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E-IJD® - CORRESPONDENCE
Year : 2022  |  Volume : 67  |  Issue : 4  |  Page : 481
A case of linear nodules on the scalp – Dermoscopy rules the diagnosis


1 From the Department of Dermatology, Venereology and Leprosy, Jawaharlal Nehru Medical College and AVBR Hospital, Wardha, Maharashtra; Department of Dermatology, Government Medical College, Bhavnagar, Gujarat, India
2 Department of Dermatology, Government Medical College, Bhavnagar, Gujarat, India

Date of Web Publication2-Nov-2022

Correspondence Address:
Arjun Prakashey
From the Department of Dermatology, Venereology and Leprosy, Jawaharlal Nehru Medical College and AVBR Hospital, Wardha, Maharashtra; Department of Dermatology, Government Medical College, Bhavnagar, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.ijd_655_21

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How to cite this article:
Prakashey A, Mehta H, Agrawal N, Sondagar DM. A case of linear nodules on the scalp – Dermoscopy rules the diagnosis. Indian J Dermatol 2022;67:481

How to cite this URL:
Prakashey A, Mehta H, Agrawal N, Sondagar DM. A case of linear nodules on the scalp – Dermoscopy rules the diagnosis. Indian J Dermatol [serial online] 2022 [cited 2022 Dec 4];67:481. Available from: https://www.e-ijd.org/text.asp?2022/67/4/481/360347




Sir,

Molluscum contagiosum (MC) is a common benign cutaneous viral infection caused by a poxvirus and is transmitted by skin-to-skin contact commonly occurring in children between 2 and 5 years of age. MCV 1 is the most common virus subtype affecting children.[1] The individual lesion is a shiny, pearly white, hemispherical, papule with a central umbilication. In children, lesions most commonly affect the extremities (particularly the intertriginous areas), trunk, and less commonly, the face; however, isolated lesions on the scalp are infrequent and considered atypical.[2] Giant, verrucous, hypertrophic, papular, pedunculated or widespread lesions giving atypical presentations are more common in conditions that involve altered immunity such as immunosuppressive therapy and AIDS.[1],[2] The dermoscopic features are well characterized. Here, we describe an atypical case of MC wherein a 6-month-old, immunocompetent female infant presented with multiple asymptomatic, nodular skin lesions on the midline of the scalp for 4 months.

On cutaneous examination, the lesions were 1–1.5 cm in diameter, round, mildly erythematous to white, firm, non-tender nodules, of which one lesion was crusted. These nodules were linearly arranged along the midline of the scalp [Figure 1]a. The mother did not had any cutaneous lesions nor did she give any history of similar lesions. Considering the clinical picture and the age of the infant, pyogenic granuloma, MC, cylindroma, appendageal tumour and epidermoid cyst as differentials were considered and consequently, ultrasonography (USG) was performed. Initially, MC was thought to be less likely as no significant history or tests revealed any signs of immuocompromisation in the infant or the mother. USG of the local part revealed hypo-echoic lesions with minimal vascularity likely to be an epidermoid cyst. On dermoscopic examination (DermLite DL4 dermatoscope – 3 Gen Inc., San Juan Capistrano, CA, USA – 10 × magnification), the lesions displayed pink homogenous areas, radial branching vessels with yellowish crusts and scales, which aroused the suspicion of MC [Figure 1]b. Lesions were excised, which displayed epidermal acanthosis with structures in the dermis which were eosinophilic at the base and turn basophilic in the dermis suggestive of Henderson–Paterson bodies.
Figure 1: (a) Multiple discrete erythematous to skin-colored shiny nodules with one of them being crusted, linearly distributed over the scalp midline. (b) Dermoscopy of the lesion showing pink homogenous areas, radial branching vessels, yellowish crusting in the centre and whitish polylobular structures. (c) Scalp pyogenic granuloma of another patient showing crusting with red homogenous areas showing no surface changes. (d) Molluscum contagiosum of our patient showing white dots in the homogenous areas with polylobular white structures starting from the base of the lesion and extending into the crusted part of the lesion (DermLite DL4 dermatoscope – 3 Gen Inc., San Juan Capistrano, CA, USA – 10 × magnification)

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MC is a self-limiting epidermal viral infection, which manifests as skin-colored papules, often umbilicated and a whitish curd-like substance containing the virions can be expressed with pressure. It is rare below 1 year of age, probably due to maternally-transmitted immunity and a long incubation period. There are only a few cases reported in the first few days or weeks of life, suggesting that vertical transmission is a possibility.[3]

Owing to the typical appearance, diagnosis is usually made clinically without any laboratory testing, however the lesion morphology may change with host defense abnormalities and dermoscopy may aid the diagnosis such difficult cases. Few lesions in our case clinically as well as dermoscopically resembled pyogenic granuloma (PG) [Figure 1]c and [Figure 1]d, but the central amorphous structures in the case of MC aided us to differentiate between the two. Of note, dermoscopic features of MC have been described as polylobular white to yellowish amorphous structures resembling a popcorn-like globular structure, central pore or umbilication (which may be present or absent in a few cases), vessels arranged in a crown pattern, radial pattern, punctiform and flower pattern.[4],[5] On the contrary, PG shows red homogenous areas, white rail Lines, white collarette, linear irregular vessels, dotted vessels, hairpin vessels, ulcerations and crusts.[6]

Thereby, dermoscopy could help us rule in the diagnosis of MC despite the unusual site, morphology, absence of immunocompromization and the age of onset of just 2 months, which is considered to be an uncommon phenomenon, making this case unique and atypical.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Seth J, Gorai S, Bandopadhayay A, Ghosh UK, Shome K. Epidermoid cyst turned out to be a common viral infection in an uncommon site!. Indian J Dermatol 2016;61:343-4.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Leung AK, Barankin B, Hon KL. Molluscum contagiosum: An update. Recent Pat Inflamm Allergy Drug Discov 2017;11:22-31.  Back to cited text no. 2
    
3.
Connell CO, Oranje A, Van Gysel D, Silverberg NB. Congenital molluscum contagiosum: Report of four cases and review of the literature. Pediatr Dermatol 2008;25:553-6.  Back to cited text no. 3
    
4.
Ianhez M, Cestari SD, Enokihara MY, Seize MB. Dermoscopic patterns of molluscum contagiosum: A study of 211 lesions confirmed by histopathology. An Bras Dermatol 2011;86:74-9.  Back to cited text no. 4
    
5.
Ku SH, Cho EB, Park EJ, Kim KH, Kim KJ. Dermoscopic features of molluscum contagiosum based on white structures and their correlation with histopathological findings. Clin Exp Dermatol 2015;40:208-10.  Back to cited text no. 5
    
6.
Zaballos P, Carulla M, Ozdemir F, Zalaudek I, Bañuls J, Llambrich A, et al. Dermoscopy of pyogenic granuloma: A morphological study. Br J Dermatol 2010;163:1229-37.  Back to cited text no. 6
    


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