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Year : 2020  |  Volume : 65  |  Issue : 6  |  Page : 556-558
Spectrum of dermoscopic pattern in a patient with angiolymphoid hyperplasia with tissue eosinophilia


Department of Dermatology, Seth G.S. Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India

Date of Web Publication23-Oct-2020

Correspondence Address:
Mayuri Kalantri
Department of Dermatology, Seth G.S. Medical College and KEM Hospital, Parel, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.IJD_180_19

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How to cite this article:
Kalantri M, Khopkar U. Spectrum of dermoscopic pattern in a patient with angiolymphoid hyperplasia with tissue eosinophilia. Indian J Dermatol 2020;65:556-8

How to cite this URL:
Kalantri M, Khopkar U. Spectrum of dermoscopic pattern in a patient with angiolymphoid hyperplasia with tissue eosinophilia. Indian J Dermatol [serial online] 2020 [cited 2020 Dec 4];65:556-8. Available from: https://www.e-ijd.org/text.asp?2020/65/6/556/298901




Sir,

Angiolymphoid hyperplasia with tissue eosinophilia is a benign vasoproliferative disorder of unknown etiology, presenting with solitary or multiple, papules or nodules over scalp and periauricular region first described by Wells & Whimster in 1969.[1] There are several reports in the literature of pregnancy related-angiolymphoid hyperplasia with tissue eosinophilia but only a few reports describe the dermoscopic features of this rare entity.

A 25-year-old pregnant female (gravida 2, parity 1) presented with multiple red raised lesions over scalp since 3rd month of gestation. The lesion started as asymptomatic papules over the occipital area, which gradually increased in number and a few of those lesions increased in size. She denied history of bleeding on trauma or history of similar lesions in the previous pregnancy. On examination, there were multiple, erythematous to skin colored, discrete as well as grouped, dome-shaped papules and nodules over occipital and parietal areas of scalp [Figure 1]. They varied in size from 2 mm to 2 cm, were mobile, soft in consistency, and a few of them showed crusting. Dermoscopy of various lesions with a polarized video-dermoscope showed five patterns:(1) white shiny irregular area [Figure 2]; (2) white shiny streaks with linear vessels with red dots and globules over pink white background [Figure 3]; (3) linear irregular vessels over pink shiny white background [Figure 4]; (4) reticular vessels with yellow-orange crust over pink white background [Figure 5]; and (5) linear irregular vessels over yellow-orange background [Figure 6]. Biopsy of the lesion showed dilated thick-walled small to medium-sized blood vessels (capillaries and venules) involving the dermis with moderately dense perivascular infiltrate of lymphocytes and eosinophils around and within the walls of vessels. The endothelial cells lining these vessels were thick, prominent, large, and appear to project into lumina [Figure 7].
Figure 1: Multiple erythematous to skin colored, papules and nodules over scalp

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Figure 2: White shiny irregular area (arrow) (polarized light ×200)

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Figure 3: White shiny streaks (arrow) with linear vessels (circle) and red dots and globules (star) over pink white background (polarized light ×200)

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Figure 4: Linear irregular vessels (arrow) over pink shiny white (star) background (polarized light ×200)

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Figure 5: Reticular vessels (arrow) with yellow orange crust (star) over pink white background (circle). (polarized light ×200)

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Figure 6: Linear irregular vessels (arrow) over yellow orange background (star) (polarized light ×200)

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Figure 7: The endothelial cells lining the thick walled, dilated blood vessels are prominent and at few places appear to project into lumina. The moderately dense perivascular infiltrate in dermis consists of lymphocytes and eosinophils (H and E, ×200)

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Pregnancy is considered as a predisposing factor for increased vascular proliferation favoring the role of estrogen in angiolymphoid hyperplasia with tissue eosinophilia. Other predisposing factors include insect bite, infections, trauma, and immunologic factors.[1] Padilla et al. described the lacunar pattern similar to the characteristic pattern of hemangioma on dermoscopy in a single lesion.[2] Polymorphous vascular pattern composed of dotted and linear irregular vessels with a regular distribution over light pink background had been described in 2 cases.[3] Calvin et al . reported as white keratin mass with pink background and central ulcer with red dots and globules.[4] We found the polymorphic vascular pattern on dermoscopy consisting of red dots and globules, linear regular and irregular vessels, reticular vessels on pink white background. The white shiny structures and streaks are new dermoscopic feature of angiolymphoid hyperplasia with tissue eosinophilia.

The white, shiny structures are exclusively seen under polarized dermoscopy. The various described morphologies of white shiny structures are white shiny lines, white shiny areas, and rosettes. These are also seen in BCC, melanoma, dermatofibroma, actinic keratosis, and scar. White shiny structures are believed to correlate histopathologically with fibrosis or altered collagen in the dermis; however, this relationship has not yet been definitively established.[5] Angiolymphoid hyperplasia with tissue eosinophilia usually presents with a few papulonodules. Our patient had around sixty papulonodules that gave us a rare opportunity to study the spectrum of a dermoscopic pattern.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Damarla S, Chintagunta S, Arakkal G. Recurrent unilateral angiolymphoid hyperplasia with eosinophilia in pregnancy. Indian J Dermatol Venereol Leprol 2018;84:325-7.  Back to cited text no. 1
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2.
Padilla-España L, Fernández-Morano T, Del Boz J, Fúnez-Liébana R. Angiolymphoid hyperplasia with Eosinophilia: Analysis of 7 cases. Actas Dermosifiliogr 2013;104:353-5.  Back to cited text no. 2
    
3.
Rodríguez-Lomba E, Avilés-Izquierdo JA, Molina-López I, Parra-Blanco V, Lázaro-Ochaita P, Suárez-Fernández R. Dermoscopic features in 2 cases of angiolymphoid hyperplasia with eosinophilia. J Am Acad Dermatol 2016;75:e19-21.  Back to cited text no. 3
    
4.
Santosa C, Wardhana M, Saputra H. Angiolymphoid hyperplasia with eosinophilia with clinical pictures of keratoacanthoma: A rare case report. Clin Case Reports 2019;7:189-92.  Back to cited text no. 4
    
5.
Liebman TN, Rabinovitz HS, Dusza SW, Marghoob AA. White shiny structures: dermoscopic features revealed under polarized light. J Eur Acad Dermatol Venereol 2012;26:1493-7.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]



 

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