Epidermal spongiotic Langerhans cell collections, but not eosinophils, are a clue to the diagnosis of allergic contact dermatitis: A series of 170 clinically- and patch test-confirmed cases

Document Type

Journal Article

Publication Date

12-19-2024

Journal

Journal of the American Academy of Dermatology

DOI

10.1016/j.jaad.2024.11.062

Keywords

Langerhans cell collections; Langerhans cells; allergic contact dermatitis; dermatitis; dermatopathology; diagnosis; eczema; eosinophilic spongiosis; eosinophils; patch test; spongiosis; spongiotic dermatitis

Abstract

BACKGROUND: Allergic contact dermatitis cannot be reliably differentiated from other forms of spongiotic/eczematous dermatitis by histology alone. Textbooks and recent studies have variably supported the specificity of dermal eosinophils, eosinophilic spongiosis, and Langerhans cell collections, among other features. OBJECTIVE: To assess which histopathologic features favor a diagnosis of allergic contact dermatitis. METHODS: In this case control study with prospective validation, patients were evaluated by patch testing and skin biopsy. Lesional histopathologic features were independently assessed. RESULTS: 170 cases fulfilled inclusion criteria. Langerhans cell collections were more likely to be found in allergic contact dermatitis (29/111, 26%)(p = 0.03). Heavy dermal eosinophilic infiltration was associated with diagnoses other than allergic contact dermatitis. No significant differences were found for any other predictor variables. LIMITATIONS: Mostly retrospective study with small validation sample. CONCLUSION: This largest study to date is the first to independently confirm Langerhans cell collections as the single histopathologic feature most closely associated with allergic contact dermatitis.

Department

School of Medicine and Health Sciences Student Works

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