The nail biopsy specimen showed a dense infiltrate of large mononuclear cells with reniform vesicular nuclei and abundant eosinophilic cytoplasm, typical of Langerhans cells (LCs), and an admixture of eosinophils. The diagnosis of LCH was confirmed by positive immunoperoxidase staining for S100 protein (Figure 4). Further investigation, including a cranial magnetic resonance imaging scan and computed tomography of the chest and abdomen, disclosed no evidence of disease elsewhere. The nail lesions regressed gradually without treatment, but the scalp lesions became more florid and typical of LCH, despite topical treatment with clobetasone propionate lotion, and hemorrhagic papular lesions appeared in the natal cleft and groins. At present, the patient is receiving intermittent chemotherapy with vinblastine sulfate.
Nail and Scalp Lesions in a Man With Diabetes Insipidus. Arch Dermatol. 1998;134(11):1477-1482. doi: