Indian Journal of Dermatology
E-IJDŽ - CORRESPONDENCE
Year
: 2022  |  Volume : 67  |  Issue : 4  |  Page : 481-

A case of linear nodules on the scalp – Dermoscopy rules the diagnosis


Arjun Prakashey1, Hita Mehta2, Neha Agrawal2, Dharm M Sondagar2,  
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

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




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;67:481-481


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 2023 Feb 7 ];67:481-481
Available from: https://www.e-ijd.org/text.asp?2022/67/4/481/360347


Full Text



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}

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.

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