Acral pseudolymphomatous angiokeratoma of children in an elderly man: report of a case and review of the literature

Acral pseudolymphomatous angiokeratoma of children (APACHE) is clinically characterized by angiomatous papules that preferentially affect acral areas of children. It is currently believed to be a variant of pseudolymphoma rather than angiokeratoma. Histopathologically, a mixed inflammatory cell infiltrate comprising B‐ and T‐lymphocytes and a proliferation of thick‐walled blood vessels are the hallmark. In the literature, although more adult cases are being described, the clinical, epidemiologic and histopathologic data of this presentation is scant. We report a 76‐year‐old man who presented with a 5‐year history of progressively increasing asymptomatic dusky dome‐shaped papules and plaques on his upper and lower extremities. Histology was consistent with APACHE. After reviewing all the adult cases in the literature and comparing them to the classical variant in children, we found no significant difference warranting separating these two variants. We prefer the designation “papular angiolymphoid hyperplasia” to APACHE as it encompasses all the childhood and adult cases involving acral and nonacral sites and highlights the histological and sometimes clinical similarities this entity shares with angiolymphoid hyperplasia with eosinophilia.