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Post‐Scabetic Nodules: A Lymphohistiocytic Reaction Rich in Indeterminate Cells
Author(s) -
Hashimoto Ken,
Fujiwara Keiko,
Punwaney Juanita,
DiGregorio Fiorino,
Bostrom Paul,
ElHoshy Khaled,
Aronson Peter J.,
Schoenfeld Robert J.
Publication year - 2000
Publication title -
the journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.9
H-Index - 65
eISSN - 1346-8138
pISSN - 0385-2407
DOI - 10.1111/j.1346-8138.2000.tb02148.x
Subject(s) - birbeck granules , pathology , histiocyte , stain , dermis , medicine , antigen , langerhans cell , immunology , staining
We studied six infants and two adult cases of nodular scabies with immunostains and electron microscopy. All eight cases have had either direct (KOH) or family histories of scabies and were treated with lindane 1% cream or permethrin 5% cream. Family members responded very well, but our patients developed multiple papulo‐nodular lesions which were initially very pruritic and, in some cases, persisted from several months to over one year. H & E stain of biopsied tissue sections revealed a heavy perivascular and periappendageal lymphohistiocytic cell infiltration. Immunophenotype of these cells was compatible with Langerhans cells, i.e . CD1A (+), S‐100 (+) and HLA‐DR (+). Electron microscopy showed that these histiocytic cells satisfied all the ultrastructural criteria of Langerhans cells except for the absence of Birbeck's granules. Lag, a monoclonal antibody for Birbeck's granules, was negative. “Persistent nodules in scabies” or “nodular scabies” seems to represent a prolonged response of indeterminate cells‐lymphocytes to mite antigens.