Molluscum folliculitis after leg shaving

To the Editor: We report an unusual case of follicular mollusum contagiosum that appeared after leg shaving. Biopsy of the follicular papules revealed multiple molluscum bodies within the epithelium of the hair follicle.A 23-year-old healthy female presented with pruritic erythematous papules on both shins. Ten months before, she shaved her legs with a disposable razor. After several days, she noted multiple erythematous papules on the shaved sites. The patient had been evaluated by several dermatologists, and the clinical diagnosis was bacterial folliculitis or pesudofolliculitis. She received several types of therapy, including topical retinoic acid and antibiotics. None of these treatments were successful, and the patient experienced side effects from the topical tretinoin, such as xerosis, desquamation, and erythema. She denied any previous skin lesions, including atopic dermatitis, and had no sexual contact. Examination revealed multiple, nonumblicated, erythematous follicular papules on xerotic patches (Fig 1). Biopsy of the follicular papules revealed multiple molluscum bodies within the epithelium of the hair follicle (Fig 2). She was tested for HIV, which was negative.Fig 1a, Multiple, nonumbilicated, erythematous, follicular papules on xerotic patches in both shins. b, Close-up.View Large Image Figure ViewerDownload (PPT)Fig 2Multiple molluscum bodies within the epithelium. (Hematoxylin-eosin stain; original magnification ×40.)View Large Image Figure ViewerDownload (PPT)Folliculitis caused by viruses is not a well-known disease; in particular, folliculitis caused by molluscum contagiosum (MC) has been rarely described. Krishnamurthy first described a case of viral sycosis caused by MC in 1974.1.Krishnamurthy J. Viral sycosis.Arch Dermatol. 1974; 109: 578Crossref PubMed Scopus (11) Google Scholar Extensive MC has been reported in patients receiving chemotherapy or corticosteroids, as well as those with congenital and acquired immune deficiencies.2.Ratka P. Fitowski J.A. Atypical iatrogenic presentations of molluscum contagiosum.Dermatol Monatsschr. 1990; 176: 735-739PubMed Google Scholar Some authors found that the lesions in patients with HIV infection were limited to the face and neck region, and noted that extensive MC of the beared area was common, suggesting spreading caused by shaving.3.Schwartz J.J. Myskowski P.L. Molluscum contagiosum and human immunodeficiency virus.Arch Dermatol. 1992; 128: 1407-1408Crossref PubMed Scopus (8) Google Scholar Although our patient had no evidence of immunodeficiency, our experience is similar to theirs. However, it is speculated that the eruption in our patient could have arisen because of the presence of the virus before shaving, with subsequent inoculation.Viral folliculitis can occur after hair removal procedures.4.Weinberg J.M. Mysliwiec A. Turiansky G.W. Redfield R. James W.D. Viral folliculitis. Atypical presentations of herpes simplex, herpes zoster, and molluscum contagiosum.Arch Dermatol. 1997; 133: 983-986Crossref PubMed Google Scholar The MC virus characteristically proliferates within the follicular epithelium. The incidence of subclinical infection is unknown. Therefore, clinicians should consider viral causes, especially MC, in the differential diagnosis of difficult to eradicate folliculitis-like dermatoses after epilation. To the Editor: We report an unusual case of follicular mollusum contagiosum that appeared after leg shaving. Biopsy of the follicular papules revealed multiple molluscum bodies within the epithelium of the hair follicle. A 23-year-old healthy female presented with pruritic erythematous papules on both shins. Ten months before, she shaved her legs with a disposable razor. After several days, she noted multiple erythematous papules on the shaved sites. The patient had been evaluated by several dermatologists, and the clinical diagnosis was bacterial folliculitis or pesudofolliculitis. She received several types of therapy, including topical retinoic acid and antibiotics. None of these treatments were successful, and the patient experienced side effects from the topical tretinoin, such as xerosis, desquamation, and erythema. She denied any previous skin lesions, including atopic dermatitis, and had no sexual contact. Examination revealed multiple, nonumblicated, erythematous follicular papules on xerotic patches (Fig 1). Biopsy of the follicular papules revealed multiple molluscum bodies within the epithelium of the hair follicle (Fig 2). She was tested for HIV, which was negative. Folliculitis caused by viruses is not a well-known disease; in particular, folliculitis caused by molluscum contagiosum (MC) has been rarely described. Krishnamurthy first described a case of viral sycosis caused by MC in 1974.1.Krishnamurthy J. Viral sycosis.Arch Dermatol. 1974; 109: 578Crossref PubMed Scopus (11) Google Scholar Extensive MC has been reported in patients receiving chemotherapy or corticosteroids, as well as those with congenital and acquired immune deficiencies.2.Ratka P. Fitowski J.A. Atypical iatrogenic presentations of molluscum contagiosum.Dermatol Monatsschr. 1990; 176: 735-739PubMed Google Scholar Some authors found that the lesions in patients with HIV infection were limited to the face and neck region, and noted that extensive MC of the beared area was common, suggesting spreading caused by shaving.3.Schwartz J.J. Myskowski P.L. Molluscum contagiosum and human immunodeficiency virus.Arch Dermatol. 1992; 128: 1407-1408Crossref PubMed Scopus (8) Google Scholar Although our patient had no evidence of immunodeficiency, our experience is similar to theirs. However, it is speculated that the eruption in our patient could have arisen because of the presence of the virus before shaving, with subsequent inoculation. Viral folliculitis can occur after hair removal procedures.4.Weinberg J.M. Mysliwiec A. Turiansky G.W. Redfield R. James W.D. Viral folliculitis. Atypical presentations of herpes simplex, herpes zoster, and molluscum contagiosum.Arch Dermatol. 1997; 133: 983-986Crossref PubMed Google Scholar The MC virus characteristically proliferates within the follicular epithelium. The incidence of subclinical infection is unknown. Therefore, clinicians should consider viral causes, especially MC, in the differential diagnosis of difficult to eradicate folliculitis-like dermatoses after epilation.