98 Angiolymphoid Hyperplasia with Eosinophilia

Laboratory Findings.

Blood eosinophilia is seen in both diseases and may be as high as 75% in patients with Kimura disease [24]; serum IgE levels may also be elevated. Kimura disease may be complicated by proteinuria and nephrotic syndrome [25].

Differential Diagnosis.

Clinically, the lesions do not have a characteristic morphology other than a vascular background. Therefore, diverse lesions such as epidermoid cysts, angiomas, angiosarcomas, Kaposi sarcoma, bacillary angiomatosis, pseudo-Kaposi sarcoma, pseudo-angiosarcoma and pyogenic granulomas may be confused with ALHE. Biopsy of the lesion is necessary to rule out these other entities. Histologically, ALHE can resemble angiosarcoma and many lesions may have CD30+ cells, but not in numbers great enough to consider lymphoma or lymphomatoid papulosis.

Therapy and Prognosis.

Angiolymphoid hyperplasia with eosinophilia is benign, and the general health of the patient is unaffected. Plaques may resolve spontaneously within months or may remain active for years with gradual enlargement, persistent eosinophilia and pruritus [1]. Rarely, lesions can be locally destructive. There are no reports of malignant change in ALHE but one report of an adult patient who had peripheral T-cell lymphoma. A 13-year-old male with Kimura disease, coronary spasm and coronary aneuyrsms has been described [26].

When lesions are small, few and persistent, excision is the treatment of choice for both AHLE and Kimura disease, but recurrences may still occur [12,27]. Intralesional corticosteroids, cryotherapy and topical tacrolimus are effective, especially in early lesions [28–30], and oral prednisone has induced regression [4]. Pentoxifylline has been used to treat AHLE and two patients with Kimura disease [31,32]. Vinblastine may be effective for treating large or disfiguring lesions of AHLE [23], as is radiation or carbon dioxide laser therapy. Pulse dye laser may be used to eradicate lesions of ALHE [33]. Interferon-α 2a and 2b have both been used sucessfully to treat AHLE in areas not suitable for surgical removal [34,35].

References

1 Olsen TG, Helwig EB. Angiolymphoid hyperplasia with eosinophilia. J Am Acad Dermatol 1985;12:781.

2 Blauvelt A, Cobb MW, Turner ML. Widespread cutaneous vascular papules associated with peripheral blood eosinophilia and prominent inguinal lymphadenopathy. J Am Acad Dermatol 2000;43(4):698–700.

3 Wells GC, Whimster IW. Subcutaneous angiolymphoid hyperplasia with eosinophilia. Br J Dermatol 1969;81:1.

4 Allen PW, Ramakrishna B, MacCormac LB. The histiocytoid hemangiomas and other controversies. Path Annu 1992;2:51.

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