Recibido:

Orbital Langerhans cell histiocytosis with focus on treat-ment Dear Editor: We read with great interest the article by Ulivieri et al regarding the treatment of an orbital eosinophilic granuloma (EG). The authors treated a 25-year-old male harbouring an orbital EG by curettage of the lesion after bicoronal skin incision. Follow-up examinations revealed no evidence of recurrence5. EG is the mildest form of Langerhans cell histiocytosis and usually affects children and young adults. The most common presentation is that of a solitary skeletal lesion, usually of the calvarium2. Surgical excision is the treatment mainstay. Nevertheless, other non-surgical treatments, such as the use of indomethacin, have been reported especially for lesions that are not accessible or when there is a danger for cosmetic defect3. In a series of 22 children with cranium EG, we encountered 3 biopsy proven periorbital EGs, in which due to the risk of disfigurement, we administered for a period of 6 months sulfamethoxazole and trimethoprim1. After treatment all lesions were totally resolved. This mana-gement has been selected due to previous experience with this regimen in our institute4. Regarding the remaining 19 lesions in our series, radical surgical excision was performed and methylprednisolone was applied in the tumor bed. On follow-up examinations no tumor recurrence was noted1. We believe that surgery is the option of choice in most lesions of EG that are accessible. For the remaining lesions we propose, apart from intralesional corticosteroid injec-tion, the administration of sulfamethoxazole and trimetho-prim as an effective treatment. Future studies should be focused on this issue