Indian Journal of Dermatology
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CORRESPONDENCE COLUMN
Year : 2005  |  Volume : 50  |  Issue : 4  |  Page : 238-239
Angiolymphoid hyperplasia with eosinophilia


, India

Correspondence Address:
Santanu Banerjee
,
India
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How to cite this article:
Banerjee S. Angiolymphoid hyperplasia with eosinophilia. Indian J Dermatol 2005;50:238-9

How to cite this URL:
Banerjee S. Angiolymphoid hyperplasia with eosinophilia. Indian J Dermatol [serial online] 2005 [cited 2020 Aug 5];50:238-9. Available from: http://www.e-ijd.org/text.asp?2005/50/4/238/19755


Wells and Whimster, in 1960 reported an unusual subcutaneous angiomatous lesion on the head and neck with characteristic clinical and histopathological findings and termed it as angiolymphoid hyperplasia with eosinophilia (ALHE).[1]

These lesions are benign, locally proliferating, composed of vascular channels with surrounding infiltrate of lymphocytes and eosinophils and are clinically characterized by nodules or papules of angiomatoid appearance over head and neck.[2]

We herein report a case of ALHE who presented with typical clinical and histopathological pictures and responded to intralesional steroids.

A 55 year male presented with multiple asymptomatic nodular swellings over right side of the forehead of six months duration. General physical and systemic examinations revealed no relevant significant changes. Dermatological examination revealed multiple compressible nodules, few grouped together giving a cluster of grapes appearance over right side of the forehead, supraorbital area, medial canthus of right eye and infra orbital area. The overlying skin was normal. There was no pulsation or bruit over the lesions.

There was no evidence of regional lymphadenopathy and oral mucosa was normal. Lab findings revealed eosinophilia of 12% with absolute eosinophil count 840/ cmm. ELISA for HIV was negative. Chest X-ray and Mantoux test were normal. Skin biopsy revealed normal overlying epidermis along with plump swollen endothelial cells with proliferating capillaries and cellular infiltrate of eosinophils and lymphocytes.

Clinically and histopathologically he was diagnosed as a case of ALHE and was treated with intralesional steroids to which he responded well.

ALHE is common in young to middle-aged individuals and is characterized clinically by single or multiple compressible papules or nodules, erythematous to violaceous in color, located over head and neck.[1]

The lesion may be intradermal (superficial) or subcutaneous (deep). The superficial lesions usually appear as multiple grouped lesions giving a cluster of grapes appearance while the deeper ones appear generally as solitary tumor. They are usually asymptomatic but pruritis and pain may be present. Sometimes due to vascularity, they become pulsatile and may easily bleed on trauma.[2] Peripheral eosinophilia is found in 6-34% of cases as was present in our case.

Initially Kimura's disease was thought to be synonymous with ALHE. But later on it was found to be a separate entity. In Kimura's disease, the lesions are usually larger, subcutaneous nodules with involvement of salivary glands and regional lymph nodes.[3] Histopathologically lymphoid infiltrate is more florid than the vascular component. Other conditions from which ALHE should be differentiated are persistent insect bite reaction and angiosacroma.

The smaller lesions of ALHE usually require no treatment and undergoes spontaneous regression, but larger lesions require therapy. Surgical exicision was found to be effective in 65% cases. At present intralesional corticosteroids and pulsed dye laser therapy offer excellent results.[5] Other modes of therapy include cryotherapy, pentoxifyline, indomethacin, while resitant cases have been treated with vinblastine and intralesional cytotoxic agents with good results.

 
   References Top

1.Wells GC, Whimster IW. Subcutaneous angiolymphoid hyperplasia with eosnophilia Br J Dermatol 1969;81:1-15.  Back to cited text no. 1  [PUBMED]  
2.Grimwood R, Swinehart JM, Aeling JL. Angiolymphiod hyperplasia with eosinophilia. Arch Dermatol 1979;115:205-7.  Back to cited text no. 2  [PUBMED]  
3.Churn SI, Ji HG. Kimura's disease and angiolympphoid hyperplasia with eosinophilia. J Am Acad Dermatol 1992,27:954-8.  Back to cited text no. 3    
4.Vazquez-Botet M, Sanchez JL. Angiolymphoid hyperplasia with eosinophilia. J Dermatol Surg Oncol 1978;4:931-6.  Back to cited text no. 4    
5.Lertzman BH, McMeeking T, Gaspari AA. Pulse dye laser treatment of angiolymphoid hyperplasia with eosinophilia lesions. Arch Dermatol 1997,133:920.  Back to cited text no. 5    




 

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