Membranous nephropathy accompanied by angiolymphoid hyperplasia of the skin

Combined pulsed dye and CO2 lasers in the treatment of angiolymphoid hyperplasia with eosinophilia

Angiolymphoid hyperplasia with eosinophilia (ALHE) is an uncommon dermatosis of unknown etiology that manifests as characteristic red nodules and papules with a predilection for the scalp and periauricular region. Treatment is required for both esthetic and functional reasons, as lesions may ulcerate and bleed. Many treatment approaches have been reported, including excision, systemic medical approaches, topical or intralesional therapies, and non-invasive modalities including cryotherapy, electrosurgery, and laser. Treatments have exhibited variable efficacy, and the recurrence rate is 100 %. We report the combination of pulsed dye laser and CO2 laser in the treatment of ALHE in 14 patients. All patients exhibited clinical response after a mean of 2.4 ± 0.4 treatment sessions. The clinical efficacy of the combined treatment, together with its well-tolerated nature, render the use of pulsed dye laser in combination with CO2 laser, a viable treatment for debulking ALHE lesions. Ongoing maintenance treatments are needed to due to the high degree of relapse.

Epidemiology and treatment of angiolymphoid hyperplasia with eosinophilia (ALHE): A systematic review

BACKGROUND

Current knowledge of angiolymphoid hyperplasia with eosinophilia (ALHE) derives from retrospective reports and case series, leading to a nonevidence-based treatment approach.

OBJECTIVE

We sought to systematically review the literature relating to cutaneous ALHE to estimate its epidemiology and treatment outcomes.

METHODS

A literature search of PubMed, EMBASE, Web of Science, and Google Scholar was conducted. Articles detailing cases of histologically confirmed cutaneous ALHE were included.

RESULTS

In all, 416 studies were included in the review, representing 908 patients. There was no sex predominance among patients with ALHE. Mean age at presentation was 37.6 years. There was a significant association between presence of multiple lesions and pruritus, along with bleeding. Surgical excision was the most commonly reported treatment for ALHE. Treatment failure was lowest for excision and pulsed dye laser. Mean disease-free survival after excision was 4.2 years. There were higher rates of recurrence postexcision with earlier age of onset, longer duration of disease, multiple lesions, bilateral lesions, pruritus, pain, and bleeding.

LIMITATIONS

Potential for publication bias is a limitation.

CONCLUSIONS

Surgical excision appears to be the most effective treatment for ALHE, albeit suboptimal. Pulsed dye and other lasers may be effective treatment options. More studies are needed to improve the treatment of ALHE.

Angiolymphoid hyperplasia with eosinophilia associated with tetanus toxoid vaccination

Three cases of angiolymphoid hyperplasia with eosinophilia are reported at the site of tetanus toxoid vaccination. All presented as nodules on the upper arm, a known adverse effect of the vaccine following superficial inoculation. Histologically the nodules showed numerous small and medium sized vessels, some lined by hyperplastic endothelial cells with perivascular lymphocytic cuffing and an inflammatory infiltrate of plasma cells, eosinophils and scattered mast cells. Lymphoid follicles replete with germinal centres were identified in the dermis and subcutaneous tissue. Immunostaining revealed a polytypic lymphoplasmacytic infiltrate and a curious IgE reticulated pattern within the germinal centres, a feature described in both Kimura's disease and angiolymphoid hyperplasia. The present study suggests that atopic reaction to tetanus toxoid may be an aetiological factor in some cases of angiolymphoid hyperplasia.