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 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.