A 36-year-old male presented with multiple papules on the upper and lower right and left eyelids. Seven months prior to consult, acne-like, pin-point sized, mildly pruritic papules appeared on the patient’s right cheek. The papules multiplied and appeared on the right upper eyelid within a month. Patient often rubbed the papules on the right upper eyelids, which then increases in number and size, became confluence, and spread to the right lower eyelid measuring more than 1 cm in diameter ( and ). The complaint is occasionally followed by eye redness and discharge with no blurred vision or pain. Difficulty in opening the eye was more prominent in the last two weeks. The patient was diagnosed with HIV in 2012 and started ARV therapy in 2017. CD4+ value was 31 cells/μL. Tzanck smear from skin lesion on the forehead revealed Henderson–Paterson bodies as round hyperbasophilic mass (). The patient was diagnosed with giant MC on the eyelids and stage 2 HIV. We consulted the patient to an ophthalmologist who suggested excisional surgery, but the patient refused the option. The patient was then treated with self-administered 20% KOH solution applied once daily at night. The application methods were as follows: the surrounding healthy skin was covered with vaseline album, the upper and lower eyelids covered with wet gauze to prevent the solution from dripping or irritating the eye, then the 20% KOH solution was spread evenly using a cotton tip on the skin lesions. Follow up visit one week later revealed superficial ulceration with crusts on most papules on the right eyelids. The patient’s complaint of red eyes remained, but with no blurred vision or pain (). The patient was again referred to an ophthalmologist who suggested using artificial tears and discontinuing the 20% KOH solution, followed with the application of an open wet dressing using saline solution twice daily for a week. The patient then resumed treatment with 20% KOH solution once daily at night, three times a week. Clinical improvement was observed after four weeks of therapy, all lesions on right eyelids disappeared and no new lesions were observed (). The burning sensation side effect was well tolerated by the patient, who was satisfied and willing to redo the treatment if new lesion appears.
A 56-year-old male presented with multiple skin-colored umbilicated papules on the pubic, penis, and scrotum without itch and pain (). The lesion first appeared as one skin-coloured papule on the scrotum for the past 2 years PTC. One and a half years later, the papules increased in number for more than 10 papules. Six months later, papules multiplied and spread over the scrotum, penis, and pubic. There has been a history of promiscuity with nine female prostitutes since 2 years ago and had sexual contact with the prostitute who has the same lesions. Physical examination of the pubic, scrotum, and the shaft of the penis showed some papules with central umbilication. A Tzanck smear with Giemsa staining showed Henderson–Paterson’s bodies (). While VDRL, TPHA, and HIV tests were nonreactive. The patient was treated with 20% KOH solution applied by the patient once daily for 4 weeks on the left side of the pubic, penis, and scrotum. The right side of the pubic, penis, and scrotum was treated with 80% TCA once a week, as for comparing the efficacy of MC treatment. The MC lesions on both sides gradually became smaller after 2 weeks of treatment and disappeared on day 31. The patient complained of pain and stinging sensation in 3–5 minutes after 20% KOH being used, and lesions became redness for 4–5 days. With 80% TCA solution, there were side effects such as pain and stinging sensation shortly after being used, which last about 10 seconds. Both treatments using 20% KOH and 80% TCA solutions caused side effects of hypopigmented macules.