Indian Journal of Dermatology
: 2020  |  Volume : 65  |  Issue : 6  |  Page : 556--558

Spectrum of dermoscopic pattern in a patient with angiolymphoid hyperplasia with tissue eosinophilia

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

Correspondence Address:
Mayuri Kalantri
Department of Dermatology, Seth G.S. Medical College and KEM Hospital, Parel, Mumbai, Maharashtra

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;65:556-558

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Kalantri M, Khopkar U. Spectrum of dermoscopic pattern in a patient with angiolymphoid hyperplasia with tissue eosinophilia. Indian J Dermatol [serial online] 2020 [cited 2021 Jan 16 ];65:556-558
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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}{Figure 2}{Figure 3}{Figure 4}{Figure 5}{Figure 6}{Figure 7}

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.

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