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Flame figures in molluscum contagiosum.

Flame figures represent dermal collagen fibers coated with eosinophilic granules, first described in eosinophilic cellulitis (Wells syndrome). They are known to occur in a variety of other dermatoses such as bullous pemphigoid, eczema, urticaria, myeloproliferative disease, tinea, and arthropod bite reactions, but not in molluscum contagiosum (MC). We found flame figures in an inflamed lesion of molluscum contagiosum in a 10-year-old female. There were multiple pruritic erythematous papules in a linear arrangement on the groin and thigh. Each lesion measured 2 to 3 mm in diameter. The lesions had waxed and waned for about 8 years, so we performed a skin biopsy to rule out the possibility of other diseases (eg, histiocytosis X). On histopathologic examination, many epidermal cells contained large intracytoplasmic inclusion bodies, the so-called molluscum bodies with partial intradermal rupture (Fig. 1). There was a dense infiltrate of lymphohistiocytes and moderate number of eosinophils, especially in the lower half of the dermis and several typical flame figures were found (Fig. 2). Possible explanations of the formation of flame figures include an isolated occurrence, a hypersensitivity response to the invading parasite, or simply a reaction pattern seen with eosinophil-mediated tissue injury. Peters et al 2 have shown that major basic protein, a toxin important in resistance to parasites and the major constituents of eosinophilic granules, may play a role in the tissue injury seen with flame figures. As for another possible causative factor of flame figures, the degree of tissue eosinophilia may be relevant to its formation. Flame figures are also found in bullous pemphigoid with marked tissue eosinophilia and their incidence in bullous pemphigoid is unexpectedly high (8.8%). We suppose that MC, more spe-