Unusual presentation of angiolymphoid hyperplasia with eosinophilia treated with intralesional and topic corticosteroid combination therapy

Abstract

Angiolymphoid hyperplasia with eosinophilia (ALHE) is an uncommon angioproliferative benign disorder. A 24- year-old Caucasian female patient presented with multiple itchy reddish pearly nodule.

Successful Treatment of Angiolymphoid Hyperplasia with Eosinophilia Associated with Scalp Demodicosis Using Cryotherapy and Topical Metronidazole

“…[1][2][3] Usually presents as single or multiple well-defined, erythematous or brownish papulonodular lesions and can be pulsatile. 4 The condition is usually localised to the head and neck, mainly in the periauricular region; however, it has rarely been reported to affect other parts of the body, such as the colon, hands, penis, and oral mucosa. 5,6 Overall, ALHP can be asymptomatic but may also present with spontaneous bleeding, itchiness, or pain.…”

“…10,11 The differential diagnoses of ALHE include epithelioid haemangioendotheliomas, pyogenic granulomas, Kaposi sarcomas, and Kimura disease (KD). 4 The latter is considered the main differential diagnosis of ALHE due to their clinical and histopathological similarities. 12 Previously, ALHE and KD were assumed to be the same disorder, but now the two entities can be distinguished due to the distinctive features of the latter condition, as KD presents with subcutaneous masses in the head and neck region, alongside regional and, rarely, systemic lymphadenopathy, peripheral eosinophilia, and elevated serum immunoglobulin E levels, and is infrequently associated with nephrotic syndrome.…”

“…2 Other modalities include administration of topical and intralesional corticosteroids, topical tacrolimus or imiquimod, oral isotretinoin, interferon alfa-2b, radiotherapy, thalidomide, photodynamic therapy, propranolol, laser therapy (using neodymium-doped yttrium aluminium garnet, carbon dioxide, ultralong pulsed dye, or copper vapor lasers), electrosurgery, and cryosurgery. 4,[15][16][17][18][19][20][21][22][23] In the present case, given that superficial vascular proliferation was a major feature, cryotherapy was deemed the best treatment option as it causes necrosis of vascular lesions, provoking an inflammatory response and lesion clearance. 24 In particular, cryotherapy is indicated for multiple ALHE lesions with a prominent vascular component or for lesions located in sites difficult for excision.…”