Answer to Image Quiz - 2

ANSWER:The eyelid lesions are suggestive of Molluscum contagiosum (MC).Multiple MC in facial location in an adult are indicative of underlying immunosuppression, especially Human Immunodeficiency Virus (HIV)/ Acquired Immuno-deficiency Syndrome (AIDS).EXPLANATION: Molluscum contagiosum (MC) is a viral infection caused by a poxvirus (molluscum contagiosum virus).It commonly affects children, presenting as small, umbilicated papules.The presence of lesions in atypical locations or in greater number, especially with recalcitrant behavior, is often seen in patients with HIV infection.Periocular MC in adults is uncommon and may lead to complications such as chronic conjunctivitis or keratitis.Dermoscopy is a valuable tool for bedside diagnosis, demonstrating characteristic features such as a central yellow-white amorphous core surrounded by radial crown vessels.This pattern is highly suggestive of MC and helps differentiate it from other eyelid lesions, including basal cell carcinoma, verruca vulgaris, and adnexal tumors. 1,2 our case, the diagnosis was confirmed clinically and dermoscopically.HIV serology was positive.The patient fit into World Health Organization (WHO) Clinical stage 2 of HIV/AIDS in Adults and Adolescents based on unintentional weight loss <10% and extensive molluscum contagiosum. 3He was referred for initiation of antiretroviral therapy (ART).Treatment of molluscum contagiosum (MC) in HIV-positive individuals is recommended to reduce autoinoculation, secondary infection, transmission, and improve cosmetic appearance.Therapy choice should consider efficacy, patient tolerance, preferences, cost, accessibility, and practicality.No standard regimen exists due to the chronic and recurrent nature of lesions.MC may resolve as CD4+ counts improve; thus, initiating ART is essential.Destructive methods, including cryotherapy and curettage, may be limited by lesion location in our case.Potassium hydroxide (KOH) offers a safe, affordable, self-administered, and effective chemical alternative in such cases. 4 in atypical sites such as the periocular area in adults should prompt evaluation for underlying immunosuppression.Early diagnosis, aided by dermoscopy, along with timely HIV testing, is critical for appropriate management.