Lichen Amyloidosis Treatment & Management

Updated: Dec 11, 2015
  • Author: Sultan Al-Khenaizan, MBBS, FRCPC; Chief Editor: William D James, MD  more...
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Treatment

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. [16]

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. [17]

Topical dimethyl sulfoxide (DMSO), a chemical solvent, was used with moderate success, but failures are also reported. [18, 19, 20] Pandhi et al reported a lack of effect with DMSO treatment for cutaneous amyloidosis. [21]

Anecdotes of both success and failure with etretinate have been reported. [22, 23, 24] Acitretin, a prodrug of etretinate, has been used successfully to relieve pruritus and flatten hyperkeratotic papules in 2 patients with lichen amyloidosis. [25, 26]

Sawamura et al reported satisfying improvement of lichen amyloidosis with pulsed dye laser. Both pruritus and the papular eruption of lichen amyloidosis improved. [27]

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. [28]

In 2009, Aoki and Kawana reported successful treatment of lichen amyloidosis of the auricular concha using electrodesiccation. [29]

Terao et al evaluated the effects of topical tocoretinate on lichen amyloidosis and macular amyloidosis lesions. The outcome was very good for 4, good for 2, moderate for 2, and poor for 2 of 10 treated patients. [30]

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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. [31, 32]

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. [33]

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