LANGERHANS CELL HYPERPLASIA OF THE SKIN MIMICKING LANGERHANS CELL HISTIOCYTOSIS: A Report of Two Cases in Children Not Associated with Scabies

Abstract

Langerhans cells histiocytosis (LCH) affecting the skin most commonly has clinical and histopathologic diagnostic features. We are reporting two examples of Langerhans cell (LC) hyperplasia recognized in the skin biopsies of two children initially interpreted as LCH. The first was an 8-year-old boy finally interpreted as having an atypical type of contact dermatitis, while the second, an 8-year-old girl, was assumed to have Pytiriasis lichenoides et varioliformis acuta. None showed evidences of scabies. Both presented spongiotic dermatitis with numerous CD1a+ cells. As more cases of LC hyperplasia are recognized, new details emerge helping in the differential diagnosis. Strict clinical-pathologic correlation is suggested in order to avoid misdiagnosis.

Langerhans Cell Histiocytosis and Langerhans Cell Sarcoma: Current Understanding and Differential Diagnosis

“…10). Dermal LC hyperplasia can be practically separated into either that associated with scabies 46 or not, 47 and the latter includes drug eruption (Fig. 10).…”

Unilesional self‐limited Langerhans cell histiocytosis: a case report and review of the literature

“…Of the cases reported in the literature, 86% showed S100 protein positivity, while only 46 and 49% showed positive CD1a staining and Birbeck granules, respectively. Furthermore, other disease entities with significant Langerhans cell hyperplasia that may mimic LCH include scabies, contact dermatitis, pityriasislichenoides et varioliformis acuta and different types of T cell lymphoproliferative disorders, such as lymphomatoid papulosis, mycosis fungoides, parapsoriasis or cutaneous T cell hyperplasia …”

Skin Biopsy Diagnosis of Langerhans Cell Neoplasms

“…In children with eczematous eruptions and histiocytic infiltrates, langerhans cell hyperplasia (LCHP) has to be ruled out. LCHP can mimic LCH and has been reported in cases of human scabies, arthropod bite reaction, contact dermatitis and pytiriasis lichenoides and usually cells express CD1a and S100 [17][18][19][20]. The increased in LC in the dermis can be explained by the antigenic stimulation and cutaneous trauma that produce LC migration into the skin, especially when occurs in perivascular areas.…”