BENIGN CEPHALIC HISTIOCYTOSIS

By Gary M. White, MD

Benign Cephalic Histiocytosis


Benign cephalic histiocytosis (BCH) is a rare, benign papular eruption typically of the head and neck in children. Histologically, one sees a collection of histiocytes in the upper and mid dermis. The male to female ratio has been reported about 2:1.

Clinical

Smooth, yellow to red papules 2-3 mm in size on the head and neck of an infant or young child with onset ranging from 6 months to 3 years is seen. The proximal parts of the extremities and trunk are also commonly involved, but less densely. No systemic abnormalities are associated. Occasionally, the papules may coalesce to form a reticulate pattern. Upon healing, atrophic hyperpigmented areas may be left.

One should exclude Langerhans cell histiocytosis, indeterminate cell histiocytosis [may mimic benign cephalic histiocytosis--Dermatology Online Journal], and JXG with immunohistochemistry and/or EM.

Differential Diagnosis

Flat warts are often considered and occasionally a biopsy is necessary. Urticaria pigmentosa may also be considered, but UP usually urticates whereas BCP does not. Lesions of JXG are a less common consideration. Generalized eruptive histiocytoma is usually widespread, sometimes with mucosal involvement and is uncommonly reported in children.

See progressive nodular histiocytosis for more discussion.

Treatment

These lesions resolve over several years. No treatment is necessary.

References

Virtual Grand Rounds in Dermatology

Ann Dermatol. 2011 Nov; 23(4): 508–511

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