LAUSR

Dear Editor, Angiolymphoid hyperplasia with eosinophilia (ALHE) is an uncommon, chronic, benign, idiopathic vascular proliferation tumor that manifests as multiple erythematous or violaceous papules or nodules on the head and neck. The etiopathogenesis is still unknown, and the treatment is still unclear and challenging. Here, we present two cases of ALHE who were successfully treated with oral propranolol after several therapeutic failures. The first case is about a 56-year-old woman, who presented with a slowly growing violaceous elevated firm papulonodular lesions of 1.0–2 cm diameter in the retroauricular area and the front of her scalp over the preceding 2 years (Figure 1A). The histopathologic findings were consistent with the diagnosis of ALHE (Figure 1E,F). The patient was treated initially with pentoxyfylline. However, retroauricular lesions kept on growing. Hence, pentoxyfylline was stopped after 3 months of therapy and replaced by a topical tacrolimus (0.1%) twice a day for 2 months which was also discontinued due to its inefficacy. Because of the impossibility of surgical excision and the failure of previous treatments, a decision to opt for oral propranolol (40 mg/day) was taken. The pre-therapeutic assessment including a fasting blood glucose, a blood pressure, a pulse rate and an ECG were normal. After 8 weeks of treatment, retroauricular lesions disappeared (Figure 1B) along with significant regression of the other lesions. After 1 year of treatment, there has been no local recurrence nor obvious cardiovascular and blood sugar side-effects. The second case was regarding a 35-year-old woman who was referred with one-year history of multiple violaceous pruritic nodules involving the face and the scalp (Figure 1C) that had gradually increased in size and number. The histological findings confirmed the diagnosis of ALHE (Figure 1G). The patient was started on