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Chapter 119: Angiolymphoid Hyperplasia with Eosinophilia

Shanthi Narla; Jonathan I. Silverberg

ANGIOLYMPHOID HYPERPLASIA WITH EOSINOPHILIA

Therapeutic Approach

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare vasoproliferative disorder that presents as single or multiple pink to red-brown papules or nodules. ALHE most commonly affects the head and neck areas, and less commonly the trunk, extremities, and genital areas. Extracutaneous involvement including the orbit, oral mucosa, parotid gland, colon, and bone have been reported. Despite its benign nature, AHLE can bleed with minimal trauma and is frequently accompanied by pain, itch, or a pulsing sensation. In certain instances, spontaneous regresson of lesions may occur with time. In the authors’ experience, surgical excision is commonly used as a first-line therapy, but local reoccurrence is quite variable. Other therapies are still experimental at this time. See Table 119-1.

Table 119-1Angiolymphoid Hyperplasia with Eosinophilia Treatment Table
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Table 119-1 Angiolymphoid Hyperplasia with Eosinophilia Treatment Table
MEDICATION NAME INDICATION MECHANISM OF ACTION DOSING ADVERSE EFFECTS SUGGESTED MONITORING LEVEL OF EVIDENCE (REFERENCE)
Topical Therapy
Tacrolimus ALHE Antieosinophilic

  • Tacrolimus ointment 0.1% twice daily

 None None IV1-3
Imiquimod ALHE Immunomodulatory, antiangiogenic

  • Imiquimod 5% cream twice daily was applied, 5 times in a week.

  • Imiquimod 5% cream twice daily, 5 times in a week, for 2 wk

 Pain, marked erythema, and tenderness of the affected area, resolved with 7 day withdrawal of treatment None IV4-6
Intralesional Therapy
Corticosteroids ALHE Anti-inflammatory, Antieosinophilic, other

  • 2 mL of triamcinolone acetonide (20 mg/mL) once a month

 None None IV7-10
Bleomycin sulfate ALHE Anti-tumoral

  • 1st injection: 0.2 U (0.1 mg); 2nd-5th injections: 0.4 U; once monthly

 The pain was mild to moderate but always tolerable and subsided within 30 min after the injection None IV11
Interferon alpha 2b ALHE Antiangiogenic

  • 1 million IU IFN-alpha2b twice a week for 5 wk

  • 1–3 mU/cm2 not exceeding 5 mU per injected area, 3 times a week

 None None IV12,13
Systemic Therapy
Isotretinoin ALHE Antiangiogenic

  • 0.5 mg/kg/d for 1 y

  • 0.75 mg/kg/d for 2 mo, and then decreased to half the dose for 2 more months

 None Baseline liver function test, pregnancy test, and lipid panel; pregnancy test every 30 d for females; repeat liver function tests and lipid panel at least once during treatment14 IV15,16
Corticosteroids ALHE Anti-inflammatory, Antieosinophilic, other

  • Prednisolone 60 mg once daily, tapered to 5 mg once daily over 3 mo (cetirizine 10 mg once daily for 2 wk was also added)

 None None IV17
Procedural Therapy
Surgical excision ALHE Excise tissue

  • Not applicable

 None None IV9,18-25
Mohs micrographic surgery ALHE Excise tissue

  • Not applicable

 None None IV26
Cryotherapy ALHE Superficial vascular damage

  • 15 s of liquid nitrogen after ice formation using an open spray

  • 4 sessions at 4-wk intervals; each lesion received 20 s of liquid nitrogen after ice formation using an open spray

 None None IV19,27,28...

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