ANGIOLYMPHOID HYPERPLASIA WITH EOSINOPHILIA

By Gary M. White, MD


Angiolymphoid hyperplasia with eosinophilia (ALHE) is an unusual vascular proliferation that tends to occur in the head and neck in adults, particularly about the ears. Its cause is unknown. Although HHV8 DNA has been reported in at least one case of ALHE, a larger series failed to show any connection.

Etiology

Whether ALHE represents avascular neoplasm or a reactive healing process is not clear. It has been associated with elevated hormones (e.g., pregnancy and oral contraceptive use), but it has also been reported after trauma, e.g., ear piercing [Peds Derm 2014;31;738].

Clinical

The ear and preauricular areas are most commonly affected by the red papulonodules of angiolymphoid hyperplasia with eosinophilia. The head and neck may also be affected. Widespread papules mimicking prurigo nodularis have been reported as well as widespread vascular papules [JAAD 2000;43;698]. Peripheral eosinophilia is often seen. Pain, itching, ulceration, and bleeding may occur. Lymphadenopathy is not uncommon. Rarely, extracutaneous cases affection the orbit, oral mucosa, parotid gland, colon and bone have been reported.

Workup

Workup should include a CBC, a skin biopsy, and a lymph node exam. Kimura's disease must be considered as it has a similar histologic picture. Its lesions however are typically larger, deeper nodules with normal overlying skin and often with lymphadenopathy.

Treatment

Excision is very appropriate, although recurrence may occur in up to 1/3 of cases.   Mohs surgery is reported to be very effective, with the characteristic cells readily identified in frozen sections. Some cases have resolved spontaneously. Alternative therapies include IL steroids, cryotherapy, electrodessication, or laser, e.g., the pulsed dye or long-pulsed tunable dye laser [AD 1997;133;920]. Two cases related to elevated female hormones (BCP and pregnancy) resolved or improved after the exposure stopped (stopping BCP's and after delivery). Radiation therapy was successful in one case without any side effects after 9 years of followup. Thalidomide given to a patient with 20 nodules experienced near clearing after 6 months, but developed neuropathy [JEADV 2016;30;527]. topical steroids may be tried and topical tacrolimus was successful in one case [Eur J Dermatol 2017;27:194].

References

A 30-year-old woman with a three-year history of itchy and tender lesions over the left ear, mastoid region and adjacent scalp. Indian J Dermatol Venereol Leprol 2016;82:457-8

Angiolymphoid hyperplasia with eosinophilia of the infra-axillary region: report of a case Dermatology Online Journal 20 (3)

A 50-year-old woman with asymptomatic skin lesions over left ear lobe and retroauricular area for 1 year. Indian J Dermatol 2013;58:493

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