A late presentation of benign cephalic histiocytosis

A 5-year-old girl presented to the dermatology clinic with numerous hyperpigmented macules on the bilateral cheeks (Fig 1).According to the patient's mother, the macules had spontaneously appeared 6 months prior to the patient's presentation to the clinic.The macules were not painful or pruritic.The patient's past medical history was noncontributory.On examination, there were multiple 1-mm, round, well-demarcated, light brown macules on the bilateral cheeks.A few lesions exhibited the morphology of papules.A punch biopsy was performed and demonstrated a prominent histiocytic infiltrate with foci of foamy cells in the superficial dermis (Fig 2 ,A), highlighted by CD163 (Fig 2, B) and CD68 stains.A CD1a stain failed to highlight the cells (Fig 2, C).The combination of these dermatopathology findings with the clinical presentation was consistent with a diagnosis of benign cephalic histiocytosis (BCH).