P034 Multiple vascular nodules on the scalp

Abstract

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare, benign vasculoproliferative disorder of unknown aetiology. We present a case highlighting the progressive nature of the disease and the value of repeat biopsy to obtain clinicopathological correlation. A 47-year-old woman presented with a 1-year history of a pruritic eruption of monomorphic, erythematous papules with a vascular appearance on the right occipital scalp. Initial biopsy suggested a capillary haemangioma, and associated folliculitis was treated with oral minocycline. The patient was lost to follow-up and re-presented 2 years later with progression in the both size and number of lesions. Examination revealed a cluster of 42 firm erythematous papules and nodules, ranging from 4 to 13 mm in diameter, without epidermal change. The lesions were pruritic and prone to bleeding with minimal trauma. There was no personal or family history of haemangiomas and full-skin examination was otherwise unremarkable. A trial of oral propranolol, titrated to 40 mg three times daily, was ineffective and discontinued after 6 months. Repeat biopsy demonstrated vascular proliferation of ectatic vessels with a nodular lymphocytic infiltrate and numerous eosinophils, consistent with ALHE. The patient subsequently underwent serial surgical management with curettage and cautery of individual lesions. Over a 2-year period, six procedures were performed, with significant improvement in pruritus and cosmetic outcome. No new lesions have developed and the patient remains satisfied with ongoing surgical management. ALHE typically presents as isolated or clustered pink-to-red papules or nodules, most commonly affecting the head and neck. The condition may be asymptomatic or associated with pruritus, pain or bleeding. The pathogenesis remains incompletely understood, with proposed roles for trauma, infection or hormonal factors. There is no standardized medical therapy, and recurrence rates remain high across treatment modalities. This case emphasizes the importance of clinicopathological correlation and repeat biopsy in establishing the diagnosis of ALHE.