Angiolymphoid Hyperplasia With Eosinophilia Clinical Presentation

Updated: Apr 11, 2019
  • Author: Gauri Panse, MBBS, MD; Chief Editor: William D James, MD  more...
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Patients with angiolymphoid hyperplasia with eosinophilia (ALHE) typically present with an expanding flesh-color to erythematous 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 typica Angiolymphoid hyperplasia with eosinophilia typically exhibits flesh-color to erythematous nodules in the vicinity of the ear.

Physical Examination

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 [19] and the conjunctiva. [20]

Pronounced erythema and nodularity due to angiolym Pronounced 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.



Conductive hearing loss resulting from obstruction of the auditory canal can occur in severe cases of angiolymphoid hyperplasia with eosinophilia (ALHE). Diplopia and proptosis was noted in one patient with orbital involvement.