A 54 year-old-woman presented with a one-year history for asymptomatic papular lesions on her chest, back and upper extremities .  There was no mucosal lesions and routine laboratory tests were in normal range. Histologic examination revealed a monomorphous histiocytic infiltration....

 What is your diagnosis?

Diagnosis: Generalized Eruptive Histiocytosis (GEH)

Comment by Dr.M. Mehravaran, Szeged/Hungary:

In 1963 Winkelmann and Muller reported and named this syndrome, which occurs in otherwise healthy adults.1

Generalized eruptive histiocytoma is rare and has been reported more frequently in adults, but it also occurs in children. The skin lesions consist of fine papules that are yellow to bluish-red and range from 3-10 mm in size. The lesions tend to be symmetrically distributed on the face, trunk and proximal limbs, and old lesions tend to fade as new ones appear. Mucous membrane involvement is rare and has not been reported in children, and visceral lesions have not been observed. The diseases lasts for a few years and then spontaneously resolves, usually without scarring. 

Histologic examination reveals a monomorphous histiocytic infiltrate in the upper and mid dermis. Ultrastructural studies shown that the histiocytic cells lack Birbeck granules but have cytoplasmic laminated bodies.

Differential Dg:

1. Xanthoma Disseminatum

2. Eruptive Xanthoma

 Reference:

1. Winkelmann RK, et al: Generalized eruptive histiocytoma. Arch Dermatol 1963, 88:586.