Proposed diagnostic criteria for acquired APD include: (1) histopathologic findings of elimination of necrotic basophilic collagen tissue into a cup-shaped epidermal depression, (2) clinical presentation of umbilicated
papules or nodules with a central adherent keratotic plug, and (3) onset of skin lesions after the age of 18 years.
On examination, he had clinically compatible VACV lesions, including papular, umbilicated lesions with overlying vesicles and a few pustules.
At his public health evaluation on March 12, he had numerous papular lesions that were umbilicated with overlying vesicles, several of which were draining serous fluid, and VACV was clinically diagnosed.
His lesions were umbilicated
pustules [approximately equal to]0.
5 cm raised, centrally umbilicated
ulcers and several embedded anisakid nematodes.
Within 4 weeks, he was hospitalized (in an overseas US military hospital) for generalized umbilicated
papulopustules accompanied by profound hypothermia, hypotension, and mental status changes.
Lesions were typically small, rounded, umbilicated
, and nodular in appearance with an erythematous base (Figure 1A).
A 4-year-old girl from a small farm in eastern Finland was hospitalized in September 2000 because of umbilicated
vesicopapules, which developed over the previous 5 days (Figure 1), and unresponsiveness to cephalexin.