Title: Angiolymphoid hyperplasia with eosinophilia of the medial canthus: A multispecialty approach (dermatology, ophthalmology, OMFS)
Abstract:
Introduction: Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare, benign vascular proliferative disorder predominantly affecting the head and neck. Lesions may be solitary or multiple, asymptomatic or occasionally pruritic or tender. Differential diagnoses can include Kimura’s disease, cutaneous lymphoma, basal cell carcinoma, haemangioma, pyogenic granuloma, Kaposi’s sarcoma, and vasculitides. Histopathology is essential for diagnosis, and management ranges from medical therapy to surgical excision, with recurrence rates up to 40%.
Case Presentation: A 51-year-old male presented with a large lesion involving the medial canthus and nasal bridge. Initial dermatological review for widespread pruritic rash led to a diagnosis of eczema. Early biopsy revealed dermal lymphocytic and eosinophilic infiltrates. Blood work, serology, and imaging were unremarkable. A repeat skin biopsy confirmed ALHE. Over several years, multiple medical therapies—including corticosteroids, antihistamines, montelukast, hydroxychloroquine, topical tacrolimus, and methotrexate—achieved only partial disease control. Definitive surgical excision was performed collaboratively by ophthalmology and OMFS colleagues with reconstruction in a single stage, requiring careful haemostasis due to the lesion’s vascularity.
Discussion: ALHE is challenging to diagnose and treat, particularly in cosmetically and functionally sensitive facial regions. Histopathology distinguishes it from other vascular or lymphoproliferative disorders. While medical therapy may be appropriate for some patients, surgical excision—preferably tissue-sparing techniques such as Mohs micrographic surgery—may reduce recurrence risk. Long-term follow-up is essential to monitor for recurrence and preserve function.
Conclusion: This case enriches the body of literature on the rare vascular disorder ALHE and highlights the diagnostic and therapeutic challenges of ALHE in the head and neck, emphasizing individualized, multidisciplinary management across three disciplines (OMFS, ophthalmology and dermatology) to achieve optimal functional and cosmetic outcomes.
