Case Number : Case 2811- 15 April 2021 Posted By: Saleem Taibjee

Eosinophils-rich dermal inflammation extending deep to perieccrine and subcutaneous regions with flame figures. Epidermis is unremarkable other than the focal changes centrally which could be a clue to something at further sections.

When correlated with the available clinical features, it could be an arthropod assault/papular urticaria Vs infestation (scabies). It will be a bit unusual if it was a latter and no one else in the family not infested by now (one year) but exceptions happens. 

Are the papules evolves to annular or arcuade plaques with progress of time?

Other histological DDx include Well syndrome/Eosinophilic Annular Erythema spectrum pending CPC.

spongiotic vesicles, with dermal eosinophils and flame figures

rule out Insect bite reactions

I agree with the diagnoses suggested above.  Perhaps the epidermal disruption makes insect bite reaction the most likely diagnosis.

From a histological perspective I would also add Churg-Strauss syndrome into the differential diagnosis, although of course that condition is more usually seen in middle-aged adults.

?Scabies. Agree with Colleagues. Further sections needed. 

Bite reaction

Yes, well done, the clinician was querying insect bite reaction / papular urticaria.

I included this case as a particularly nice example of flame figures. Saman has provided a comprehensive differential diagnosis.

BW
Saleem

Nice illustrative case!

Insect bite reaction