Laboratory Studies

A CBC count reveals eosinophilia in approximately 20% of patients with angiolymphoid hyperplasia with eosinophilia (ALHE). Given that some patients with ALHE have also been found to have renal disease, urinalysis could be considered.

Procedures

The clinical presentation of papules around the ears may suggest angiolymphoid hyperplasia with eosinophilia (ALHE), but a biopsy is required to establish the diagnosis.

Histologic Findings

Angiolymphoid hyperplasia with eosinophilia (ALHE) shows characteristic histologic features, including a proliferation of small blood vessels, many of which are lined by enlarged endothelial cells with uniform ovoid nuclei and intracytoplasmic vacuoles. These distinctive endothelial cells have been described as having a hobnail appearance. In addition, a perivascular and interstitial infiltrate composed primarily of lymphocytes and eosinophils (see the image below) is present. Eosinophils typically comprise 5-15% of the infiltrate. Rarely, they can account for as much as 50% of the infiltrate. Occasionally, the infiltrate is devoid of eosinophils. Lymphoid aggregates with or without follicle formation are typical. A subset of ALHE, including multiple eruptive lesions, may show increased cellularity.^[22]

In 2018, immunohistochemical staining for FOSB, with nuclear staining in ALHE, was reported as a useful marker in distinguishing ALHE from its morphologic mimics.^[23]

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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Treatment & Management

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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.