Angiolymphoid Hyperplasia With Eosinophilia Clinical Presentation

  • Author: Sarah K Taylor, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jun 2, 2010
 

History

Patients with angiolymphoid hyperplasia with eosinophilia (ALHE) typically present with an expanding nodule or group of nodules, usually in the vicinity of the ear (see the image below). The lesion(s) may be associated with pain or pruritus. Uncommon symptoms include pulsation and spontaneous bleeding.

Angiolymphoid hyperplasia with eosinophilia typicaAngiolymphoid hyperplasia with eosinophilia typically exhibits flesh-color to erythematous nodules in the vicinity of the ear.
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Physical

Angiolymphoid hyperplasia with eosinophilia (ALHE) typically appears as dome-shaped, smooth-surfaced papules or nodules (see the image below). Approximately 85% of lesions occur in the skin of the head and neck; most of them are on or near the ear or on the forehead or scalp. The extremities are the next most common site. Involvement at other sites is rare. However, case reports have described ALHE affecting the penis[12] and the conjunctiva.[13]

Pronounced erythema and nodularity due to angiolymPronounced erythema and nodularity due to angiolymphoid hyperplasia with eosinophilia.

The lesions range from erythematous to brown, and they may be eroded or crusted. Approximately 80% of patients present with isolated lesions, while the remaining patients usually demonstrate grouped papules or nodules in a single region. Rarely, the lesions may be pulsatile. Most lesions are 0.5-2 cm in diameter, with a range of 0.2-8 cm. Larger nodules tend to be deeply centered within the subcutis.

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Causes

Angiolymphoid hyperplasia with eosinophilia (ALHE) is idiopathic. Whether this condition is a neoplastic or reactive state is uncertain; a reactive cause is favored.

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Contributor Information and Disclosures
Author

Sarah K Taylor, MD  Staff Physician, Kimbrough Dermatology, Ft George G Meade

Disclosure: Nothing to disclose.

Coauthor(s)

Jon H Meyerle, MD  Assistant Professor, Department of Dermatology, Johns Hopkins University School of Medicine; Chief, Immunodermatology, Dermatology Laboratory Director, Department of Dermatology, Walter Reed Army Medical Center and National Naval Medical Center

Jon H Meyerle, MD is a member of the following medical societies: American Academy of Dermatology and Sigma Xi

Disclosure: Nothing to disclose.

Earl J Glusac, MD  Professor, Departments of Pathology and Dermatology, Yale University School of Medicine

Earl J Glusac, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Warren R Heymann, MD  Head, Division of Dermatology, Professor, Department of Internal Medicine, University of Medicine and Dentistry of New Jersey

Warren R Heymann, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Hamilton TK, Baughman RD, Perry AE. Persistent pruritic plaque of the ear. Arch Dermatol. Apr 1999;135(4):464-5, 467-8. [Medline].

  2. Arnold M, Geilen CC, Coupland SE, Krengel S, Dippel E, Spröder J, et al. Unilateral angiolymphoid hyperplasia with eosinophilia involving the left arm and hand. J Cutan Pathol. Oct 1999;26(9):436-40. [Medline].

  3. Chan JK, Hui PK, Ng CS, Yuen NW, Kung IT, Gwi E. Epithelioid haemangioma (angiolymphoid hyperplasia with eosinophilia) and Kimura's disease in Chinese. Histopathology. Dec 1989;15(6):557-74. [Medline].

  4. Googe PB, Harris NL, Mihm MC Jr. Kimura's disease and angiolymphoid hyperplasia with eosinophilia: two distinct histopathological entities. J Cutan Pathol. Oct 1987;14(5):263-71. [Medline].

  5. Tsuboi H, Masuzawa M, Katsuoka K. Angiolymphoid hyperplasia with eosinophilia affecting the nail bed and underlying bone. J Dermatol. Jun 2006;33(6):399-402. [Medline].

  6. Esmaili DD, Chang EL, O'Hearn TM, Smith RE, Rao NA. Simultaneous presentation of Kimura disease and angiolymphoid hyperplasia with eosinophilia. Ophthal Plast Reconstr Surg. Jul-Aug 2008;24(4):310-1. [Medline].

  7. Zarrin-Khameh N, Spoden JE, Tran RM. Angiolymphoid hyperplasia with eosinophilia associated with pregnancy: a case report and review of the literature. Arch Pathol Lab Med. Sep 2005;129(9):1168-71. [Medline].

  8. Angiolymphoid Hyperplasia with Eosinophilia and Kimura Disease. In: Wolff, Goldsmith, Katz, Gilchrest, Paller, Leffell, eds. Fitzpatrick's Dermatology in General Medicine. Vol 1. 7th ed. New York, NY: McGraw-Hill Medical; 2008:313-14.

  9. Joshi R. Angiolymphoid hyperplasia with follicular mucinosis. Indian J Dermatol Venereol Leprol. Sep-Oct 2007;73(5):346-7. [Medline].

  10. Gonzalez-Cuyar LF, Tavora F, Zhao XF, Wang G, Auerbach A, Aguilera N, et al. Angiolymphoid hyperplasia with eosinophilia developing in a patient with history of peripheral T-cell lymphoma: evidence for multicentric T-cell lymphoproliferative process. Diagn Pathol. May 29 2008;3:22. [Medline].

  11. Wang YH, Yin HF. [One patient with Kimura's disease and angiolymphoid hyperplasia with eosinophilia also suffers from kidney injury]. Beijing Da Xue Xue Bao. Aug 18 2008;40(4):405-7. [Medline].

  12. Dewan P, Francis ND, Lear JT, Bunker CB. Angiolymphoid hyperplasia with eosinophilia affecting the penis. Br J Dermatol. Sept 2008;159(3):755-7. [Medline].

  13. Huang M, Lloyd WC 3rd, O'Hara M. Angiolymphoid hyperplasia with eosinophilia: an unusual presentation in a child. J AAPOS. Jun 2008;12(3):302-4. [Medline].

  14. Carlesimo M, Mari E, Tammaro A, Persechino S, Camplone G. Angiolymphoid hyperplasia with eosinophilia treated with isotretinoin. Eur J Dermatol. Nov-Dec 2007;17(6):554-5. [Medline].

  15. Abrahamson TG, Davis DA. Angiolymphoid hyperplasia with eosinophilia responsive to pulsed dye laser. J Am Acad Dermatol. Aug 2003;49(2 Suppl Case Reports):S195-6. [Medline].

 
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Angiolymphoid hyperplasia with eosinophilia typically exhibits flesh-color to erythematous nodules in the vicinity of the ear.
Pronounced erythema and nodularity due to angiolymphoid hyperplasia with eosinophilia.
Histologically, angiolymphoid hyperplasia with eosinophilia is marked by thick-walled blood vessels with protuberant endothelium and a prominent inflammatory infiltrate, which typically includes eosinophils.
 
 
 
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