18F Post swimming papular non erythematous rash WB PaJR

 

18-04-2026

THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HER SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY EXPERTS WITH AN AIM TO SOLVE THOSE PATIENT'S CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUTS.

[10.21 am, 18/04/2026] PA: Hello, From 10th April small bumps have been appearing around elbows and they are spreading every day. They are itching a lot. 

Patient has applied calamine lotion on 16th April only once but I don't think it helped. 

Patient's mom has tinea. Also patient started swimming (in chlorine treated pool) from 9th April. 

What should she do about this?

[10:26 am, 18/04/2026] PPM1: @PaJR Health going by the images of the skin lesions and the prior history of exposure what is your take on the possible diagnosis?

[10:26 am, 18/04/2026] PaJR Health: Based on the clinical morphology and the timeline of exposure, here is the diagnostic breakdown:

*PRIMARY DIFFERENTIAL: MOLLUSCUM CONTAGIOSUM*

📋 *Case Title:* 18F Bumps Jalpaiguri PaJR

🔹 *Morphology:* The images show multiple 1–3 mm, pearly-white, dome-shaped papules. Crucially, several lesions exhibit *central umbilication* (a tiny dimple in the center), which is a hallmark sign of the Molluscum contagiosum virus (MCV).

🔹 *Exposure:* Onset occurred on April 10th, exactly one day after starting swimming in a public pool (April 9th). While the incubation period for Molluscum is typically 2–7 weeks, public pools and shared towels are classic vectors for transmission.

🔹 *Pruritus:* While Molluscum is often asymptomatic, it can cause "Molluscum dermatitis"—an eczematous reaction around the bumps that leads to the intense itching reported.

*SECONDARY CONSIDERATIONS*

1. *Chlorine-Induced Folliculitis / Irritant Dermatitis:* The rapid onset (24 hours post-swim) and intense itching are highly suggestive of a reaction to pool chemicals. However, the "pearly" and "umbilicated" nature of the bumps seen in the images is more specific to a viral etiology than simple irritation.

2. *Tinea Corporis (Fungal):* Given the household exposure (mother has tinea), this must be considered. However, the lesions lack the classic "ring-worm" annular scaling and instead present as discrete papules.

💡 *CLINICAL NOTE*

The patient reports the lesions are "spreading every day." This is likely due to *autoinoculation*—scratching the itchy lesions and then touching other areas of the skin, which spreads the virus. 

*RECOMMENDATIONS*

* *Avoid Scratching:* To prevent further spread, the patient should avoid picking or scratching the bumps.

* *Hygiene:* Do not share towels, razors, or personal items with others in the household.

* *Evaluation:* A formal dermatological review is advised to confirm the diagnosis, especially if the lesions continue to spread rapidly or show signs of secondary bacterial infection (pus or increasing redness).

🔗 *Ref Media:*

1. [Antecubital Papules](https://vault.pajrhealth.org/storage/v1/object/public/pajrmedia/stupa-rangoli-28004/1776487888376.jpg)

2. [Forearm Distribution](https://vault.pajrhealth.org/storage/v1/object/public/pajrmedia/stupa-rangoli-28004/1776487890310.jpg)

[10:30 am, 18/04/2026] PPM 1: 👆@PPM3 there's only one differential that can be tackled with a fungal smear although false positives can be a confounder?

[10:31 am, 18/04/2026] PPM 3: In this case, wouldn't we go on as usual until 'if the lesions continue to spread rapidly or show signs of secondary bacterial infection (pus or increasing redness).'. If that happens won't a formal dermatological review be recommended?

False positives are characteristic risk of any test. But given that 1% probability of false positive, doesn't mean that we don't act on the 99% probability that it is indeed that cause, no?

[11:04 am, 18/04/2026] PPM 1: Yes and hence we wait with reassurance till the patient's illness evolves to a point beyond that, which is when we explore the first differential with further testing but by that time even our differentials and order of priority would have changed as the lesions would have evolved?

[11:23 am, 18/04/2026] PPM 1: While the medicine trained members (including the engineers) in the PaJR team will have their thoughts around all the above suggestions, as part of our medical cognition inquiry that digs deep into both physician's as well as patient cognition, @~Pranjal , I am really interested to know what are the patient's advocate's thoughts when processing the load of information presented above! @PA

[11:52 am, 18/04/2026] PPM 4: From the patient's pov, I believe it is important to find the root cause of the disease rather than "wait and watch". Infact, waiting will delay treatment thus further leading to complications and worsening the prognosis. 

As a physician, we should stick to treating the most likely diagnosis: molluscum contagiousum/dermatitis, while following the precautions and recommendations listed above. In the meantime, it is important to keep the other dds in mind, by ruling out any fungal skin infectious. 

I'd like to point out two things here:

1. Just like viral infections, fungal infections also rapidly spread.

2. Not all tinea present as a classic "ringworm" annular pattern. For example: the atypical varients of tinea corporis. (Eczematous plaques). We must also ask if there is any previous h/o tinea or any other skin condition in the patient, and whether the patient was compliant to the medication. 

Therefore we must rule out any fungal or irritant etiology, alongside treating the condition as molluscum contagiousum.

[12:01 pm, 18/04/2026] PA: It is a little bit difficult to understand some of the medical terms.

 It would be helpful if you could simplify the main points, if not then she will just google.

Also she is keen to know what are causing the bumps and what she should do to prevent it.