title: Post-scabetic nodules: a lymphohistiocytic reaction rich in indeterminate cells.
abstract: 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.
authors.affiliation: Department of Dermatology & Syphilology, Wayne State University School of Medicine, Detroit, MI 48201, USA.
authors.forename: K
authors.initials: K
authors.lastname: Hashimoto
authors.forename: K
authors.initials: K
authors.lastname: Fujiwara
authors.forename: J
authors.initials: J
authors.lastname: Punwaney
authors.forename: F
authors.initials: F
authors.lastname: DiGregorio
authors.forename: P
authors.initials: P
authors.lastname: Bostrom
authors.forename: K
authors.initials: K
authors.lastname: el-Hoshy
authors.forename: P J
authors.initials: PJ
authors.lastname: Aronson
authors.forename: R J
authors.initials: RJ
authors.lastname: Schoenfeld
mesh_terms: D000328:Adult; D018949:Antigens, CD1 / Q000032:analysis; D002675:Child, Preschool; D005260:Female; D006684:HLA-DR Antigens / Q000032:analysis; D001556:Hexachlorocyclohexane / Q000627:therapeutic use; D015614:Histiocytosis / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology / Q000473:pathology; D006801:Humans; D016130:Immunophenotyping; D007223:Infant; D008297:Male; D009824:Ointments; D026023:Permethrin; D011722:Pyrethrins / Q000627:therapeutic use; D009418:S100 Proteins / Q000032:analysis; D012532:Scabies / Q000150:complications* / Q000188:drug therapy / Q000276:immunology / Q000473:pathology; D012867:Skin / Q000276:immunology / Q000648:ultrastructure
chemical_list: D018949:Antigens, CD1; D006684:HLA-DR Antigens; D009824:Ointments; D011722:Pyrethrins; D009418:S100 Proteins; D026023:Permethrin; D001556:Hexachlorocyclohexane