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LETTER TO EDITOR
Year : 2020  |  Volume : 21  |  Issue : 3  |  Page : 243-245

Langerhans cell histiocytosis: Can dermoscopy help in diagnosis?


1 Department of Dermatology, Venereology and Leprosy, Government Medical College, University of Kashmir, Srinagar, Jammu and Kashmir, India
2 Department of Pathology, Government Medical College, University of Kashmir, Srinagar, Jammu and Kashmir, India

Date of Submission23-Feb-2019
Date of Decision16-Mar-2019
Date of Acceptance21-Mar-2020
Date of Web Publication30-Jun-2020

Correspondence Address:
Dr. Yasmeen Jabeen Bhat
Department of Dermatology, STD and Leprosy, Government Medical College, University of Kashmir, Srinagar - 190 010, Jammu and Kashmir
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpd.IJPD_22_19

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How to cite this article:
Bhat YJ, Latif I, Wani R, Daing AU, Hassan I. Langerhans cell histiocytosis: Can dermoscopy help in diagnosis?. Indian J Paediatr Dermatol 2020;21:243-5

How to cite this URL:
Bhat YJ, Latif I, Wani R, Daing AU, Hassan I. Langerhans cell histiocytosis: Can dermoscopy help in diagnosis?. Indian J Paediatr Dermatol [serial online] 2020 [cited 2020 Aug 13];21:243-5. Available from: http://www.ijpd.in/text.asp?2020/21/3/243/288497



Sir,

Langerhans cell histiocytosis (LCH) is the most common type of histiocytosis which generally affects children.[1] It is characterized by abnormal proliferation of Langerhans cells in one or more body organs. The typical cutaneous manifestation of LCH is a seborrheic dermatitis-like lesion on the scalp and the flexural regions.[2]

Our first case was a 6-month-old boy who was brought to our outpatient department by his parents with chief complaints of rash over the scalp, forehead, trunk, limbs, palms, and soles. The duration of rash was 1½ months and was associated with fever off and on.

On cutaneous examination, there were multiple erythematous and skin-colored grouped papules covered with greasy yellowish scales over the scalp, forehead, and both eyelids [Figure 1]. Multiple bilaterally symmetrical erythematous discrete as well as grouped papules of variable sizes were present over the trunk, limbs, palms, and soles. These papules showed umbilication and scaling at some places [Figure 2] and [Figure 3].
Figure 1: A 6-month-old male child with a scaly rash over the scalp and forehead

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Figure 2: Multiple erythematous grouped and discrete papules of variable sizes present on the trunk of a 6-month-old child

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Figure 3: Erythematous papules over the palms and soles

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The dermoscopy of these lesions was done (Dermlite DL3N, California, ×10) and showed irregular vascular blotches and brown structureless areas within a pale pinkish background [Figure 4] and [Figure 5].
Figure 4: Dermoscopy (Dermlite DL3N, California, ×10) of Langerhans cell histiocytosis lesions showing vascular blotches (white arrow) and brown areas (black arrow)

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Figure 5: Dermoscopy (Dermlite DL3N, California, ×10) of Langerhans cell histiocytosis lesions showing vascular blotches (white arrow) and brown areas (black arrow)

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Another case was a 6-year-old boy who was brought to our outpatient department by his parents. The boy had dystrophy of almost all fingernails for 1 year with no other cutaneous complaints. He was diagnosed as lichen planus and received several intramatricial steroid injections, but no improvement was seen.

On cutaneous examination, there was erythematous-to-purplish discoloration of the distal nail plate, thinning and ridging, roughening of nail plates, and even loss of nail plate in some fingers [Figure 6]. On onychoscopy, the proximal part of the nail bed showed subungual purpura in the form of red and purplish vascular blotches and distally onychodystrophy was seen [Figure 7].
Figure 6: A 6-year-old boy with dystrophic fingernails

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Figure 7: Onychoscopy (Dermlite DL3N, California, ×10) of a fingernail in a patient of Langerhans cell histiocytosis

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Rest of the cutaneous and mucosal involvement was normal in both the cases. General physical and systemic examination was also normal in them. Routine laboratory investigations were normal. Histopathological examination of the skin biopsy and nail bed biopsy was done which showed dermal infiltration of histiocytes with a reniform nucleus and abundant eosinophilic cytoplasm [Figure 8]. Diagnosis was further confirmed by positive S100 and CD1a immunostaining.
Figure 8: (a) Skin biopsy showing infiltration of the dermis by dense inflammatory infiltrate spilling over to the epidermis also (red arrow) (H and E, ×100). (b) Photomicrograph of closer view shows inflammation composed of cells with eosinophilic cytoplasm (red arrow) with nuclear grooves and a few are reniform in shape (H and E, ×400)

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The data regarding dermoscopy of LCH are very limited. Various dermoscopic features that have been described earlier include widespread red–blue lacunes of different sizes, reddish–purple areas and brown dots, and central white area with peripheral telangiectasia.[3] Certain dermoscopic features of LCH that may help in differentiating it with closely mimicking conditions such as seborrheic dermatitis include vascular blotches and the absence of atypical red vessels and arborizing vessels.[4] These vascular blotches may correspond to the subclinical hemorrhages associated with lesions.

The vascular blotches have been seen in LCH and correspond to dermal hemorrhage and brown dots or yellow structureless areas to the epidermal infiltration and necrosis by Langerhans cells.[5]

The dermoscopic features of LCH are expected to show wide variations. To add to the list of its dermoscopic features, further studies are needed.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Foster A, Epanoimeritakis M, Moorehead J. Langerhans cell histiocytosis of the perianal region. Ulster Med J 2003;72:50-1.  Back to cited text no. 1
    
2.
Field M, Inston N, Muzaffar S, Cruickshank N. Perianal langerhans cell histiocytosis. Int J Colorectal Dis 2007;22:1141-2.  Back to cited text no. 2
    
3.
Behera B, Malathi M, Prabhakaran N, Divya K, Thappa DM, Srinivas BH. Dermoscopy of langerhans cell histiocytosis. J Am Acad Dermatol 2017;76:S79-81.  Back to cited text no. 3
    
4.
Kibar M, Aktan Ş, Bilgin M. Dermoscopic findings in scalp psoriasis and seborrheic dermatitis; two new signs; signet ring vessel and hidden hair. Indian J Dermatol 2015;60:41.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Behera B, Malathi M, Thappa DM, Gochhait D, Srinivas BH, Toi PC. Dermoscopic features of three cases of Langerhans cell histiocytosis. Indian J Dermatol Venereol Leprol 2018;84:730-5.  Back to cited text no. 5
[PUBMED]  [Full text]  


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]



 

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