Langerhans Cell Histiocytosis Presented as Persistent Diaper Dermatitis

A report describes a case of a seven-month-old male patient who presented with complaints of diaper rash of three months of duration with no response to treatment. He had no relevant medical history and vital signs within normal limits. 

Physical examination revealed 1-2 mm pink to skin color papules disseminated in the trunk, perineum, flexural areas, and axilla.

Additionally, he displayed skin fissures on the axilla and inguinal region. The patient's forehead displayed thin plaques of "flaky and greasy" scales similar to seborrheic dermatitis. Palpation neither revealed hepatosplenomegaly nor bone alterations.

An incisional skin biopsy and microscopic examination showed an ulcerated epidermis with fibrin, cellular debris, parakeratosis, irregular acanthosis, spongiosis, and hydropic degeneration of basal epidermal cells. Dermis and epidermis revealed infiltration of abundant polygonal histiocytes with cytoplasmic vacuolation along with eosinophils, lymphocytes, and plasma cells. Additionally, there was the presence of microabscesses. CD207, CD1a, and S-100 were positive by immunohistochemistry. 

The patient received a histopathologic diagnosis of superficial perivascular dermatitis with a lichenoid pattern and histiocytic infiltration.

Moscona-Nissan A, Maldonado-Colin G, Romo-López A, et al. Langerhans Cell Histiocytosis Presented as Persistent Diaper Dermatitis: A Case Report. Cureus.2022; 14(7): e26606. doi:10.7759/cureus.26606