Umbilicated Papules Research Articles

Cutaneous and Osseous Histoplasmosis caused by Histoplasma capsulatum var. duboisii in a Seemingly Immunocompetent Young Senegalese Woman

African histoplasmosis is a rare deep mycosis caused by Histoplasma capsulatum var duboisii. It can affect various organs such as the skin, lymph nodes, and bones. The diagnosis is often delayed due to its similarity to certain diseases such as tuberculosis, cryptococcosis, pyogenic abscesses, and even neoplasia. We report a case of cutaneous and osseous histoplasmosis caused by H. capsulatum var. duboisii in a seemingly immunocompetent 19-year-old senegalese woman who presented with chronic disseminated cutaneous abscesses, some of which had fistulised, and umbilicated papules on the face. The radiograph of the right forearm showed a metaphyso-diaphyseal osteolytic lesion of the ulna. Histology after biopsy of a facial papule confirmed the diagnosis of histoplasmosis caused by H. capsulatum var duboisii. The patient's condition improved with fluconazole treatment.

Widespread umbilicated papules and nodules in an immunosuppressed patient

Widespread umbilicated papules and nodules in an immunosuppressed patient

Linear Sebaceous Gland Hyperplasia behind the Right Ear Clinically Simulating Verrucous Nevus

Sebaceous Glandhy Perplasia (SGH) is a common benign proliferative skin disorder, which most commonly involves the faces and usually appears as yellow, soft, umbilicated papules. But the clinical manifestations of SGH vary greatly. We presented a 40-year-old man with the flesh-colored to light brown linear plaque behind the right ear mimicking verrucous nevus clinically.

Detection of sebaceous gland hyperplasia with dermoscopy and reflectance confocal microscopy.

Sebaceous gland hyperplasia (SGH) is a benign cutaneous proliferation of the sebaceous glands that are mostly present on the face or the neck of older adults. They typically appear as single or multiple soft umbilicated papules; however, in challenging cases, it can be difficult to distinguish them from trichoepitheliomas, base cell carcinomas, or other tumors. Although pathological results have diagnostic value, the significance of non-invasive examinations in diagnosis and differential diagnosis is also worth exploring. This study aimed to describe the dermoscopic and reflectance confocal microscopy (RCM) features of SGH. A total of 31 patients diagnosed with SGH, according to clinical and histopathological standards, were examined using dermoscopy and RCM between March 2018 and January 2022. Dermoscopically, lesions revealed a yellowish-red background and a faint-yellow background in 25 (80.65%) and six cases (19.35%), respectively. White-yellowish lobulated structures in the center of the lesion were present in 31 patients (100%) and umbilications in 19 patients (61.29%). Crown vessels at the periphery of the lesions were observed in 11 patients (35.48%), whereas irregular linear vessels were observed on the surface of the lesions in 18 patients (58.06%). Under RCM, all lesions presented a honeycomb pattern in the epidermis and the typical morulae-shaped sebaceous lobules in the dermis. A dilated follicular infundibulum was observed in 15 patients (48.39%) and dilated vessels in 26 patients (83.87%). Dermoscopy and RCM enabled us to describe the imaging features of SGH. Combining these two useful tools provides a non-invasive basis for accurate clinical diagnosis.

Persistent umbilicated papules on the left ear and neck in an adolescent boy.

Pediatric DermatologyVolume 40, Issue 3 p. 562-564 PHOTOQUIZ Persistent umbilicated papules on the left ear and neck in an adolescent boy Shibhani Sudheer Hegde MD, FRGUHS, Corresponding Author Shibhani Sudheer Hegde MD, FRGUHS [email protected] orcid.org/0000-0002-5415-3702 Department of Pediatric Dermatology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India Correspondence Shibhani Sudheer Hegde, Department of Pediatric Dermatology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India. Email: [email protected]Search for more papers by this authorSahana M. Srinivas DNB, DVD, FRGUHS, Sahana M. Srinivas DNB, DVD, FRGUHS orcid.org/0000-0002-4356-2535 Department of Pediatric Dermatology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, IndiaSearch for more papers by this authorRajalakshmi Tirumalae MD, Rajalakshmi Tirumalae MD Department of Pathology, St John's Medical College and Hospital, Bengaluru, Karnataka, IndiaSearch for more papers by this author Shibhani Sudheer Hegde MD, FRGUHS, Corresponding Author Shibhani Sudheer Hegde MD, FRGUHS [email protected] orcid.org/0000-0002-5415-3702 Department of Pediatric Dermatology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India Correspondence Shibhani Sudheer Hegde, Department of Pediatric Dermatology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India. Email: [email protected]Search for more papers by this authorSahana M. Srinivas DNB, DVD, FRGUHS, Sahana M. Srinivas DNB, DVD, FRGUHS orcid.org/0000-0002-4356-2535 Department of Pediatric Dermatology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, IndiaSearch for more papers by this authorRajalakshmi Tirumalae MD, Rajalakshmi Tirumalae MD Department of Pathology, St John's Medical College and Hospital, Bengaluru, Karnataka, IndiaSearch for more papers by this author First published: 22 May 2023 https://doi.org/10.1111/pde.15221Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume40, Issue3May/June 2023Pages 562-564 RelatedInformation

Use of tecovirimat for mpox infection followed by JYNNEOS vaccination postinfection in a liver transplant recipient.

Use of tecovirimat for mpox infection followed by JYNNEOS vaccination postinfection in a liver transplant recipient.

Umbilicated vesicles and multiple pustules on the genital area in a man

Umbilicated vesicles and multiple pustules on the genital area in a man

A Review on Palmoplantar keratodermas

A palmoplantar keratoderma is a group of hereditary, keratinization disorders characterised by hyperkeratotic thickening of the palms and soles. PPK presents in three forms namely diffuse, focal & punctate. The aetiological factors of Palmoplantar keratoderma are drug-related, chemical-related, systemic disease-related, infection-related, & idiopathic. Palmoplantar keratodermas are diagnosed based on their clinical manifestations and forms. Tiny raindrop-shaped lesions, which are relatively uncommon in nature are one of the clinical symptoms of Type-I PPK. The papules are round and hyperkeratotic and the lesions are yellow to flesh-coloured, well-circumscribed, and firm to the touch. Type-II usually presents with small spines to protrude from the palms and soles whereas Type-III is characterised by tiny flat or umbilicated keratotic shining papules to form along the palms, soles, and digits borders. The prevalence of PPK is less among Indian populations hence managing these conditions might be more challenging due to limited treatment options. However, managing these conditions is based on the classifications and their presentation.

Lobulated red nodule on right lower back.

A 60-year-old man with a history of basal cell carcinoma (BCC) on his forehead excised 10 years ago presented to the dermatology clinic with an enlarging red bump on his back for the past few months. He had no other personal or family history of malignancy and no known radiation exposure (Fig. 1). Physical examination revealed a 2 cm lobulated red nodule with multiple serpiginous vessels coursing through it located on the right lower back. There was no regional lymphadenopathy clinically. Histopathology showed lobules of basaloid tumor cells displaying vesicular, overlapping nuclei, and prominent nucleoli. Admixed aggregates of mature sebocytes, scattered foci of necrosis, and easily identifiable mitotic figures were seen (Fig. 2). Sebaceous carcinoma. This is sebaceous carcinoma, with an estimated incidence of 1–2 cases per 1,000,000 person-years.1, 2 Most cases of sebaceous carcinoma are ocular, and extraocular sites are usually in the head and neck area as a yellowish or red nodule with ulceration.1, 3 Histopathology shows sheets of basaloid and sebaceous cells sheets or asymmetric sebaceous lobules and other signs of malignancy like necrosis, pleomorphism, hyperchromatism, and numerous mitotic figures.1 Mohs surgery is considered first-line for removal of nodules suspicious for sebaceous carcinoma, as is wide-local excision with frozen sections.1 Further studies should include margin assessment of both peripheral and deep tissue edges, with regional lymph node biopsy if there is clinical suspicion of lymphatic involvement.1 As this patient had no clinical lymphadenopathy, no lymph node biopsy was indicated. However, the further pathological analysis showed negative nuclear staining for MSH2 and MSH6, concerning for Muir–Torre syndrome. Muir–Torre syndrome is an autosomal dominant phenotypic variant of Lynch syndrome, and typical findings include a constellation of sebaceous cutaneous neoplasms and visceral malignancies, most commonly colon cancer.4 Immunohistochemistry can be conducted on sebaceous neoplasms to identify mismatch repair gene mutations, and a thorough review of family and personal history of neoplasms as well as personal history of radiation exposure and immunosuppression is indicated. With this patient's multiple sebaceous nodules and DNA mismatch mutation on histology, extensive malignancy workup was started. To date, computed tomography (CT) revealed a multicystic pancreatic tail lesion and multiple metastatic lesions to the liver, with plans to conduct further colonoscopy and upper gastrointestinal (GI) imaging. This case is an excellent example of how dermatologic evaluation can help identify unsuspected internal disease. Sebaceous hyperplasia is incorrect. This is common in older adults and can often be confused with nodular BCC.3 Clinically, these appear as smooth yellow soft umbilicated papules and may elicit sebum with lateral compression, and histopathology would show enlarged sebaceous glands with normal morphology. Typical MCC includes a cutaneous or subcutaneous pink to violet dome-shaped rapidly growing papule or nodule with intact overlying skin in an immunosuppressed patient.3 Histopathology reveals aggregated, deeply blue staining small basaloid or lymphoma-like cells in sheets with CK20 positivity. SCC is incorrect, as these lesions are often plaques or nodules and can be differentiated (hard, keratinized) or undifferentiated (soft, no keratinization).3 These are tumors of pleomorphic keratinocytes that extend into the dermis, and histopathology yields keratinocyte anaplasia, multiple mitoses, and varying degrees of keratinization. FeP is considered a rare variant of BCC characterized by a skin-colored, firm, sessile, fleshy papule, or plaque which often develops in patients with a history of BCC.5 Histopathology is definitive with thin anastomosing basaloid or squamous strands of keratinocytes in a fibrous stroma projecting down from the epidermis, resembling a honeycomb.

Monkeypox Diagnosis by Cutaneous and Mucosal Findings.

A monkeypox outbreak has been reported in several countries since early May 2022. Human monkeypox (MPX) diagnosis is based on a clinical suspicion supported by typical skin and mucosal lesions, confirmed with molecular testing. We present the results of all MPX confirmed patients presenting to our department until July 15 of 2022, describing the characteristics of the lesions at diagnosis. In total, 47 patients were included, all men and 44.7% (n = 21) were HIV-positive. Skin lesions were noted in all patients. The most commonly affected area was the genital region (63.8%), followed by the anorectal region (46.8%). Extra anogenital mucosal (oral or conjunctival mucosa) involvement was reported in three patients. Typical skin findings included erythematous papules, whitish, umbilicated papules, some with a necrotic center and an elevated whitish border. Most patients had lesions in multiple phases presenting simultaneously. Correct identification of MPX skin and mucosal lesions is crucial to avoid late diagnosis and prevent further spreading, ensuring less worldwide morbidity.

Human monkeypox virus infection in an immunocompromised man: trial with tecovirimat

Human monkeypox virus infection in an immunocompromised man: trial with tecovirimat

Monkeypox: Cutaneous clues to clinical diagnosis

Monkeypox: Cutaneous clues to clinical diagnosis

Unilateral Blepharoconjunctivitis due to Monkeypox Virus Infection

A 35-year-old Italian man presented with unilateral ocular pain and photophobia that started 7 days before presentation. Anterior segment examination (aided by asking the patient to pull down his lower eyelid; Fig A-B) revealed multiple (> 10) umbilicated papules on the tarsal and bulbar conjunctiva, the fornix, and at the temporal limbus; the fellow eye was uninvolved. He had multiple cutaneous, genital, oropharyngeal and anal vesicular-pustular lesions, generalized lymphadenopathy, and fever (Fig C-D).

Laporan Kasus Terapi Kombinasi Kuretase dan <i>Cimetidine</i> Oral pada Pasien Moluskum Kontangiosium

Background: Molluscum contagiosum is an infectious disease of the skin caused by poxvirus. The virus may be transmitted through direct skin and mucous membrane contact, including sexual contact, and through contaminated fomites. The prevalence of sexually transmitted molluscum contagiosum has increased in recent years. This disease causes anxiety and discomfort for the patients. Diagnosis of molluscum contagiosum is made based on history taking, physical examination, dermoscopic examination, and histopathological examination. Proper diagnosis and management can help to reduce risk of recurrence. Case: A 26-year-old woman with main complaint of developing shiny white rashes on her thighs and buttocks since 3 months ago. The nodules felt itchy yet painless. At first, only 4 papules appeared on the buttocks. In the last month, the nodules multiplied and spread to the thighs. The patient had tried to squeeze the nodule and rice-like white mass came out. The patient had history of unprotected sexual intercourse. Dermatological examination on the right and left femoral regions and the gluteus, found that there were discrete, multiple shiny white pearl-like papules of 0.1-0.5 cm in size, smooth surface, well-defined, dome-shaped, umbilicated with caseous plug. Dermoscopic examination showed a white to yellow polylobular appearance with crown vessel. Histopathological examination showed an appearance of intracytoplasmic eosinophil inclusion bodies (molluscum bodies). Discussion: Clinical findings such as discrete multiple, pearl-colored, umbilicated dome-shaped papules, are characteristic features of molluscum contagiosum. Dermoscopic examination results and histopathological images also support the diagnosis of molluscum contagiosum. Treatment was carried out using curettage on the lesions and prescription of oral cimetidine 2x800 mg for 2 months. No recurrence was found after 5 months of follow-up

Disseminated cryptococcosis in a renal transplant recipient.

Key messageSkin cryptococcosis often manifests as an umbilicated papule, and chest computed tomography findings of multiple nodules and cavities are also characteristic. The combination of characteristic cutaneous manifestations and radiological findings can help clinicians make an “at‐a‐glance” diagnosis of disseminated cryptococcosis.

A patient with fever and umbilicated papules

A patient with fever and umbilicated papules

Crusted Umbilicated Papules in a Child.

Crusted Umbilicated Papules in a Child.

Clinical characteristics of patients with Monkeypox infection at their first visit to dermatologist: A case series

Introduction/Aim: Monkeypox disease (MPX) is caused by Monkeypox virus (MPXV) which is endemic in countries of Central and West Africa. Since May 2022 an outbreak of Monkeypox has been recorded in various regions of the world, including the Republic of Serbia. The aim of this study is to present the clinical characteristics of monkeypox cases during their first visit to a dermatologist. Case series: The study includes seven patients who consulted a dermatologist during the months of June and July 2022 due to ano-genital rash and in whom Monkeypox infection was confirmed via PCR (Polymerase chain reaction) tests. The average age of patients was 35.8 years, all were men who have sex with men, three patients were HIV-positive and the infection was transmitted through sexual intercourse. Three patients were infected abroad and four in Belgrade. In most cases incubation lasted less than a week and prodromal signs were absent. Skin lesions most frequently appeared on the penis in the form of white umbilicated papules, pustules and crusts. Serological tests for syphilis showed that none of the patients had a recent infection. Conclusion: Dermatologists should be sensitized to the presence of this disease in our country, they should suspect it early on, refer the patient to laboratory diagnostics and evaluation by an infectious disease specialist, and advise patients to isolate and abstain from sex because the disease can be transmitted during sexual intercourse.

Molluscum contagiosum treated with individualized homoeopathic medicine: A case report

Molluscum contagiosum is infectious, benign skin condition. Typically present with umbilicated papule. A 15-year-old male patient presented popular eruption on neck with itching. After clinical examination and characteristic umbilicated papule, it was diagnosed as case of molluscum contagiosum. On the basis of presentation and characteristic symptoms, the patient was treated with individualized homoeopathic medicine. After a span of 4 months the papules were found to be disappeared. Rationale of this particular case is to show the better outcome of molluscum contagiosum with individualized homoeopathic medicines.

Histoplasma capsulatum var. duboisii: A KwaZulu-Natal, South Africa public sector perspective.

Histoplasma capsulatum var. duboisii (H. duboisii) causes potentially fatal disease in the immunocompromised patient, and the literature on these cases is limited. The study was undertaken to describe the cases of H. duboisii seen in a resource-limited setting. A 5-year retrospective, laboratory-based histopathologic review of all H. duboisii cases. A total of 24 patients were diagnosed with cutaneous H. duboisii infection. The male-to-female ratio was 1.4. All the patients were human immunodeficiency virus (HIV) positive, and 70.83% (17 of 24 patients) were on antiretroviral therapy. The clinically identified lesions were as follows: plaques, nodular plaques, papules, papulo-pustules, and umbilicated papules. Histopathological appraisal revealed organisms typical of H. duboisii. The commonest epidermal alterations were interface change, parakeratosis, spongiosis, ulceration, acanthosis, hyperkeratosis, transepidermal elimination, and exocytosis in decreasing order. The dermal changes included histiocytic pattern (n=14), neutrophil-rich (n=13), non-necrotizing granulomatous inflammation (n=9), and karyorrhexis (n=6). Histoplasma was confirmed in 53% (8 of 15 samples) of the tissue samples submitted for routine fungal culture. This study showed the demographics, clinical and histopathology features of H. duboisii infection in a resource-limited setting. Further research on histopathological features of this rare infection is essential to expand on the knowledge base and support findings in this study.