Oral Ivermectin to Treat Papulopustular Rosacea in a immunocompetent patient.

We present a 7-year-old girl with no past history of interest, who was seen for an asymptomatic lesion that had arisen in the right axilla 3 months earlier and had grown progressively, but that had remained stable after a cycle of cryotherapy in her health center 2 months earlier. Examination revealed a well-defined oval papule in the right axilla. The papule was of yellowish color centrally and more erythematous peripherally. No drainage orifice was present and no material was emitted when pressure was placed on the lesion (Fig. 1). Color Doppler ultrasound (Esaote MyLabClass C with an 18 MHz transducer) was performed, showing a well-defined, homogeneous, hypoechoic lesion in the dermis, measuring 6.5 × 3.5 mm, and that depressed the subcutaneous cellular tissue (Fig. 2). No posterior enhancement or lateral shadow was observed. Color Doppler showed no flow within the lesion. We performed complete excision of the lesion. Histopathology study revealed a diffuse histiocytic proliferation that occupied the full thickness of the dermis (Fig. 3A). The lesion was formed of cells with isomorphic oval nuclei and eosinophilic cytoplasm and foam cells, some of which were multinucleated, including occasional Toutontype cells (Fig. 3B). These cells were accompanied by numerous lymphocytes. No epidermotropism was observed. The diagnosis was xanthogranuloma. Juvenile xanthogranuloma (JXG) is a benign histiocytic tumor characterized by being most common in the first 2 decades of life. Various classifications place this lesion in the non-Langerhans cell histiocytoses, together with other diseases such as disseminated xanthoma, diffuse eruptive histiocytosis, benign cephalic histiocytosis, and sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease). JXG is the most common histiocytic disease of childhood,1 though its incidence may be underestimated due to the indolent, asymptomatic nature of these solitary lesions and their tendency to resolve spontaneously. Clinically, it presents as yellowish papulonodular lesions in the skin and other organs, but it is not associated with