A 26-year-old female presented with multiple papules on the upper and lower left eyelid with occasional itch. The first lesion appeared as a single pin-sized papule on the left eyelid six months prior to consult, which multiplied and spread quickly within one month to the upper and lower left eyelids. Patient admitted to being in the habit of rubbing the eye. The pre-existing papules increased in number in the past month and became confluent with a diameter of 1 cm (). The patient was diagnosed with HIV in 2016 and consumed ARV routinely. CD4+ value was 46 cells/μL. Tzanck smear from the skin lesion revealed Henderson–Paterson bodies (). Other physical examination was within normal limits. The patient was diagnosed with giant MC on the eyelid and stage 2 HIV. The patient was treated with 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 three weeks later revealed slight erythema and edema on the right eyelids and smaller lesion (). All the lesions were cleared completely four weeks after therapy (). Side effects reported by the patient include stinging and burning sensation immediately after application, but these symptoms improved after one to five minutes without any additional treatment. The patient was satisfied with the final result.
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.