 10.14 vs 81.90 ± 8.47 μg/dL, respectively, P = 0.370). After zinc sulfate supplementation, the mean serum zinc levels increased from 80.57 ± 10.14 to 100.5 ± 9.95 μg/dL (P < 0.001) in subjects with MC. After a 2-mo treatment period, six subjects exhibited resolution of lesions at the 1-mo follow up, 10 subjects at the 2-mo follow-up, and three subjects at the 3-mo follow up. Disease recurrence was not observed. A 6-y-old boy and two 4-y-old girls without other systemic symptoms had MC lesions that persisted after zinc sulfate therapy and throughout the 1-y follow up. One female subject experienced complete recovery in after treatment month 4, but recurrence was observed in month 7 and persisted for 18 mo.Conclusions: Our findings support the use of oral zinc sulfate as a therapy for children with MC.

Contributing Factors and Outcome after Cryotherapy of Molluscum Contagiosum among Patients Attending Tertiary Hospital, Northern Tanzania: A Descriptive Prospective Cohort Study.

Background Molluscum contagiosum (MC) is a benign infection caused by a member of the Poxviridae family, molluscum contagiosum virus (MCV). The contributing factors for MCV infection are different in different populations and study areas. Few studies have been conducted to determine the effectiveness of cryotherapy in the treatment of MC. The study's objectives were to determine contributing factors and outcome after cryotherapy of MC among patients attending a tertiary hospital in Northern Tanzania. Methods A hospital-based cohort study was conducted at the Regional Dermatology Training Centre (RDTC) from September 2018 to August 2019, involving all patients clinically diagnosed with MC. We used a consecutive sampling method to recruit study participants. We treated all participants with cryotherapy and assessed them after two weeks. Data were collected using a structured questionnaire and analyzed using Statistical Package for the Social Sciences (SPSS) software version 21. Results There were 49 patients with MC who agreed to participate in this study with a median age of 8 (IQR 3–22). We found 18.4% of patients with active atopic dermatitis (AD) had MC while those with a history of atopic diseases (Ad) were 32%, and 22.4% had a history of using immunosuppressive drugs. The clearance rate of cryotherapy on MC lesions was found to be 94%. Hypopigmentation was the commonest adverse effect. Conclusion The findings of this study show that AD and immunosuppression may be contributing to MC development. Based on the clearance rate results, cryotherapy has shown to be effective and may be used in the treatment of MC.