10.5826/dpc.1401a5
text/xml
2160-9381
3216
en
Iria Neri
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
A Rare Case of Angiolymphoid Hyperplasia With Eosinophilia: A Dermoscopic and Therapeutic Teaching Point
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Image Letter
2024-01-31
2023-02-04
2024-01-31
2024-02-21
e2024005
Dermatol Pract Concept
Iria Neri
2024/01/31
10.5826/dpc.1401a5
e2024005
Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
2160-9381
en
e2024005
Zou A, Hu M, Niu B. Comparison between Kimura's disease and angiolymphoid hyperplasia with eosinophilia: case reports and literature review. J Int Med Res. 2021;49(9):3000605211040976. DOI: 10.1177/03000605211040976. PMID: 34525882. PMCID: PMC8451002.
A Rare Case of Angiolymphoid Hyperplasia With Eosinophilia: A Dermoscopic and Therapeutic Teaching Point
https://dpcj.org/index.php/dpc/article/download/3216/2562
     A Rare Case of Angiolymphoid Hyperplasia
  With Eosinophilia: A Dermoscopic and Therapeutic
                    Teaching Point
         Marco Adriano Chessa1,2, Lorenzo Maltoni2, Silvia Robuffo2, Francesco Savoia3,
                            Bianca Maria Piraccini1,2, Iria Neri2


1 Dermatology Unit - IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
2 Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
3 IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori," Skin Cancer Unit, Meldola, Italy



Citation: Chessa MA, Maltoni L, Robuffo S, Savoia F, Piraccini BM, Neri I. A Rare Case of Angiolymphoid Hyperplasia with Eosinophilia:
A Dermoscopic and Therapeutic Teaching Point. Dermatol Pract Concept. 2024;14(1):e2024005. DOI: https://doi.org/10.5826/dpc.1401a5
Accepted: May 17, 2023; Published: January 2024
Copyright: ©2024 Chessa et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Lorenzo Maltoni, MD, Dermatology, Sant’Orsola-Malpighi Hospital, Bologna, Italy.
E-mail: lorenzo.maltoni2@studio.unibo.it




Case Presentation                                                             Several treatments with a combination of CO2 and dye
                                                                         laser were performed leading to debulking of the lesions and
A 45-year-old Caucasian woman referred to us for a 2-year                the treatment of the vascular component. Our treatment pro-
history of multiple, intensely itchy, red-purple papulonod-              tocol involved two laser sessions with a 5-weeks interval.
ular skin lesions located on the occipital area of her scalp             In the first session, each laser treatment was performed in
(Figure 1A). The lesions were firm to palpation, measuring               continuous wave mode at 3 W/cm2. Vaporized debris was
from 0.5 to 1 centimeter in diameter. The patient had no                 removed using a cotton-tipped applicator soaked in saline
significant past medical history and denied any history of               solution. In the same session, a second pass was performed in
trauma or systemic infection. Topical treatment with potent              focalized mode at 3 W/cm2. For the Dye laser, we used a 7 mm
corticosteroids resulted in no improvement. Dermoscopy                   spot size, 1.5 ms pulse duration, and fluence of 12.0 J/cm2.
showed red clods on the scratched lesions and dotted and                 Both treatments were well tolerated, and no complications
peripheral linear unfocused vessels on pink-whitish struc-               were reported. After surgery, fusidic acid ointment and
tureless area (Figure 1, B and C).                                       a mild pressure dressing were applied; the patient was in-
    A punch biopsy was performed, and the histological ex-               structed to apply the ointment to the treated area for 7 days.
amination revealed pathognomonic features leading to the                      The patient was evaluated every 3 weeks with import-
diagnosis of angio-lymphoid hyperplasia with eosinophilia                ant improvement of her symptoms and minimal scarring
(ALHE) (Figure 1D).                                                      (Figure 1E).




Image Letter | Dermatol Pract Concept. 2024;14(1):e2024005                                                                           1
Figure 1. (A) Multiple red-purple papulonodular skin lesions on the occipital area of the scalp; (B) Central amorphous pink-whitish structure
with dotted and peripheral linear unfocused vessels; (C) Red clods in the central part on pink-whitish background; (D) Histology revealed
a proliferation of blood vessels, lymphoid tissue and a high number of eosinophils within the lesion (H&E magnification X20); (E) Clinical
picture of the improvement after ablative treatment with the combination of CO2 and dye laser.


Teaching Points                                                             Treatment options mainly includes surgical excision of
                                                                        the lesions, cryotherapy or laser ablation. In ALHE recur-
ALHE is a rare idiopathic vascular disorder of unknown                  rences may occur and multiple treatments and follow up are
etiopathogenesis characterized by the presence of red-purple            mandatory [2].
papules located in the head and neck area.
    Dermoscopy of ALHE is unspecific and may show a pat-
tern characterized by red clods, pink-whitish background and            References
polymorphous vascular pattern consisting of dotted, globular             1. Akay BN, Fatih Atak M, Farabi B. Dermoscopic Features
and linear vessels [1]. In our opinion, the red rather than pink            of Two Cases of Angiolymphoid Hyperplasia with Eosino-
color may be related to traumatic scratching of lesions, and                philia and Review of the Literature. Dermatol Pract Concept.
lesions at different stages may coexist in the same patient.                2021;11(2):e2021003. DOI: 10.5826/dpc.1102a03. PMID:
                                                                            33747617. PMCID: PMC7943206.
    The main differential diagnoses include Kimura disease,
                                                                         2. Zou A, Hu M, Niu B. Comparison between Kimura's disease and
lichen planus, kaposi sarcoma, and molluscum contagiosum.
                                                                            angiolymphoid hyperplasia with eosinophilia: case reports and
The histological features of ALHE are the clue for the diag-                literature review. J Int Med Res. 2021;49(9):3000605211040976.
nosis and biopsy should be performed in all cases in which                  DOI: 10.1177/03000605211040976. PMID: 34525882. PMCID:
doubtful dermoscopic finding.                                                PMC8451002.




2                                                                              Image Letter | Dermatol Pract Concept. 2024;14(1):e2024005
