Lichen Amyloidosis Treatment & Management

  • Author: Sultan Al-Khenaizan, MBBS, FRCP(C); Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 24, 2012
 

Medical Care

Because of the growing appreciation of the importance of pruritus as the primary trigger for the deposition of amyloid, treatment modalities are directed toward the relief of pruritus.

  • Sedating antihistamines have been found to be moderately effective.
  • Menthol, in combination with other agents (eg, antihistamines), has been used successfully to relieve the pruritus associated with lichen amyloidosis.[15]
  • Topical and intralesional steroids are beneficial if combined with other modalities. Costanedo-Cazares et al reported improvement in lichen amyloidosis using treatment with 0.1% topical tacrolimus ointment.[16]
  • Topical dimethyl sulfoxide (DMSO), a chemical solvent, was used with moderate success, but failures are also reported.[17, 18, 19] Pandhi et al reported a lack of effect with DMSO treatment for cutaneous amyloidosis.[20]
  • Anecdotes of both success and failure with etretinate have been reported.[21, 22, 23] Acitretin, a prodrug of etretinate, has been used successfully to relieve pruritus and flatten hyperkeratotic papules in 2 patients with lichen amyloidosis.[24, 25]
  • Sawamura et al reported satisfying improvement of lichen amyloidosis with pulsed dye laser. Both pruritus and the papular eruption of lichen amyloidosis improved.[26]
  • In a report emphasizing the localization of lichen amyloidosis in body regions with lower temperatures, narrow-band UVB was used to treat the patient; marked improvement of pruritus and clearing of the amyloid deposits was reported.[27]
  • In 2009, Aoki and Kawana reported successful treatment of lichen amyloidosis of the auricular concha using electrodesiccation.[28]
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Surgical Care

Aggressive strategies proposed for the removal of amyloid include laser vaporization, dermabrasion, and excision of individual lesions. However, both the lesions and the pruritus usually promptly recur after these treatments.

In a prospective, side-by-side, controlled, clinical trial study, Ostovari et al used the Q-switched Nd:YAG laser (532- and 1064-nm) in 20 subjects with a clinical diagnosis and pathologic confirmation of macular amyloidosis. Using colorimetric score assessment and digital photographs before laser therapy and 8 weeks after treatment, they concluded that the 2 lasers (Q-switched 532- and 1064-nm Nd:YAG) are effective in reducing the degree of pigmentation in macular amyloidosis patches, with the 532-nm laser being more effective than the 1064-nm laser. The pictures shown in this paper were of low quality.[29]

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Contributor Information and Disclosures
Author

Sultan Al-Khenaizan, MBBS, FRCP(C)  Consulting Staff, Departments of Dermatology and Internal Medicine, King Fahad National Guard Hospital, Saudi Arabia

Disclosure: Nothing to disclose.

Specialty Editor Board

Catharine Lisa Kauffman, MD, FACP  Georgetown Dermatology and Georgetown Dermpath

Catharine Lisa Kauffman, MD, FACP is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Royal Society of Medicine, Society for Investigative Dermatology, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Warren R Heymann, MD  Head, Division of Dermatology, Professor, Department of Internal Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Warren R Heymann, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous Chief Editor, William D. James, MD, to the development and writing of this article.

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