Answers to Dermatophile

LCH exhibits heterogeneous clinical pictures and evolution-it varies from the isolated cutaneous lesion with spontaneous resolution to severe cases involving the liver, spleen, lung and haematopoietic system. 1 The most common skin lesion is similar to seborrhoeic dermatitis, but exhibits petechiae and purpura, and affects the scalp, eyebrows, ears and intertriginous areas. 2 Seborrhoeic-like plaques resistant to conventional therapy, no improvement until 8 months of age (both facts described in case number 1), as well as the presence of hepatosplenomegaly should indicate the hypothesis of LCH and, therefore, skin biopsy should be performed to confirm the disease. Furthermore, the worsening of the dermatitis with the use of baby wipes and cloth diapers also suggests this diagnosis, because this kind of diaper has a diminished power of absorption, enhancing the contact with urine-the main triggering factor for ICD. Besides contact with urine and faeces increasing skin pH levels, local humidity, occlusion and friction are other causative factors. 8 Recently, allergic contact dermatitis to preservatives methylchloroisothiazolinone/methylisothiazolinone) present in baby wipes has been described. 9 Since the widespread use of disposable diapers, which have a greater absorption capacity, the frequency of ICD has decreased. 10 To avoid and treat the lesions keeping the area frequently clean and dry may be enough.