We present a case of a 62-year-old woman with a 3-year history of a red indurated plaque on the right ala of the nose, which did not respond to therapy for rosacea. A skin biopsy showed a conglomerate of thick walled vessels with a wide variation of the vessel wall diameter and a cobblestone appearance. Furthermore there were some small infiltrates with eosinophilic granulocytes. The diagnosis of ALHE was made and the patient was referred to a plastic surgeon for excision of the tumour.
ALHE is a rare entity mostly found around the ears. ALHE on the nose is even more rare and could be misdiagnosed as phymatous rosacea. Misdiagnosis can lead to unnecessary treatment with antibiotics and delay of appropriate therapy.