LAUSR

Dear Editor, Molluscum contagiosum (MC) is a benign viral skin disease, which is often self-limiting. However, atypical presentations and treatment refractoriness in immunocompromised patients can be a therapeutic challenge. We present the case of an immunocompromised patient with extensive, disfiguring MC who was treated with a novel therapeutic modality. A middle aged woman presented to the dermatology department with multiple, skin colored, umbilicated, papulonodular lesions of 3 months duration distributed on the face and neck (Figure 1). The lesions had appeared gradually and varied in size from 2 mm to 1 cm. She was suffering from human immunodeficiency virus infection and was on antiretroviral treatment with a CD4 count of 394/mm at the time of presentation. Based on these features, a clinical diagnosis of giant MC was rendered. Initial treatment with touch cryotherapy (single freeze thaw cycle of 10 sec repeated weekly for 4 weeks) and intralesional 10% potassium hydroxide (4 weekly sessions) with oral elemental zinc 100 mg/ day failed to yield response. Intralesional 5-fluorouracil (5-FU, 50 mg/ mL) was then instituted. One to two drops of the drug (3–6 mg) were instilled after pricking the lesions with a 26 gauge needle. The injections were repeated at weekly intervals for 8 weeks. After 2 sessions the lesions started to heal and there was significant improvement with residual scarring at 8 weeks (Figure 2). At 3 months follow-up, there has been no recurrence of lesions; however, regular follow-up is planned. Molluscum contagiosum is a DNA poxvirus which commonly affects children, young adults, and immunocompromised individuals. However, there is no single accepted standard treatment for MC. Various modalities include physical ablative methods like enucleation, curettage, cryosurgery, chemical agents like podophyllin, potassium hydroxide, 5% imiquimod cream, interferon-alpha, among others (Nguyen, 2014). Reconstitution of normal immunologic function remains the mainstay of therapy for MC in immunocompromised patients. In immunocompetent individuals, lesions usually clear spontaneously within several months or years, whereas in immunosuppressed patients, the disease tends to take a more chronic course and often is unresponsive to various treatments. Intralesional treatment of MC lesions with immunotherapy agents like candida antigen, measles mumps rubella antigen, and trichophytin antigen has been described with varying degrees of success. The intralesional