This report describes an unusual case of a 9-year-old boy with a 6-month history of right lower eyelid lesion and excoriation of the adjoining skin that had not responded to topical treatment. The umbilicated lesion was electively excised and the base of the lesion was cauterized under general anesthesia, which resulted in complete resolution of the periocular dermatitis without additional treatment. It is important to consider molluscum contagiosum in the differential diagnosis in patients with periocular dermatitis, especially in the presence of an umbilicated vesicle, although it is classically taught that these lesions present with toxic conjunctivitis.
From the Department of Ophthalmology (YKG, SS), Wolverhampton Eye Infirmary, and the Department of Pathology (MF), Royal Wolverhampton Hospital, Wolverhampton, United Kingdom.
The authors have no financial or proprietary interest in the materials presented herein.
Address correspondence to Yajati K. Ghosh, FRCSEd, FRCSOphth, Department of Ophthalmology, Wolverhampton Eye Infirmary, Wednesfield Road, Wolverhampton, WV10 0EN, United Kingdom.
Received: September 05, 2008
Accepted: November 26, 2008
Posted Online: May 21, 2010
Toxic conjunctivitis as a result of molluscum contagiosum of the eyelid is a well-known entity.1 This report describes an unusual case of localized toxic periocular dermatitis of the lower eyelid as a result of molluscum contagiosum.
A 9-year-old boy presented with a 6-month history of a right lower eyelid lesion and excoriation of the adjoining skin that had not responded to topical antibiotic ointment or topical steroid ointment application. The latter treatment, prescribed by the patient’s family physician, was discontinued by the parents 1 week before consultation with the authors because of thinning and fissuring of the periocular skin. On examination, the right lower eyelid was noted to have a patch of periocular dermatitis, with a single blister along with a central umbilication near the lower eyelid margin (Fig. 1). The area underneath the lesion was erythematous, with fissures. The umbilicated lesion was electively excised, and the base of the lesion was cauterized under general anesthesia.
Figure 1. Patch of Periocular Dermatitis on the Lower Eyelid.
Histologic examination of the specimen showed a lobulated circumscribed lesion with epidermal hyperplasia within which the keratinocytes contained large eosinophilic viral inclusion almost completely filling the cells. The surrounding dermis showed mild chronic nonspecific inflammation. The histologic appearance confirmed the clinical diagnosis of molluscum contagiosum (Fig. 2).
Figure 2. Histologic Appearance of Molluscum Contagiosum (hematoxylin–Eosin, Original Magnification ×200).
Postoperatively, the periocular dermatitis resolved completely within 1 month of surgery without any additional treatment (Fig. 3).
Figure 3. Periocular Dermatitis Resolved Completely After Treatment.
Molluscum contagiosum is a viral infection of the skin that causes small pearly or flesh-colored swellings that are often clear, with a central umbilication. Molluscum contagiosum is caused by a poxvirus that has four subtypes. The central waxy core contains the virus.2 By a process called “autoinoculation,” the virus may spread to neighboring skin areas. In approximately 10% of cases, eczema may develop around the lesions3 and the lesions occasionally are complicated by secondary bacterial infections. Children are particularly susceptible to autoinoculation and may have widespread clusters of lesions. Sometimes this condition may be associated with immunodeficiency disorders.4 In healthy people, treatment of molluscum contagiosum may not be necessary because individual lesions usually resolve spontaneously in 2 to 4 months, although some cases may take longer. Treatment is often indicated because of chronic toxic conjunctivitis. Treatment modalities include chemical cautery with silver nitrate/trichloro-acetic acid/liquid phenol, cryotherapy, excision, and use of topical imiquimod.5,6
In the current patient, toxic viral shedding had gravitated down to the lower periocular area, causing toxic localized dermatitis. Treating such lesions with topical steroids can result in further thinning of the affected skin, formation of fissures, and further deterioration of the periocular skin, which may be very thin, unlike the skin of the rest of the body.
Classic teaching is that molluscum contagiosum lesions present with toxic conjunctivitis. However, it is important to consider molluscum contagiosum in the differential diagnosis in patients with periocular dermatitis, especially in the presence of an umbilicated vesicle.
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- Denis J, Ecoffet M, Savoldelli M, Pouliquen Y. Ultrastructural study of a case of molluscum contagiosum [article in French]. Arch Ophtalmol (Paris). 1977;37:479–486.
- Rockoff AS. Molluscum dermatitis. J Pediatr. 1978;92:945–947. doi:10.1016/S0022-3476(78)80369-2 [CrossRef]
- Goodman DS, Teplitz ED, Wishner A, Klein RS, Burk PG, Hershenbaum E. Prevalence of cutaneous disease in patients with acquired immunodeficiency syndrome (AIDS) or AIDS-related complex. J Am Acad Dermatol. 1987;17(2 Pt 1):210–220. doi:10.1016/S0190-9622(87)70193-5 [CrossRef]
- Margo C, Katz NN. Management of periocular molluscum contagiosum in children. J Pediatr Ophthalmol Strabismus. 1983;20:19–21.
- Gonnering RS, Kronish JW. Treatment of periorbital molluscum contagiosum by incision and curettage. Ophthalmic Surg. 1988;19:325–327.