Lymphangioendothelioma after a tick bite

Abstract

tain whether this influenced the appearance of the lesions and contributed to the nature of the episodes, although it has been noted that systemic corticosteroids may be associated with the occurrence of continuous EM.9 Previous studies of HAEM have demonstrated that the HSV DNA remains in the skin even after the HAEM lesions have cleared. Although the pathogenesis of HAEM is not understood, it has been speculated that this persistence of HSV in the skin is involved in the occurrence of EM lesions in the same cutaneous sites in subsequent episodes. It is of interest that in case 4 no further episodes of HAEM have been seen since the single EM lesion was completely removed by shave excision. These four subjects were unique in our experience, representing less than 3% of HAEM patients we have evaluated, and we caution against the overdiagnosis of atypical HAEM. Many conditions may involve the production of targetlike lesions and mimic EM, including giant urticaria, systemic lupus erythematosus, mycosis fungoides, granuloma annulare, fixed drug eruptions, erythema annulare centrifugum, and several forms of vasculitis. A diagnosis of HAEM should be made only after a skin biopsy specimen has Journal of the American Academy of Dermatology July 1998