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.
A 28-year-old male presented with multiple skin-colored papules with umbilication on the face, especially forehead and temple area, without itch and pain (). The lesions first appeared as skin-colored papules on the forehead for the past one-month PTC. Two weeks later, the number of papules increasing and spread to the temple area. There was a history of promiscuity with female prostitutes. He had no concern of his sexual partners who also have the same lesions. Physical examination on the forehead and the temple area showed many papules with skin-colored and central umbilication. The HIV test was reactive, otherwise VDRL and TPHA tests were nonreactive. The patient was treated with 20% KOH solution applied by the patient twice daily. He complained stinging and burning sensation after 20% KOH applied for 3 minutes. The patient died due to brain toxoplasmosis on day 7 observations, but almost all the lesions became smaller.