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Endgames Spot Diagnosis

Umbilicated papules on the face

BMJ 2019; 367 doi: (Published 14 November 2019) Cite this as: BMJ 2019;367:l6013

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Comment to "Umbilicated papules on the face"

Dear Editor

We appreciated the paper by professor Dong-Lai and resident Yue-Tong titled “Umbilicated papules on the face”. Endgame papers are an important educational source and represent a field of clinical challenge for young doctors. Nevertheless I believe, as a resident, that some issues in the above-mentioned paper were not adequately discussed and could be misleading from a didactical prospective.

The first debatable feature is that biopsy was performed in a disease that is, as a rule, diagnosed on the ground of clinical examination, without any possible alternative diagnosis.

Secondly, going straight to physical destruction treatment in a self-limiting condition is wrong: the 2009 Cochrane review of treatments for cutaneous molluscum contagiosum recommends that the condition should be left to resolve naturally[1].

Thirdly, performing three sessions of curettage without clarifying if analgo-sedation, which should be considered as a standard of care in repeated procedures in children of that age, was carried out is inaccurate.

Finally, the concept that the occurrence of molluscum contagiosum is more common in children with atopic dermatitis has been widely divulged in medicine. However there are no reports of any concrete epidemiological evidence of this association. In daily practice clinical observation challenges the concept that the frequency of molluscum contagiosum is higher in patients with atopic dermatitis.[2-3-4]


Marta Cognigni
Pediatric Resident
University of Trieste, Italy

Egidio Barbi
Professor in Pediatrics
Institute for Maternal and Child Health, Trieste, Italy
University of Trieste, Italy


[1] Van der Wouden JC, Van der Sande R, Van Suijlekom-Smit LW, Berger M, Butler CC, Koning S. Interventions for cutaneous molluscum contagiosum. Cochrane Database Syst Rev. 2009 Oct 7; (4):CD004767.
[2] Seize MB, Ianhez M, Cestari Sda C. A study of the correlation between molluscum contagiosum and atopic dermatitis in children. An Bras Dermatol. 2011 Jul-Aug; 86(4):663-8.
[3] Youn-Kwang T, Boo-Peng K, Chee-Lek G. The profile of atopic dermatitis in a tertiary dermatology outpatient clinic in Singapore. Int J Dermatol. 2002 Apr; 38(9).
[4] Dohil MA, Lin P, Lee J, Lucky AW, Paller AS, Eichenfield LF. The epidemiology of molluscum contagiosum in children. J Am Acad Dermatol. 2005;54:47-54.

Competing interests: No competing interests

02 December 2019
Marta Cognigni
Pediatric Resident
Egidio Barbi
Trieste, Italy