Angiolymphoid hyperplasia with eosinophilia

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SkinTumors-PA090956

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare, benign vascular condition characterized by the proliferation of blood vessels and an inflammatory infiltrate rich in eosinophils. It typically presents as red to brown papules or nodules, often on the head and neck region.

Presentation

ALHE commonly affects young to middle-aged adults, with a slight predilection for females. The lesions are usually asymptomatic but can be pruritic or painful. They are often mistaken for other vascular lesions such as hemangiomas or pyogenic granulomas.

Pathophysiology

The exact cause of ALHE is unknown, but it is thought to be a reactive process rather than a true neoplasm. Histologically, ALHE is characterized by the proliferation of small to medium-sized blood vessels lined by plump endothelial cells, accompanied by a dense infiltrate of lymphocytes and eosinophils. The endothelial cells often have a distinctive "hobnail" appearance.

Diagnosis

Diagnosis is primarily clinical, supported by histopathological examination. A biopsy of the lesion typically shows the characteristic vascular proliferation and inflammatory infiltrate. Immunohistochemistry may be used to differentiate ALHE from other vascular proliferations and inflammatory conditions.

Treatment

Treatment options for ALHE include surgical excision, laser therapy, and intralesional corticosteroids. Recurrence is common, and multiple treatments may be necessary. In some cases, the lesions may spontaneously regress without treatment.

Prognosis

The prognosis for ALHE is generally good, as it is a benign condition. However, the lesions can be persistent and cosmetically concerning for patients. Regular follow-up is recommended to monitor for recurrence.

See also

• Kimura disease
• Eosinophilia
• Vascular tumors