TY - JOUR
AU - Maggio, Kurt L.
AB - Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare vascular disorder of unknown pathogenesis that has a predilection for young white women. It usually presents as pink to red-brown, dome-shaped, dermal papules or nodules of the head and neck, most often in the periauricular area. Symptoms may include pain, pruritus, and spontaneous bleeding after minor trauma. Histologically, ALHE demonstrates a proliferation of thick-walled vessels with prominent endothelial cells (hobnailing) as well as an infiltration of lymphocytes and eosinophils.1 Multiple treatments have been reported, including intralesional injection with interferon alfa-2a, surgery, and various lasers including argon, carbon dioxide, and pulsed dye.2 The article by Shenefelt et al1 in “The Cutting Edge” feature of the July 2000 issue of the Archives describes a 52-year-old white woman with biopsy-proven ALHE who, at the time of presentation, was unresponsive to treatment with cryotherapy and intralesional triamcinolone. She was then treated for 11 months with intralesional interferon alfa-2a with almost complete resolution, yet recurrence occurred approximately 1 year after her last injection. The same patient presented to Walter Reed Army Medical Center in June 1999 complaining of recurrent right periauricular papules that were extremely itchy and at times painful (Figure 1A). Also, the patient was having difficulty hearing without manipulating her ear. A biopsy specimen was obtained, again confirming ALHE (Figure 2). The patient was treated 4 times at 6-week intervals with the Cynosure Inc pulsed-dye laser (Westford, Massachusetts) at 585 nm and 6 J/cm2 at 0.45-millisecond pulses with marked improvement (Figure 1B). Figure 1. View LargeDownload Clinical images of our study patient. A, At presentation in June 1999, the patient demonstrates extensive right periauricular violaceous papules with edema and external auditory meatus stenosis. B, Four months after the patient's final laser treatment, normal ear contours are restored. C, Photograph taken October 1, 2010, demonstrating complete resolution of angiolymphoid hyperplasia with eosinophilia. Figure 2. View LargeDownload Hematoxylin-eosin–stained histopathologic images from our subject case. A, Dermal infiltrate seen on low-power magnification (original magnification ×40). B, Mixed infiltrate consisting of lymphocytes and eosinophils (original magnification ×100). C, Vessel demonstrating prominent endothelial cells entering into the lumen (original magnification ×100). A supra-auricular punch biopsy specimen obtained in June 2002 at a laser-treated site demonstrated improved yet incomplete clearance of ALHE owing to the limited depth of penetration of the pulsed-dye laser. The patient's posttreatment biopsy specimen suggests that complete histologic clearance is not essential to a clinical cure for ALHE. Follow-up was extensive, and the patient demonstrated resolution of her symptoms and no clinical evidence of ALHE recurrence over a 10-year follow-up period with no other treatment or complications (Figure 1C). Several studies have indicated similar success with the pulsed-dye laser, but to our knowledge, none has included such an extensive follow-up period.3,4 Based on the published literature, intralesional interferon alfa-2a cannot be recommended for the treatment of ALHE because it does not appear to be curative. We have demonstrated a durable 10-year response to pulsed-dye laser treatment in this patient, evidenced by the extended disease-free timeframe. It is our opinion that pulsed-dye laser should be considered the standard of care for treatment of ALHE. It is capable of penetrating the skin approximately 1 cm, and the treatment can be repeated every 4 to 6 weeks. If the lesions are refractory or extensive, or if the patient has a skin type IV through VI, the long-pulsed Nd:YAG (1064-nm) laser with its inherently deeper penetration could be considered.5 Correspondence: Dr Fink, 7701 Woodmont Ave, Apartment 1008, Bethesda, MD 20814 (caitlin.fink@us.army.mil). Financial Disclosure: None reported. Additional Contributions: Robyn N. Torkowitz, BA, reformatted all photographs for publication quality. References 1. Shenefelt PDRinker MCaradonna S A case of angiolymphoid hyperplasia with eosinophilia treated with intralesional interferon alfa-2a. Arch Dermatol 2000;136 (7) 837- 83910890984Google ScholarCrossref 2. Lertzman BH McMeekin TGaspari AA Pulsed dye laser treatment of angiolymphoid hyperplasia with eosinophilia lesions. Arch Dermatol 1997;133 (7) 920- 9219236540Google ScholarCrossref 3. Abrahamson TGDavis DA Angiolymphoid hyperplasia with eosinophilia responsive to pulsed dye laser. J Am Acad Dermatol 2003;49 (2) ((suppl case reports)) S195- S19612894122Google ScholarCrossref 4. Rohrer TEAllan AE Angiolymphoid hyperplasia with eosinophilia successfully treated with a long-pulsed tunable dye laser. Dermatol Surg 2000;26 (3) 211- 21410759795Google ScholarCrossref 5. Kadurina MIDimitrov BGBojinova STTonev SD Angiolymphoid hyperplasia with eosinophilia: successful treatment with the Nd:YAG laser. J Cosmet Laser Ther 2007;9 (2) 107- 11117558761Google ScholarCrossref
TI - Angiolymphoid Hyperplasia With Eosinophilia Revisited: Lack of Durable Response to Intralesional Interferon Alfa-2a
JF - Archives of Dermatology
DO - 10.1001/archdermatol.2011.69
DA - 2011-04-01
UR - https://www.deepdyve.com/lp/american-medical-association/angiolymphoid-hyperplasia-with-eosinophilia-revisited-lack-of-durable-ki3pzdkaZv
SP - 507
EP - 508
VL - 147
IS - 4
DP - DeepDyve
ER -