New Papular Eruption in a Patient with Chronic Atopic Dermatitis
Article Outline
A 2-year-old African-American boy with a history of chronic atopic dermatitis and allergic rhinitis presented with skin lesions on his face and neck of 1 month's duration. He did not complain of pain, irritation, or pruritis. Examination revealed numerous red-brown, 2-mm, thin papules on the face and neck (Figure). The lesions were remarkably monomorphous, without erosions or scaling. The remainder of the examination was notable for eczematous plaques on the dorsum of the hands, wrists, antecubital fossa, popliteal fossa, anterior ankle, and scalp. The retroauricular region, perioral region, groin, and buttocks appeared unaffected, and no cervical or occipital lymphadenopathy was noted.
Figure.
A 2-year-old boy with numerous red-brown, 2-mm, thin papules that developed on his face and neck over the course of 1 month.
Biopsy analysis demonstrated benign proliferation of histiocytes within the superficial dermis with eosinophils and lymphocytes. Prominent xanthoma formation was not seen. Immunologically, the cells expressed CD68 diffusely. Occasional CD1a- and S-100–stained cells were seen within the dermis.
The child was diagnosed with benign cephalic histiocytosis (BCH). BCH is a relatively rare papular eruption classified as a non-Langerhans cell histiocytosis. It begins as an eruption of flat-topped, yellowish-brown or skin-colored papules 1 to 2 mm in diameter, with the average age of onset at 2 to 34 months.1 The first site of involvement is usually the upper face, with subsequent spread to the ears, neck, and scalp. Approximately 50% of cases involve the neck or shoulders; however, further distal spread is very uncommon.2 The lesions begin to regress spontaneously and usually resolve completely within 72 months with residual atrophy or hyperpigmentation.3
BCH is an important consideration in children who present with multiple facial papules. Clinical considerations also include flat warts and molluscum. Biopsy should be considered if the child does not respond to treatment. The histological differential diagnosis includes multiple juvenile xanthogranulomas, which may be associated with extracutaneous lesions and, if manifestations of neurofibromatosis I are present, is associated with juvenile chronic myelogenous leukemia.1 Follow-up is warranted in all patients diagnosed with BCH, because there are case reports linking the development of diabetes insipidus to this disease; however, most cases resolve without incident.4
References
- . Andrews' Diseases of the Skin. In: 10th edition. Philadelphia: WB Saunders; 2000;p. 714
- . Facial eruptions in a child. Arch Dermatol. 1999;135:1267–1272
- . Benign cephalic histiocytosis. Pediatr Dermatol. 1994;11:164–167
- . Benign cephalic histiocytosis with diabetes insipidus. Pediatr Dermatol. 2000;17:296–298
The views expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government.
PII: S0022-3476(08)01075-5
doi:10.1016/j.jpeds.2008.12.005
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