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 Table of Contents  
LETTER TO THE EDITOR
Year : 2022  |  Volume : 8  |  Issue : 1  |  Page : 38-39

Angiolymphoid hyperplasia: Excellent response to polidocanol sclerotherapy


Department of Dermatology, SMBT Medical College, Nashik, Maharashtra, India

Date of Submission23-Sep-2019
Date of Decision20-Apr-2020
Date of Acceptance14-Feb-2022
Date of Web Publication11-Jun-2022

Correspondence Address:
Vikrant M Jadhav
Maitreya Plot-29, Kalpatarunagar, Ashoka Marg, Nashik, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijdd.ijdd_51_19

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How to cite this article:
Jadhav VM, Gugle AS, Barde NG. Angiolymphoid hyperplasia: Excellent response to polidocanol sclerotherapy. Indian J Drugs Dermatol 2022;8:38-9

How to cite this URL:
Jadhav VM, Gugle AS, Barde NG. Angiolymphoid hyperplasia: Excellent response to polidocanol sclerotherapy. Indian J Drugs Dermatol [serial online] 2022 [cited 2022 Aug 8];8:38-9. Available from: https://www.ijdd.in/text.asp?2022/8/1/38/347292



Sir,

Angiolymphoid hyperplasia with eosinophilia (ALHE) is an uncommon benign vascular proliferative lesion of unknown cause. Also called as histiocytoid hemangioma, the lesions present clinically as vascular skin nodules of various sizes and shapes in the head and neck region, affecting the skin and subcutaneous tissue.[1] Histopathologically, it is characterized by blood vessel proliferation with distinctive large endothelial cells accompanied by a characteristic inflammatory infiltrate that includes eosinophils.[2] The cause of this disease remains unknown, and physicians have used a variety of treatment modalities including cryosurgery, intralesional steroid injections, electrodesiccation, curettage, radiotherapy, laser therapy, and excision; still treatment is challenging.

A 35-year-old female presented with multiple erythematous nodules over scalp since 5 years. Lesions were excised ones, but recurred. On examination, nodules were firm, non-tender, and non-pulsatile and were not associated with regional lymphadenopathy. The routine blood investigations including complete blood count, erythrocyte sedimentation rate, routine blood chemistry, and urine analysis were normal. Histology confirmed the diagnosis of ALHE.

In view of the vascular nature, it was decided to treat these lesions with sclerotherapy, using polidocanol 3% as a sclerosant. Sclerosant was injected with 26-gage needle at the base of the lesion till blanching was seen. Quantity injected at one session was limited to 2 mL. A total of six sittings were given with an interval of 10 days. While injecting, care was taken not to inject in the peripheral normal skin. The lesions gradually decreased and completely disappeared after the sixth treatment [Figure 1][Figure 2][Figure 3]. Sclerotherapy was stopped when lesions completely disappeared. The patient attended our clinic for follow-up visits every month after the remission. At 2-year follow-up, there was no evidence of recurrence.
Figure 1: Pre-treatment

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Figure 2: After three injections

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Figure 3: After six injections

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ALHE, also known as epithelioid hemangioma, is an uncommon benign vaso-proliferative disease. It presents most commonly in patients aged 20–50 years, with a mean onset of 30–33 years.[3] ALHE affects women more often than men.[4] The condition is more commonly encountered in the Asian population followed by Caucasians.[4]

As ALHE is a benign disease with the complaint mainly of a cosmetic nature, a minimally invasive approach with a good safety profile is preffered.

Aethoxysclerol (also called aethoxysklerol, polidocanol) is a common sclerosant used in the treatment of varicose veins. It acts by provoking damage to the endothelium by attacking the lipids of the membrane, thereby causing cell damage and inflammation. Aethoxysclerol is also a local anesthetic and therefore the injection process is relatively painless.[5] The use of sclerosants is generally safe, although complications such as necrosis and scarring can be rarely seen. An isolated case of cardiac arrest attributed to polidocanol sclerotherapy has been reported.[6]

We treated our patient for cosmetic complaints, considering recurrence after excision and vascular nature of the lesion we opted for sclerotherapy. We conclude that sclerotherapy with polidocanol 3% is effective in the treatment of ALHE. It offers an alternative to conventional methods such as surgery, radiofrequency ablation, and electrodessication and is a simple, safer, and affordable office procedure. The patient can resume her daily activities immediately. Further studies would be required to consider sclerotherapy as monotherapy in the treatment of ALHE.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Chan JK, Hui PK, Ng CS, Yuen NW, Kung IT, Gwi E Epithelioid haemangioma (angiolymphoid hyperplasia with eosinophilia) and Kimura’s disease in Chinese. Histopathology 1989;15:557-74.  Back to cited text no. 1
    
2.
Cheney ML, Googe P, Bhatt S, Hibberd PL Angiolymphoid hyperplasia with eosinophilia (histiocytoid hemangioma): Evaluation of treatment options. Ann Otol Rhinol Laryngol 1993;102:303-8.  Back to cited text no. 2
    
3.
Meyerle J, Glusac E Angiolymphoid hyperplasia with eosinophilia 2005.Available from: http://www.emedicine.com/derm/topic30.htm. [Last accessed on 18 Nov 2019].  Back to cited text no. 3
    
4.
Weiss SW, Goldblum JR Benign tumours and tumour-like lesions of blood vessels. In: Enzinger FM, Weiss SW, editors. Soft Tissue Tumours. 4th ed. Philadelphia, PA: The CV Mosby Co; 2001. p. 856-64.  Back to cited text no. 4
    
5.
Shwartz RA Cosmeceuticals. [Last updated on February 28, 2006]. Available from: http://www.emedicine.com/derm/topic509.htm. [Last accessed on 18 Nov 2019].   Back to cited text no. 5
    
6.
Marrocco-Trischitta MM, Guerrini P, Abeni D, Stillo F Reversible cardiac arrest after polidocanol sclerotherapy of peripheral venous malformation. Dermatol Surg 2002;28:153-5.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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