Angiolymphoid Hyperplasia with Eosinophilia with Follicular Mucinosis
A 49-year-old married Indian male presented with multiple, pruritic hyper-pigmented papular lesions of 0.5-1 cm in size [] over the vertex and right parietal scalp for a duration of 1 year. There was no history of preceding trauma or surgery at the site. The lesions arose spontaneously with gradual increase in size and number. There was no history of bleeding, but the patient complained of occasional pruritus in the lesions. There was no other relevant medical history. Peripheral blood eosinophilia was not present.\nA clinical differential diagnosis of prurigo nodularis and angiolymphoid hyperplasia with eosinophilia was considered.\nHistopathological examination from a papule revealed normal epidermis with large, thick-walled vessels in the upper and mid dermis lined by plump endothelial cells protruding into the lumen. There was a dense lymphocytic infiltrate along with many eosinophils present in the perivascular area and other parts of the dermis. These features were consistent with angiolymphoid hyperplasia. In addition to these, there were several hyperplastic follicles showing plenty of bluish-gray stringy mucin collected in large pools within the follicular epithelium. [Figures and ] Alcian blue stain at pH 2.5 confirmed presence of mucin within dilated follicular infundibula, interstitium, and perivascularly. [] Based on clinico-pathological correlation, a final diagnosis of angiolymphoid hyperplasia with eosinophilia with follicular mucinosis was made. Patient was advised intralesional bleomycin therapy; however, he lost to follow-up.