Umbilicated papules on the face

A 5 year old boy presented with a three month history of multiple mildly pruritic, dome shaped, skin coloured, shiny, centrally umbilicated papules (average diameter 1-5 mm) on his face and neck. His medical history included atopic dermatitis, for which he had been treated with topical hydrocortisone, without improvement. The papules were distributed mostly on the perioral and perinasal areas (fig 1) and neck. He had no lesions elsewhere on his body. Ocular examination and laboratory investigations were normal, and he tested negative for HIV. Biopsy of a lesion was sent for histopathological examination (fig 2). …