Because of the rarity of adult multisystem LCH, its treatment has been largely anecdotal, and only recently have there been attempts to develop uniform therapeutic regimens. To our knowledge, no clinical trials have yet been performed in the adult population. Observation, chemotherapy, local topical treatments, immunomodulatory agents, radiation therapy, and organ or bone marrow transplantation have been reported to be successful.1,9,16- 18 Combination therapy with vinblastine and prednisone has been evaluated and proposed as first-line treatment for pediatric multisystem LCH2,19 as well as, more recently, adult multisystem LCH.2 This combination, however, has not shown any additional therapeutic benefit with respect to response, survival, or reactivation.1 Other systemic approaches for LCH include 2-chlorodeoxyadenosine,20,21 mercaptopurine, thalidomide,1,22,23 cyclophosphamide, cyclosporine,24 and methotrexate,25 used singly or in combination. Similarly, therapeutic approaches for isolated skin LCH have not been evaluated by clinical trials and remain anecdotal. Options include observation, psoralen–UV-A,26,27 topical nitrogen mustard,28,29 topical or intralesional steroids, thalidomide,22,30 isotretinoin,31 subcutaneous interferon,15 imiquimod,32 and topical antibacterial agents.