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Summer 2015, Vol. 23 No. 2

Hong Kong J. Dermatol. Venereol. (2015) 23, 99


Answers to Dermato-venereological Quiz

Answers to Dermato-venereological Quiz

KL Yuen 原嘉麗 and WY Lam 林偉業

  1. The differential diagnosis includes benign causes such as keloid, lymphocytoma cutis, nodular prurigo, haemangioma, pyogenic granuloma, cylindroma, angiolymphoid hyperplasia with eosinophilia and Kimura's disease. Malignant causes include angiosarcoma, Kaposi sarcoma, lymphoma, squamous cell carcinoma, basal cell carcinoma and cutaneous metastases.
  2. Angiolymphoid hyperplasia with eosinophilia (ALHE) is a tumour of dermal and subcutaneous tissues composed of a proliferation of vessels lined by "epithelioid" endothelial cells (arrows in Figure 2) in a background of inflammatory cells with many eosinophils (arrow in Figure 3).
  3. The diagnosis is ALHE. ALHE usually presents as erythematous, violaceous, or brown dome-shaped plaques or nodules mostly on the head and neck region. It may pulsate or bleed and is associated with symptoms like pruritus and pain.
  4. ALHE is a benign condition. Treatment is considered when the lesions are symptomatic and for cosmetic reasons. First-line treatments include surgery, laser therapy, cryotherapy, electrosurgery, topical and intralesional steroid. Other treatment modalities include topical tacrolimus, topical imiquimod, intralesional interferon a-2b, oral propranolol, isotretinoin, thalidomide, pentoxifylline and indomethacin farnesil.