Angiolymphoid hyperplasia with eosinophilia
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2] Ammu Susheela, M.D. [3]
Synonyms and Keywords: Epithelioid hemangioma; Histiocytoid hemangioma; Inflammatory angiomatous nodule; Intravenous atypical vascular proliferation; Papular angioplasia; Inflammatory arteriovenous hemangioma; Pseudopyogenic granuloma; ALHE; EH
Overview
Historical Perspective
- Angiolymphoid hyperplasia with eosinophilia was first discovered by G. C. Wells and I. W. Whimster, two british physicians, in 1969.[1]
Pathophysiology
- Angiolymphoid hyperplasia with eosinophilia [2] is defined as red-brown, dome-shaped, dermal papule or nodule, present in the head or neck, specifically around the ears and on the scalp.[3]
- The pathogenesis of angiolymphoid hyperplasia with eosinophilia is characterized by red to brown papules or nodules dislocated in the dermis or subcutaneous tissue.
- Angiolymphoid hyperplasia with eosinophilia is a rare and idiopathic vascular disorder.
- On gross pathology, smooth-surface red to brown papules or nodules on the head, neck, trunk, extremities, genitalia, lips and oral mucosa are characteristic findings of angiolymphoid hyperplasia with eosinophilia.
- On microscopic histopathological analysis, florid vascular proliferation with atypical endothelial cells surrounded by a lymphocytic and eosinophilic infiltrate are characteristic findings of angiolymphoid hyperplasia with eosinophilia.
Causes
- Angiolymphoid hyperplasia with eosinophilia may be caused by either allergic reactions, traumas, or autoimmune disorders.
Differentiating Angiolymphoid hyperplasia with eosinophilia from other Diseases
- Angiolymphoid hyperplasia with eosinophilia must be differentiated from other diseases that cause swelling of face and neck, such as:
- Kimura disease
- Acial granuloma
- Insect bite reaction
- Cutaneous lymphoma
- Sarcoidosis
Epidemiology and Demographics
- The prevalence of angiolymphoid hyperplasia with eosinophilia is unknown as it is an extremely rare disease.
Age
- Angiolymphoid hyperplasia with eosinophilia is more commonly observed among young patients.
Gender
- Females are more commonly affected with angiolymphoid hyperplasia with eosinophilia than males.
Race
- Angiolymphoid hyperplasia with eosinophilia usually affects predominently individuals of the Asian race.
Risk Factors
- Common risk factors in the development of angiolymphoid hyperplasia with eosinophilia are allergic reactions, traumas or autoimmune disorders.
Natural History, Complications and Prognosis
- The majority of patients with angiolymphoid hyperplasia with eosinophilia remain asymptomatic for several years.
- Common complications of angiolymphoid hyperplasia with eosinophilia include pruritis, pulsation, and spontaneous bleeding.
- One-third of cases of angiolymphoid hyperplasia with eosinophilia recur when incompletely excised.
Diagnosis
Symptoms
- Angiolymphoid hyperplasia with eosinophilia lesions may be asymptomatic, painful or pruriginous.
Physical Examination
- Physical examination may be remarkable for:
- Dome-shaped, smooth-surfaced papules or expanding nodule or group of nodules
Ear
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Laboratory Findings
- A eosinophilia in complete blood count is characteristic of angiolymphoid hyperplasia with eosinophilia.
- Eosinophils in urinalysis is also a feature.
Other Diagnostic Studies
- Angiolymphoid hyperplasia with eosinophilia may also be diagnosed using biopsy.
- Findings on biopsy include proliferation of small blood vessels with endothelial cells having a cobblestone appearance, a perivascular and interstitial infiltrate of lymphocytes and eosinophils.
Treatment
Medical Therapy
- The mainstay of therapy for angiolymphoid hyperplasia with eosinophilia is intralesional corticoid therapy and imiquimod.
- Imiquimod acts by induction of the production of interferon-α and induction or inhibition of certain cytokines, mainly interleukin-5.[4]
Surgery
- Surgery is the mainstay of therapy for angiolymphoid hyperplasia with eosinophilia.
- Mohs micrographic surgery with complete margin examination is performed.
- Other treatment options include radiotherapy, curettage, shave excision with electrodessication, cryotherapy, corticosteroids (topical, systemic or intralesional preparation), and laser therapy using continuous wave carbon dioxide and argon lasers.[5]
Prevention
- There are no primary preventive measures available for angiolymphoid hyperplasia with eosinophilia.
References
- ↑ Wells GC, Whimster IW (1969). "Subcutaneous angiolymphoid hyperplasia with eosinophilia". Br J Dermatol. 81 (1): 1–14. PMID 5763634.
- ↑ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 1-4160-2999-0.
- ↑ James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN 0-7216-2921-0.
- ↑ Esteves, Paola; Barbalho, Marcella; Lima, Tiago; Quintella, Leonardo; Niemeyer-Corbellini, Jo�o Paulo; Ramos-e-Silva, Marcia (2015). "Angiolymphoid Hyperplasia with Eosinophilia: A Case Report". Case Reports in Dermatology. 7 (2): 113–116. doi:10.1159/000381843. ISSN 1662-6567. replacement character in
|first5=at position 3 (help) - ↑ Lembo S, Balato A, Cirillo T, Balato N (2011). "A Long-Term Follow-Up of Angiolymphoid Hyperplasia with Eosinophilia Treated by Corticosteroids: When a Traditional Therapy is Still Up-to-Date". Case Rep Dermatol. 3 (1): 64–7. doi:10.1159/000323182. PMC 3073756. PMID 21487464.