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 26-year-old male presented with multiple skin-colored umbilicated papules on the penis, without itch and pain (). The lesions first appeared as one skin-colored papule on the penis shaft for the past 1 month PTC. Over time, 3 weeks after, the skin lesions were spread over the base of the penis and increase in number. There was a history of promiscuity with several female prostitutes. Physical examination on the shaft and the base of the penis revealed several papules with central umbilication. VDRL, TPHA, and HIV tests were nonreactive. The patient was treated with 20% KOH solution applied by the patient twice daily for the lesions. All of the MC lesions disappeared on day 20 of observation. The patient felt a stinging sensation after 3–5 minutes application of the 20% KOH solution. Furthermore, it also caused other side effects such as erosions and post-inflammatory hypopigmentation.