Molluscum or Sebaceous Hyperplasia?

In their photographs of a 73-year-old woman with an itchy, painful rash on one side of her face and 3 lesions on the forehead (Figure), Drs Leslie Trope and Glen Marin identified the 3 lesions as molluscum contagiosum (CONSULTANT, September 1, 2004, page 1378). However, the morphology shown is consistent not only with molluscum contagiosum but also with sebaceous hyperplasia. I believe the patient's age and the location of the lesions suggest the latter as an equally plausible diagnosis.

---- Gary N. Fox, MDToledo, Ohio

We diagnosed molluscum contagiosum based on the umbilicated morphology of the lesions and their pearly white appearance (which is unfortunately not well demonstrated in the photograph). Although the lesions of sebaceous hyperplasia are also usually umbilicated, they tend to be yellowish. It is true that these lesions occur more often in elderly persons, but molluscum contagiosum can occur in persons of any age.

---- Leslie Trope, MD

Clinical Associate Professor

Albany Medical College

Albany, NY