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.

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.^[24]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.^[25]Topical timolol has also been shown to have some success.^[26]Other local treatments that have been reported include topical imiquimod,^[27]topical tacrolimus, and intralesional interferon alfa-2a.^{[28, 29]}Systemically, treatment with systemic corticosteroids, anti–interleukin 5 antibody (mepolizumab),^[30]and isotretinoin^[31]has also been reported.

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^[32]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.^[33]Cryosurgery^[34]and electrosurgery have also been reported. More recently, intralesional radiofrequency ablation was also found to produce cosmetically pleasing and lasting results.^{[35, 36]}

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Media Gallery

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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Author

Gauri Panse, MBBS, MD Fellow in Dermatopathology, Department of Dermatology, Yale University School of Medicine

Gauri Panse, MBBS, MD is a member of the following medical societies: American Society for Clinical Pathology, American Society of Dermatopathology, College of American Pathologists, International Society of Dermatopathology, United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

Coauthor(s)

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.

Jon H Meyerle, MD Assistant Professor, Department Dermatology, Uniformed Services University of the Health Sciences; Assistant Professor, Department of Dermatology, Johns Hopkins University School of Medicine; Chief, Immunodermatology, Walter Reed National Military Medical Center

Jon H Meyerle, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Dermatologic/Mohs Surgeon, The Surgery Center at Plano Dermatology

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

Disclosure: Nothing to disclose.

Warren R Heymann, MD Head, Division of Dermatology, Professor, Department of Internal Medicine, Rutgers New Jersey Medical School

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

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

Additional Contributors

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Professor of Pediatrics, Professor of Medicine, Rutgers New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, Royal College of Physicians of Edinburgh, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Sarah K Taylor, MD Staff Physician, Eisenhower Army Medical Center Dermatology, Ft Gordon

Disclosure: Nothing to disclose.

Acknowledgements

Ashley R Mason, MD Dermatopathology Fellow, Department of Dermatology, Yale University School of Medicine

Ashley R Mason, MD is a member of the following medical societies: American Academy of Dermatology and International Society of Dermatopathology

Disclosure: Nothing to disclose.