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with several episodes of dyshidrotic eczema and juvenile plantar dermatitis in the past 3 years&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The dermatologic examination revealed 2 dome-shaped erythematous papules with an umbilicated center measuring 2&#160;mm in diameter&#44; located on the instep and sole of the right foot &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>A&#41;&#46; Dermoscopy revealed a yellowish round central structure and branching vessels in a crown distribution on the periphery &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The lesions were treated with curettage and histopathology confirmed the suspected diagnosis of MC&#46; The lesion was revealed to be nodular in the form of endophytic lobules with a squamous epithelium with molluscum bodies maturing toward the surface &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">MC is a very common skin infection caused by the poxvirus <span class="elsevierStyleItalic">Molluscum contagiosum</span>&#46; Transmission is by direct contact&#44; fomites&#44; or autoinoculation&#46; It usually manifests as dome-shaped umbilicated papules that are whiteish or the same color as normal skin&#44; measuring between 3 and 5&#160;mm in diameter&#44; and generally asymptomatic&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">It mainly affects 3 population groups&#58; children&#44; sexually active adults&#44; and immunosuppressed persons&#46; In children&#44; MC lesions tend to be found on the torso and extremities&#44; whereas in adults&#44; they usually present in the genital region&#44; lower part of the abdomen&#44; pubis&#44; and proximal surface of the thighs&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> Regardless of age&#44; subungual or interdigital involvement&#44; or involvement of the conjunctival and oral mucosa and of the palmoplantar region is exceptional&#46; Atypical clinical presentations &#40;giant forms&#41;&#44; extensive lesions&#44; lesions on the face and neck&#44; or other uncommon locations tend to occur particularly in the context of immunosuppression&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The clinical diagnosis of plantar MC is more difficult&#44; as the lesions tend to lack the usual clinical characteristics &#40;they rarely present as umbilicate papules with a central keratin plug&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> They present as single or multiple papules or nodules with varying coloration &#40;normal skin&#44; erythematous&#44; brownish&#44; translucent&#44; or yellowish&#41; and with a hyperkeratotic&#44; verrucous&#44; or crusted surface&#46; Most patients have only 1 giant lesion &#40;&#8805; 1&#160;cm in diameter&#41;&#44; that is painful on walking&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;7</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">While infection with the MC virus is more frequent in childhood and in atypical locations in immunocompromised patients&#44; most cases of palmoplantar involvement have been reported in immunocompetent adults&#46; It may be that the thickness of the stratum corneum on the palms and soles makes entry of the poxvirus more difficult &#40;it is much larger than the human papilloma virus&#41;&#46; Moreover&#44; local trauma and plantar hyperhidrosis may be predisposing factors&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The differential diagnosis of plantar MC is broad and includes plantar warts&#44; plantar corns&#44; pyogenic granuloma&#44; foreign body granuloma&#44; epidermal cyst&#44; Spitz nevus&#44; and eccrine poroma&#46; Treatment is the same as that used in other locations&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;7</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The typical dermoscopic pattern of MC consists of a central round&#44; amorphous structure &#40;sometimes polylobar&#44; in the form of a four-leaf clover&#44; nonspecific&#44; or even nonvisible&#41; with a white or yellowish color&#44; and blood vessels with a crown distribution &#40;less frequently&#44; radial&#44; punctate&#44; or mixed-pattern vessels&#41;&#44; with a radial distribution in the periphery of the lesion&#46; The whiteish central structure correlates histologically with the inverted lobules of the acanthotic epidermis &#40;filled with <span class="elsevierStyleItalic">Molluscum</span> bodies&#41;&#44; which expand as the infection advances&#44; moving the dermis and&#44; therefore&#44; the vessels contained in it&#44; to the periphery of the lesion&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> We have found only 1 article that describes the dermoscopic findings of plantar MC&#59; those authors describe a yellowish destructured central area surrounded by thick branching vessels with bulbous terminations&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In conclusion&#44; we report MC with typical clinical signs on the sole of the foot of a girl who frequents a swimming pool&#46; We believe that the history of plantar skin lesions in the context of the patient&#8217;s atopy &#40;juvenile plantar dermatitis and dyshidrosis&#41; and her hyperhidrosis may have contributed to the appearance of MC in that location&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0060" class="elsevierStylePara elsevierViewall">This study has not received funding of any kind&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of Interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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Case and Research Letters
Dermoscopy of Plantar Molluscum Contagiosum
Dermatoscopia de un molusco contagioso plantar
B. Monteagudo Sáncheza,
Corresponding author
, E. León-Muiñosb, F. Piñeyro-Molinaa, J.Á. Vázquez-Buenoc
a Servicio de Dermatología, Complejo Hospitalario Universitario de Ferrol, Xerencia de Xestión Integrada de Ferrol, SERGAS, Ferrol, A Coruña, Spain
b Pediatría, Centro de Salud de Pontedeume, Xerencia de Xestión Integrada de Ferrol, SERGAS, Pontedeume, A Coruña, Spain
c Servicio de Anatomía Patológica, Complejo Hospitalario Universitario de Ferrol, Xerencia de Xestión Integrada de Ferrol, SERGAS, Ferrol, A Coruña, Spain
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with several episodes of dyshidrotic eczema and juvenile plantar dermatitis in the past 3 years&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The dermatologic examination revealed 2 dome-shaped erythematous papules with an umbilicated center measuring 2&#160;mm in diameter&#44; located on the instep and sole of the right foot &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>A&#41;&#46; Dermoscopy revealed a yellowish round central structure and branching vessels in a crown distribution on the periphery &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The lesions were treated with curettage and histopathology confirmed the suspected diagnosis of MC&#46; The lesion was revealed to be nodular in the form of endophytic lobules with a squamous epithelium with molluscum bodies maturing toward the surface &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">MC is a very common skin infection caused by the poxvirus <span class="elsevierStyleItalic">Molluscum contagiosum</span>&#46; Transmission is by direct contact&#44; fomites&#44; or autoinoculation&#46; It usually manifests as dome-shaped umbilicated papules that are whiteish or the same color as normal skin&#44; measuring between 3 and 5&#160;mm in diameter&#44; and generally asymptomatic&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">It mainly affects 3 population groups&#58; children&#44; sexually active adults&#44; and immunosuppressed persons&#46; In children&#44; MC lesions tend to be found on the torso and extremities&#44; whereas in adults&#44; they usually present in the genital region&#44; lower part of the abdomen&#44; pubis&#44; and proximal surface of the thighs&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> Regardless of age&#44; subungual or interdigital involvement&#44; or involvement of the conjunctival and oral mucosa and of the palmoplantar region is exceptional&#46; Atypical clinical presentations &#40;giant forms&#41;&#44; extensive lesions&#44; lesions on the face and neck&#44; or other uncommon locations tend to occur particularly in the context of immunosuppression&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The clinical diagnosis of plantar MC is more difficult&#44; as the lesions tend to lack the usual clinical characteristics &#40;they rarely present as umbilicate papules with a central keratin plug&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> They present as single or multiple papules or nodules with varying coloration &#40;normal skin&#44; erythematous&#44; brownish&#44; translucent&#44; or yellowish&#41; and with a hyperkeratotic&#44; verrucous&#44; or crusted surface&#46; Most patients have only 1 giant lesion &#40;&#8805; 1&#160;cm in diameter&#41;&#44; that is painful on walking&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;7</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">While infection with the MC virus is more frequent in childhood and in atypical locations in immunocompromised patients&#44; most cases of palmoplantar involvement have been reported in immunocompetent adults&#46; It may be that the thickness of the stratum corneum on the palms and soles makes entry of the poxvirus more difficult &#40;it is much larger than the human papilloma virus&#41;&#46; Moreover&#44; local trauma and plantar hyperhidrosis may be predisposing factors&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The differential diagnosis of plantar MC is broad and includes plantar warts&#44; plantar corns&#44; pyogenic granuloma&#44; foreign body granuloma&#44; epidermal cyst&#44; Spitz nevus&#44; and eccrine poroma&#46; Treatment is the same as that used in other locations&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;7</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The typical dermoscopic pattern of MC consists of a central round&#44; amorphous structure &#40;sometimes polylobar&#44; in the form of a four-leaf clover&#44; nonspecific&#44; or even nonvisible&#41; with a white or yellowish color&#44; and blood vessels with a crown distribution &#40;less frequently&#44; radial&#44; punctate&#44; or mixed-pattern vessels&#41;&#44; with a radial distribution in the periphery of the lesion&#46; The whiteish central structure correlates histologically with the inverted lobules of the acanthotic epidermis &#40;filled with <span class="elsevierStyleItalic">Molluscum</span> bodies&#41;&#44; which expand as the infection advances&#44; moving the dermis and&#44; therefore&#44; the vessels contained in it&#44; to the periphery of the lesion&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> We have found only 1 article that describes the dermoscopic findings of plantar MC&#59; those authors describe a yellowish destructured central area surrounded by thick branching vessels with bulbous terminations&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In conclusion&#44; we report MC with typical clinical signs on the sole of the foot of a girl who frequents a swimming pool&#46; We believe that the history of plantar skin lesions in the context of the patient&#8217;s atopy &#40;juvenile plantar dermatitis and dyshidrosis&#41; and her hyperhidrosis may have contributed to the appearance of MC in that location&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0060" class="elsevierStylePara elsevierViewall">This study has not received funding of any kind&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of Interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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Article information
ISSN: 15782190
Original language: English
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