LCH due to acute liver failure, presented with extensive diffuse crusted papulovesicles, which were most prominent on the scalp and trunk (Fig. 1i). Some patients presented with papules and nodules, with spontaneous resolution, leaving atrophic hypopigmented macules (Fig. 1j). Battistella et al ., 3 reported that resolution leaving hypopigmentation favoured limited disease, but this was not true in our cohort. Four children with MS-LCH had external otitis, 24 had liver and spleen involvement and lung and bone marrow involvement were present in 17 patients. No differences were observed in histologic features between SS-LCH and MS-LCH. Children with MS-LCH were treated with prednisolone in combination with chemotherapy. Patients with skin-limited disease were followed up carefully; however, no systemic treatment was used in this group and all are now in complete remission. Our data suggest earlier age of onset and isolated lesion favoured SS-LCH, while petechiae, external otitis and mucosal lesions favoured MS-LCH. Furthermore, groin involvement prone to indicate the MS-LCH. The partial retrospective design of single institution and predominant recruitment from the department of dermatology is limitations.