Dermatology: Practical and Conceptual


Image Letter | Dermatol Pract Concept. 2025;15(1):4850 1

Dermoscopy of Periungual Papules in Multicentric 
Reticulohistiocytosis

José María Llamas-Molina1, María Narváez-Simón2, Ricardo Ruiz-Villaverde1

1 Department of Dermatology, Hospital Universitario San Cecilio, Granada, Spain

2 Department of Anatomic Pathology, Hospital Universitario San Cecilio, Granada, Spain

Citation: Llamas-Molina JM, Narváez-Simón M, Ruiz-Villaverde R. Dermoscopy of Periungual Papules in Multicentric 
Reticulohistiocytosis. Dermatol Pract Concept. 2025;15(1):4850. DOI: https://doi.org/10.5826/dpc.1501a4850

Accepted: August 24, 2024; Published: January 2025

Copyright: © Llamas-Molina et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, 
distribution, and reproduction in any medium, provided the original authors and source are credited.

Funding: None.

Competing Interests: None.

Authorship: All authors have contributed significantly to this publication.

Corresponding Author: José María Llamas-Molina MD, Hospital Universitario San Cecilio, Avenida de la Ilustración S/N, 18016, Granada, 
Spain. E-mail: josellamas94@gmail.com

Case Presentation

A 54-year-old woman presented with erythematous pap-

ules and nodules on the fingers that were shiny and firm to 

palpation. She also complained of asthenia and symptoms 

of arthritis. The periungual lesions had a “coral bead” ap-

pearance (Figure 1A). Dermoscopy of the proximal nail fold 

lesions showed a homogeneous orange background with 

multiple branching vessels. On the side adjacent to the cu-

ticle, a peripheral collar was also visible (Figure 1B). The 

biopsy showed a diffuse dermal infiltration of histiocytes 

with eosinophilic ground glass cytoplasm and multinucle-

ated giant cells. Immunohistochemistry showed positivity 

for CD68 and CD163 and negativity for S100 proteins and 

CD1a (Figure 1C). This led to the diagnosis of multicentric 

reticulohistiocytosis (MRH).

Teaching Point

MRH is a very rare systemic disease that belongs to the group 

of non-Langerhans cell histiocytosis and presents with acral 

skin nodules and erosive arthritis. MRH is associated with an 

underlying neoplasm in 25% of patients. The typical skin le-

sions of MRH are firm, shiny, non-pruritic, brown-to- reddish-

brown papules, mostly located on the hands. Periungual 

papules have the characteristic “coral bead” appearance. It is a 

very important clinical sign when suspecting the diagnosis and 

has been described in 30% of patients. On dermoscopy, prom-

inent arboriform vessels and a brownish peripheral collarette 

have been described, as in our case. We add the particularity of 

the orange background, which could be related to the histio-

cytic and granulomatous nature of these lesions. In conclusion, 

dermoscopy may be useful in the diagnosis of suspected MRH 

in a patient with periungual papules.



2 Image Letter | Dermatol Pract Concept. 2025;15(1):4850

References

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Figure 1. (A) Papules and nodules on the dorsum of the hands. (B) Periungual papules   

in “coral bead” pattern. (C) Histiocytes with eosinophilic ground glass cytoplasm, multi-

nucleated giant cells, and positivity for CD68 and CD163 staining.