Diagnosis Of Contact Dermatitis Research Articles

220 Detection of skin allergy biomarkers for point-of-care diagnosis of contact dermatitis

220 Detection of skin allergy biomarkers for point-of-care diagnosis of contact dermatitis

Clinical Profile of Contact Dermatitis Patients at the Allergy-Immunology Division of Dermatology and Venereology Outpatient Clinic

Background: Contact dermatitis is an inflammatory skin response that can be caused by several things. This inflammatory reaction is most often caused by external compounds that become allergens or irritants to the body. Purpose: To evaluate the clinical profile of contact dermatitis patients at the allergy-immunology division of dermatology and venereology outpatient clinic of Dr. Soetomo general academic hospital. Methods: The sampling technique used in this study is a total sampling technique and was processed with Excel descriptively. Result: The most frequent age group diagnosed with contact dermatitis was the 20–45-year-old age group (45.5%). The most frequent gender was female (72.2%). The most frequent occupation was private employee (30.8%). The most frequent suspected causal factor was cosmetics (35.2%). Itching was the most common type of patient complaint (44.1%). Face was the most frequent location (30.8%). Erythematous macules were the most frequent clinical manifestation (45.9%). The diagnosis of contact dermatitis was divided into allergic contact dermatitis ACD (60.4%) and irritant contact dermatitis ICD (39.6%). The most frequent topical therapy was corticosteroid (53.2%). Meanwhile, the most systemic therapy is antihistamine (73.8%). Conclusion: ACD is more prevalent than ICD and is more prevalent in women between the ages of 20 and 45. The most prevalent occupation distribution is among private employees. Cosmetics are the most frequently suspected cause factor. Itch is the most common patient complaint. The face is where contact dermatitis occurs most frequently. Erythematous macules are the most frequent clinical symptom. Corticosteroids and antihistamines are the most commonly given medication.

Presentations to emergency departments in Melbourne, Australia diagnosed as allergic contact dermatitis.

This study investigated cases diagnosed as allergic contact dermatitis (ACD) in emergency departments (EDs) and management. A multisite retrospective study of patients attending EDs in metropolitan Melbourne between July 2017 and June 2018 was performed. Using International Statistical Classification of Disease-10 (ICD-10) codes, the Victorian Agency for Health Information generated a list of cases of contact dermatitis (CD). Demographic and clinical data were analysed. Two hundred twenty-eighty patients from 14 different sites were diagnosed with ACD. Hair dyes caused the most cases, and one such case was admitted to hospital. It was apparent from the specified causes that cases of irritant CD were misdiagnosed as ACD. There were significant differences in management with dermatology input, with dermatologists more often advising oral corticosteroids (33.3% vs. 14.5%, P=0.004) topical corticosteroids (92.9% vs. 38.7%, P < 0.01), emollients (38.1% vs. 20.4%, P=0.01) and less often advising antihistamines (16.7% vs. 44.6%, P < 0.001). With dermatology input, potent or very potent steroids were more likely to be prescribed (69.3% vs. 11.1%, P < 0.001); without, a mild potency steroid was more likely to be prescribed (63.9% vs. 4%, P=0.01). Improved understanding, diagnosis and management of CD are needed in EDs.

Detection of skin allergy biomarkers for point of care diagnosis of contact dermatitis

Introduction ( contexte de la recherche ) Contact dermatitis (CD) is a one of the most common inflammatory skin diseases. Distinguishing the different types of CD, especially allergic CD (ACD) versus non-allergic forms, is often challenging and requires additional investigations based on patch-testing. Early detection of relevant allergy biomarkers in active CD lesions could refine and simplify the management of CD patients. To characterize the molecular signatures of active CD lesions. We studied the expression of 12 allergy biomarkers (identified in a recent transcriptomic study) by qRT-PCR in eczema lesions of 24 CD patients. ACD was established on patch-test (PT) results and through exposure assessment. Molecular signatures of active lesions were compared to those of reference chemical allergens and irritants, and machine learning algorithm was used to develop a model to predict the allergic nature of the skin reaction. Seven of the 24 CD patients were diagnosed with ACD. The remaining 17 patients did not react to any of the allergens tested. Gene profiling of active CD lesions revealed two distinct molecular patterns: patients harbouring signatures similar to reference allergens ( n = 10), or irritants ( n = 14). Among the 10 patients with an allergy signature, we found 7 patients with confirmed ACD, and 3 other subjects for whom it was not possible to identify the culprit allergen. In contrast, the 14 other patients had negative PT, suggesting that these patients developed non-allergic reactions. Finally, using a machine learning approach, we confirmed that our biomarker combination correctly classified ACD from non-allergic CD. Molecular signatures from active lesions could help to stratify patients and open new avenues for the development of a future point of care diagnosis of CD.

Practical patch testing in allergic contact dermatitis in children

Introduction. Allergic contact dermatitis (ACD) in children appears to be on the increase, and contact sensitization may already begin in infancy. The diagnosis ofcontact dermatitis requires a careful evaluation of a patient’s clinical history, physical examination, and skin testing. Patch testing is the gold standard diagnostic test. Methods. Based on consensus, the EAACI Task Force on Allergic Contact Dermatitis in Children produced this document to provide details on clinical aspects, the standardization of patch test methodology, and suggestions for future research in the field. Results. We provide a baseline list of test allergens to be tested in children with suspected ACD. Additional tests should be performed only on specific indications.

Modern aspects of contact dermatitis in industrial poultry farming

Contact dermatitis is a lesion of the skin of broilers, which leads to a decrease in the quality of the carcass by 15-30 %. It is described as brown-black erosions and ulcers that occur on the breast (breast blisters, BB), hock burns (HB) and on the skin of the central pulp of the foot (food pad dermatitis, FPD). The most commonly affected is the pulp of the foot, followed by the hocks and chest. There are a number of factors that lead to crumb dermatitis. These include: the density of planting birds; type of troughs and the order of their use; feeding; the level of temperature and humidity in the room; type of litter, its quality and quantity; intestinal health. Birds are kept at a density of 8 individuals/m2 suffered less from dermatitis than those kept at a density of 13 individuals/m2 . Moreover, the harmful effects of high density were particularly pronounced at 18 individuals/m2 . The prevalence and severity of this pathology in broilers increases at later stages of fattening. Pododermatitis spread to several layers of skin. The condition of the crumbs worsened when the bird reached slaughter age with up to 64 % of the carcasses affected. In this case, lesions of the hocks and chest were rare. Wet litter (&gt; 30 % moisture) is associated with an increase in the incidence and severity of contact dermatitis in broiler and turkey housing systems. This state of litter is most often registered in the winter-spring and autumn seasons. The quality of the litter, especially taking into account its humidity, has been identified as an important issue of well-being, which has a great negative impact on the condition of feathers, limb health and the frequency of contact dermatitis. Litter temperature is also important. With its growth, the degree of contact dermatitis increases. The reason for the increase in litter temperature is the increase in planting density and the accumulation of more manure, which enhances bacterial fermentation. With wet litter, bird feathers become wet or contaminated with litter, feces and dirt. It loses its protective properties. The level of bird welfare is declining sharply. Diagnosis of contact dermatitis in poultry is based on characteristic clinical signs. These are lameness, impaired mobility and discoloration of the skin, which often develops into an ulcer. The lesions are clearly separated from the intact tissue and often appear as ulcers surrounded by a deep hemorrhagic shaft. Contact dermatitis can develop in less than a week. Characteristic signs at the beginning of the disease are swelling, redness and increase in local temperature, thickening of the skin. Deep ulcers usually lead to abscesses in the underlying tissues and structures. Often the affected area is covered with crusts. If large ulcers develop, they can cause pain, slow growth, obstruct gait, and open bacteria to underlying tissues. Key words: broilers, contact dermatitis, dermatitis of the central pulp of the finger, dermatitis in the area of the hocks, dermatitis in the chest.

Readability, Quality, and Timeliness of Patient Online Health Resources for Contact Dermatitis and Patch Testing.

Contact dermatitis (CD) causes significant impact on patient quality of life. It is the most common occupational skin disease, accounting for more than US $1 billion of medical costs. Patch testing (PT) is the criterion standard for diagnosis of allergic CD. Patients are increasingly using the Internet to obtain health information; however, the readability, quality, and timeliness of online health resources for CD and PT are unknown. The objective was to determine the readability, quality, and timeliness of the most frequently accessed patient online health resources for CD and PT. A Google search was performed on March 20, 2021, using the terms "contact dermatitis," "contact eczema," "patch testing," and "patch test." Websites were evaluated using several well-validated tools/criteria. Contact dermatitis and PT websites had only 2 of the 48 websites combined that met the recommended sixth-grade reading level for patients, with the majority characterized as "very poor" to "fair" quality. There was no correlation found between quality and readability of the CD and PT websites. There is a need for improvement of online CD and PT health resources. Dermatologists should take the lead to vet websites and enhance online resources to improve patient care.

Contact Dermatitis: Classifications and Management

Contact dermatitis (CD) is a common inflammatory skin disease caused by exposure to contact allergens and irritants. It is also the most common reason of occupational dermatitis and contributes greatly to hand dermatitis and facial dermatitis. Besides the two major forms of contact dermatitis: allergic contact dermatitis and irritant contact dermatitis, other subtypes of CD have been recognized including immediate skin reactions, photoinduced contact dermatitis, systemic contact dermatitis, and non-eczematous contact dermatitis. CD is a great imitator which can mimic many kinds of skin diseases, such as atopic dermatitis, lichen planus, and angioedema. For the diagnosis of CD, a complete medical history, including occupational history, is very important. It can give a clue of CD and provide a list of suspected substances. Besides the well-known diagnostic test, patch testing, there are many other diagnostic tests can be used to help diagnosis of CD and identify the causative allergens, including photopatch test, skin tests for detecting of immediate contact reactions, serum allergen-specific IgE test, and qualitative and quantitative testing of allergen in the suspected materials patients exposed to and challenge test. Before the treatment, the suspected irritants or allergens should be avoided completely. This includes both the removal of the patient from the environment that contains those substances and the promotion of the metabolism and expulsion of the allergens that have been absorbed by the body. In addition, it is also important to restore the skin barrier and reduce skin inflammation through multiple treatments, such as emollients, topical corticosteroids, and antihistamines, as well as systemic corticosteroids and immunosuppressants. Early and appropriate treatments are important to prevent further deterioration and persistence of the skin condition.

Modified Plasma Cytokine Profile in Occupational Dermatitis.

Despite significant progress in the diagnosis of contact dermatitis, the identification by specific tests or biomarkers remains an unsolved issue, particularly when needed for the confirmation of the occupational origin of the disease. To characterize the plasma proteome profile in occupational dermatitis in workers of paint industry. The study has a case-control design, comparing exposed workers with and without occupational contact dermatitis, matched for age, gender, occupational history, and comorbidities. An immunological assay (Human XL Cytokine Array Kit - ARY022B, R&D Systems) was used to measure the plasma levels of 105 cytokines and chemokines in a pooled sample of the cases and a pooled sample of the controls. A 1.5-fold increase was noticed for interleukin 3, interleukin 10, and leptin in cases, as compared to controls. Fibroblast growth factor-7 and growth/differentiation factor-15 showed a 1.4-fold increase, while interleukin 19, interleukin 31, and macrophage inflammatory protein 3a.had only a 1.3- fold increase. The leukemia inhibitory factor was the only plasma cytokine that showed a 1.3-fold decrease. All other cytokines had a variation of less than 1.2-fold between cases and controls. The recognition of the molecular signatures is very important for an accurate and indisputable diagnosis of occupational contact dermatitis. In workers from the paint industry, plasma levels of interleukins 3, 10, 13 and 19, fibroblast growth factor-7, and growth/differentiation factor-15, together with leukemia inducible factor, may differentiate subjects with contact dermatitis from those without skin lesions.

Occupational contact dermatitis in Triveneto: Analysis of patch test data of the North Eastern Italian Database from 1996 to 2016.

Occupational contact dermatitis (OCD) is frequent in the workplace. To provide recent data on the epidemiology of OCD in Italy. This multicenter retrospective study, conducted from 1996 to 2016, included patients with suspected allergic contact dermatitis (ACD) patch tested in the departments comprising the North-East Italy Contact Dermatitis Group. We studied 18 859 workers with a diagnosis of contact dermatitis (CD), of which 10.4% were recognized as being of professional origin. OCD declined from 1996 to 2011-2013 and increased in 2014-2016. The overall prevalence of both CD and OCD was higher in women compared to men, but the share of OCD of the total CD was greater for men compared to women. A history of atopic dermatitis was less frequent in workers with OCD than in non-OCD patients (5.8% vs 8.6%). Hairdressers were the youngest profession (27.1 ± 11.7 years). Hands were the primary site of involvement in patients with OCD (76.6%). The five highest risk occupations for OCD were hairdressers, cooks, metalworkers, chemical industry workers, and construction workers. OCDs have a relevant impact in our region, mainly for five job categories, and the increase in the last 3 years suggests the need to improve preventive measures.

Photodermatitis from topical phenothiazines: A case series.

In Europe, contact photosensitivity to phenothiazines is well-known, particularly in southern countries. Topical phenothiazines are widely used and sold over-the-counter (OTC) for the treatment of mosquito bites and pruritus in France. To report a series of cases with photodermatitis following use of topical phenothiazines. A retrospective study of cases of contact dermatitis from phenothiazines seen in French photodermatology centers was performed. In all, 14 patients with a diagnosis of contact dermatitis from phenothiazines were included. These patients developed eczema on the application sites, and in 13 the eruption spread to photodistributed sites. Topical products containing isothipendyl were the most common cause of photodermatitis. One patient had photoaggravated eczema due to promethazine cream. All patients stopped using topical phenothiazines and were treated successfully with topical corticosteroids. One patient relapsed and developed persistent light eruption. In all of the nine cases tested, photopatch testing to the topical phenothiazine used "as is" was positive. Isothipendyl, chlorproethazine, and the excipients were not tested. Photopatch tests to chlorpromazine and promethazine were positive in 8 of 12 and 7 of 13 tested, respectively. Use of isothipendyl and promethazine as OTC (or even prescribed) drugs needs to be limited due to severe reactions and sensitization to other phenothiazines that consequently will have to be avoided.

Contact allergen sensitivity in children with contact dermatitis.

Irritant contact dermatitis and Allergic contact dermatitis are two distinct forms of contact dermatitis. Allergic contact dermatitis is a Type 4 (delayed-type) hypersensitivity reaction that occurs during subsequent contact with an allergen to a previously sensitized person. The number of allergens that cause allergic contact dermatitis is increasing day by day. Although it is not the gold standard for the detection of these allergens, skin patch testing is a very helpful method. This study aimed to determine the most common contact allergens in the pediatric age group. All patients with the diagnosis of contact dermatitis who underwent a skin patch test (TRUE TEST) in the department of Pediatric Allergy and Immunology between March 2017-February 2018 were enrolled in this study. The patch test was evaluated 72 hours later by the same physician and interpreted as recommended by the American Academy of Dermatology. In addition to the patient files, demographic and clinical characteristics, localization of lesions, and itch score according to visual analog scale were recorded. A total of 80 children enrolled in the study; 45 (56.3%) were girls and 35 (43.7%) were boys. The mean age of the children was 7.37±3.84 years and 57.5% of the patients who underwent skin patch testing had a positive response to at least one or more allergens. The most common allergens were Nickel sulfate, CI + Me-Isothiazolinone, Thiuram Mix, Formaldehyde, and P-tert-butylphenol formaldehyde resin (14.8%, 10%, 6.3%). There was no difference in terms of age, sex, duration of complaints, and pruritus score according to nickel sensitization. In the presence of chronic dermatitis in children, allergic contact dermatitis should be considered in the differential diagnosis. The culprit allergen should be determined. Also, the most common contact allergen is Nickel Sulphate in the world and the increased sensitization to other allergens is due to the increased contact of children with cosmetics and different contact allergens.

Retrospective review of insurance coverage for patch testing

BackgroundThere is a paucity of data on the burden of insurance limitations for patients undergoing patch testing. ObjectiveTo characterize the burden of insurance limitations and its impact on differences in management and execution of patch testing. MethodsA retrospective chart review was performed on patients with a diagnosis of contact dermatitis (International Classification of Disease [ICD], Ninth Edition, code ICD 692) who received patch testing (Current Procedural Terminology code 95044) at the George Washington Medical Faculty Associates Dermatology Clinic between January 1, 2015 and June 30, 2017. Variables including allergen limitations were compared between government-sponsored insurance and private insurance providers (eg, Insurers A, B, C, and D). ResultsA total of 371 records were identified. Government-sponsored insurance patients encountered allergen limitations more frequently than private insurance patients (86.8% vs 14.2%, P < .0001). Insurer C and D patients were least likely to encounter allergen limitations (1.2% vs 0%, P < .0001) and were tested to the most allergens (mean = 146 vs 152, P < .0001). Insurer A patients had the least allergens tested among those privately insured. ConclusionConsidering modification of insurance policies to allow patch testing with a larger number of allergens without restrictions is needed, with the goal of improving quality of life of these patients while saving costs from chronic use of topical corticosteroids.

Contact Dermatitis after Prescription of an Ophthalmic Ointment Containing Fradiomycin Sulfate: A Retrospective Database Study Using Japanese Health Insurance Claims Data.

BackgroundTopical ointments containing fradiomycin sulfate, such as fradiomycin sulfate/methylprednisolone (F/M) and fradiomycin sulfate/betamethasone sodium phosphate (F/B), are known to cause allergic contact dermatitis (CD) in some patients, especially when used for the periocular region. F/M is commonly prescribed to patients for various conditions; however, there are no reports with respect to the incidence of CD caused by F/M in actual practice.ObjectiveThe aim was to investigate the incidence of CD using a data-based retrospective cohort study.MethodsUsing a Japanese health insurance claims database [MinaCare Co. Ltd. healthcare database (MinaCare HDB)], a comparative assessment was conducted of F/M and another combination drug (F/B) and two single-drug treatments (ophthalmic ointments with either an antibiotic or a steroid). The total data set consisted of 1,176,082 individuals in the MinaCare HDB, with 54,016 having received prescriptions for one of the four investigational drug regimens.ResultsOverall, the incidences of CD were similar in three of the four groups in this study (F/M 0.091; F/B 0.092; steroids 0.102), while being lower in the fourth group (antibiotics 0.060). Even after confirmation of a diagnosis of CD, prescriptions for the investigational drugs were repeatedly filled for some patients.ConclusionThis study demonstrated that there was no clear difference in the incidence of CD after filling prescriptions for F/M, F/B, and ophthalmic ointment containing a steroid, while the incidence with antibiotics was lower by 0.03–0.04 compared with the other groups. Considering the observation that the investigational drugs were repeatedly prescribed even after the diagnosis of CD, it is critical that the risk of CD with these prescribed topical ointments is better understood by primary care physicians in order to take appropriate countermeasures.

Pattern of patch test reactivity among patients with clinical diagnosis of contact dermatitis: A hospital-based study

Pattern of patch test reactivity among patients with clinical diagnosis of contact dermatitis: A hospital-based study

Best practices, new perspectives and the perfect emollient: optimizing the management of contact dermatitis

Contact dermatitis (CD) is caused by environmental agents, irritants, and allergens that penetrate the epidermis and lead to inflammation. An intact skin barrier prevents penetration and is important in maintaining healthy skin. Classical diagnosis of CD is made using the patch test, and traditional treatment strategies for CD promote skin barrier integrity and resolve the inflammatory component of the condition. This can be achieved by using emollient-based therapy, which is most important for skin barrier repair, and in addition to topical glucocorticosteroids, which are used in severe cases of CD and are most effective in reducing inflammation. Preventative measures, such as irritant and allergen avoidance in the workplace, also play a pivotal role in effective CD management. Moreover, CD management necessitates a holistic approach that incorporates prevention, barrier repair, and inflammatory resolution to ensure optimized efficacy. It is also important to consider potential barriers to optimal management when evaluating individuals with CD, such as limited patient education or poor access to care. Finally, key literature and our own clinical practice experience have highlighted the value of patient preference, as well as safety, efficacy and simplicity, in building the perfect emollient.

Principais sensibilizantes em pacientes idosos e não idosos com dermatite de contato

Aims: To evaluate the prevalence of the main allergens found in allergic contact dermatitis among elderly and non-elderly patients.Methods: Retrospective study of the medical records of patients clinically diagnosed with contact dermatitis treated from August 2000 to January 2012 at the Allergy Outpatient Clinic of Marília Medical School and at an Allergy and Dermatology private clinic in Marília, state of São Paulo, Brazil. The inclusion criteria were clinical diagnosis of contact dermatitis, patch test performed during the study period, and no treatment with systemic corticosteroids or any other immunosuppressants. Age, sex, history of other types of allergy and allergens used were assessed. The patch test results were read 48 hours and 72 hours after application of the test chambers.Results: A total of 362 patients were included in the study: 60 elderly patients (aged 60 years or older) and 302 non-elderly patients. In addition to contact dermatitis, other types of allergies were observed in 20 (33.3%) of elderly patients and in 113 (37.4%) of non-elderly patients (p=0.54). There were 162 positive reactions on the patch test among elderly patients and 738 positive reactions among non-elderly patients (p=0.24). Strong positive reactions were present in 41 (68.3%) elderly patients and in 156 (51.6%) non-elderly patients (p=0.02). Strong and very strong positive reactions, when assessed together, were detected in 44 (73.3%) elderly patients and in 214 (70.8%) non-elderly patients (p=0.69). The most common allergens were nickel sulfate (in 33.3% of elderly and 38% of non-elderly patients) and fragrance mix (in 25% of elderly and 27.8% of non-elderly patients), with no statistical difference between the groups.Conclusions: There was a high rate of positive reactions on the patch test among patients with contact dermatitis, with no difference between elderly and non-elderly individuals, and the most common allergens were nickel sulfate and fragrance mix. Therefore, it is important that allergy to nickel and fragrances be included in the etiologic investigation of contact dermatitis, regardless of age.

Contact Dermatitis Following Use of Tropical Traditional Medicine

Traditional or herbal medications are generally perceived as safe since it is derived from natural or plant sources. A rise in number of adverse reactions are being reported with the use of traditional medications including localized cutaneous reactions. The diagnosis of contact dermatitis is often quite straight forward based on its appearance, pattern, site and distribution of the lesion which usually corresponds to the area of contact. We report the case of a 65-year-old woman who presented with redness, burning sensation and swelling of her hand after applying topical Chinese traditional medication. This report aims to outline simple measures to identify and manage contact dermatitis secondary to topical medication. The present case creates awareness that topical traditional medications are not as harmless as previously thought to be. Precautions regarding adverse reactions are required, as those with conventional medications.

The use of patch testing for the diagnosis of contact dermatitis: an Albanian experience

Introduction: The daily increase of using chemical, aromatic and cosmetic products has been associated with significant increase in frequency of skin diseases such as eczemas and contact dermatitis (CD). The aim of this study was to evaluate the use of patch testing (PT) for the diagnosis of CD and provide current data on the frequency of sensitization to various contact allergens among patients with CD in the Albanian population.Methods: We retrospectively analyzed all consecutive patients clinically suspected for CD during the period February 2010 – February 2011, in the outpatient setting. PT was done using Baseline European Series consisting of 31 allergens. Risk factors (age, gender, occupation and place of residence) and sensitization to various contact allergens were evaluated. Results: In total, 193 patients clinically suspected for CD were included in the study and underwent PT. The highest prevalence of CD was found in the age-group of 31-40 years (32.6%), with a statistically significant difference between other age-groups (X2 = 141.2, p&lt;0.01). Positive PT results with at least one allergen were seen in 144 (74.6 %) patients suspected for CD. The two most common allergens were nickel and potassium dichromate. Construction worker and hairdresser were the most affected professions. Females had a chance of 1.8 times higher for having a positive patch test result compare to males (OR = 1.8; 95% CI 0.91 – 3.39).Conclusion: Determination of allergens that cause contact dermatitis is a necessity not only to confirm the correct diagnosis, but also for the qualitative treatment and prevention of the disease. Patch testing, even though an old method, still remain a valuable and non-invasive approach to determine the causes of contact dermatitis.

Infantile Scabies Masquerading as Langerhans Cell Histiocytosis.

Dear Editor: Scabies is a contagious skin infestation caused by Sarcoptes scabiei burrowing into the epidermis. Scabies can cause clinical eruptions and intense pruritus with nocturnal exacerbation1. The presence of typical skin lesions and nocturnal pruritus enable rapid diagnosis and treatment1. Clinical eruptions, including scabietic nodules and visible skin burrows, can be the pathognomonic lesions of scabies2. However, infants and young children may present with atypical skin nodules, vesicles, and pustules that tend to be more generalized. These atypical manifestations often can be confused with seborrheic dermatitis, eczematous dermatitis, impetigo, multiple arthropod bites, and Langerhans cell histiocytosis (LCH)3. Here, we report the case of a 6-month-old infant with scabies who was misdiagnosed with LCH on the basis of histopathologic findings and clinical manifestations. A 6-month-old girl presented with a 1-month history of erythematous to brownish papules and nodules on her trunk (Fig. 1A). The patient was initially treated with topical corticosteroid cream under a diagnosis of contact dermatitis. However, the lesions quickly spread to the patient's hands and feet, with scales and erythematous patches (Fig. 1B). Therefore, she underwent abdominal punch biopsy. Histopathologic findings showed cellular infiltrate within the upper dermis with a perivascular distribution consisting of histiocytes, lymphocytes, and eosinophils (Fig. 2A). The histiocytes in the upper dermis stained positive for CD1a and S-100 (Fig. 2B, C). Therefore, she was diagnosed with LCH on the basis of histopathologic findings and clinical manifestation. However, at that time, her mother complained of pruritus and presented with scabietic nodules on the interdigital web and periumbilical area. Dermoscopy-assisted skin scraping was performed on both the palm of the patient and periumbilical area of her mother, revealing mites and eggs in both lesions (Fig. 2D). Therefore, the patient's lesions were scabietic and not due to LCH. The patient was treated with 10% crotamiton cream and achieved complete remission after 1 week. After 1 month, the patient experienced relapse of the skin lesions on her hands and feet. Skin scraping was performed again and showed positive findings for scabies. The patient was re-treated with crotamiton 10% cream. At the last follow-up of 8 months, she was relapse free. Fig. 1 (A) The patient had several erythematous to brownish papules and nodules on her trunk on the initial visit. (B) Scales and erythematous patches on the palm of the patient after 1 month from the initial visit. Fig. 2 (A) The dermal infiltration was composed of Langerhans cells admixed with lymphocytes and eosinophils (H&E stain, ×200). (B, C) Immunophenotyping demonstrated the majority of the histiocytic cells to be S-100 (B, ×40) and CD1a ... Infantile scabies can have diverse skin manifestations, making it difficult to correctly diagnose on the basis of clinical findings alone. The histopathologic findings of scabies are also nonspecific and are insufficient for diagnosis; they include eczematous reactions in the epidermis and perivascular area, and inflammatory cell infiltrate in the dermis4. The infiltrate usually comprises numerous histiocytes positive on CD1a and S-100 staining. Therefore, these findings can be often misdiagnosed as LCH. Meanwhile, Langerhans cell hyperplasia has been reported to be present in scabies4. The presence of scattered CD30+ cells, which appears in scabies, can aid the differential diagnosis4. In addition, using electron microscopy to assess the presence or absence of Birbeck granules, which is the hallmark of LCH, can also aid diagnosis5. In conclusion, clinicians should be aware of confusing infantile scabies with LCH. Careful history taking including exposure to scabies and performing CD30 staining, electron microscopy, and dermoscopy will aid diagnosis.