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Epidemiology and Treatment of Angiolymphoid Hyperplasia With Eosinophilia
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersBACKGROUND
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.
Additional Info
Epidemiology and Treatment of Angiolymphoid Hyperplasia With Eosinophilia (ALHE): A Systematic Review
J Am Acad Dermatol 2015 Dec 11;[EPub Ahead of Print], BL Adler, AE Krausz, A Minuti, JI Silverberg, H Lev-TovFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Angiolymphoid hyperplasia with eosinophilia (ALHE) is common enough that clinicians may encounter it a few times in their career. Although benign, it may be disfiguring and symptomatic and, therefore, will inevitably keep presenting a therapeutic challenge; however, little is known about treatment outcomes. Since randomized controlled trials and even retrospective chart reviews are not practical in this case, we opted to collect all case reports ever published on this condition and see what we could learn. We found over 900 cases. We confirmed that ALHE indeed has a predilection for the face and particularly the ear. We also found that multiple lesions are associated with bleeding and pruritus; therefore, a thorough search for additional lesions should be performed in symptomatic patients prior to treatment. We found that steroids don’t seem to work. We found that surgery was the best treatment option, albeit suboptimal given an estimated recurrence rate of about 40%. That is far from perfect, but at least we can now manage our patients’ expectations better and rely on an evidence-based approach (inferior as it may be). Lasers may prove to be a promising solution, but not enough cases have been reported; thus, all practitioners are encouraged to report their experience with lasers for treatment of ALHE.