Angiolymphoid Hyperplasia With Eosinophilia Treatment & Management

Updated: Jul 14, 2016
  • Author: Sarah K Taylor, MD; Chief Editor: William D James, MD  more...
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Treatment

Approach Considerations

The most effective treatment for angiolymphoid hyperplasia with eosinophilia (ALHE) is generally surgical excision, but its success rate is limited. Pulsed dye laser and other destructive modalities are effective treatment options in select patients and topical medications have been reported to be successful.

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Medical Care

Treatment of angiolymphoid hyperplasia with eosinophilia (ALHE) is often challenging. Rarely, spontaneous resolution occurs, obviating the need for medical intervention in some cases. While surgery is considered the treatment of choice, management with intralesional corticosteroids may be a viable alternative in some cases, especially in cosmetically sensitive sites on the head and neck. [22] Irradiation has been used but is not optimal. A very promising treatment is oral propranolol, which has been used very successfully for infantile hemangiomas. One report noted no recurrence up to two years after oral propranolol therapy. [23] Topical timolol has also been shown to have some success. [24] Other local treatments that have been reported include topical imiquimod, [25] topical tacrolimus, and intralesional interferon alfa-2a. [26] Systemically, treatment with systemic corticosteroids, anti–interleukin 5 antibody (mepolizumab), [27] and isotretinoin [28] has also been reported.

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Surgical Care

Simple surgical excision is sometimes used, but the lesions tend to recur. [17] Mohs micrographic surgery has been attempted in order to address ALHE through better margin control. Excisions that include the arterial and venous segments at the base of the lesion prove most efficacious. The pulsed-dye laser [29] and carbon dioxide laser have been used with some success. 5-Aminolevulinic acid photodynamic therapy (ALA-PDT) has also been reported to show some success. [30] Cryosurgery [31] and electrosurgery have also been reported. More recently, intralesional radiofrequency ablation was also found to produce cosmetically pleasing and lasting results. [32]

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