Approach Considerations

Many therapeutic modalities have been suggested, including topical and systemic medications, phototherapy, electrodessication, dermabrasion, cryosurgery, and lasers, but no standardized treatment has been established.^[7] Because of the growing appreciation of the importance of pruritus as the primary trigger for the deposition of amyloid, treatment modalities are often directed toward the relief of pruritus.

Medical Care

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 have also been reported.^{[18, 19, 20]}Pandhi et al reported a lack of effect with DMSO treatment for cutaneous amyloidosis.^[21]

Acitretin has been used successfully to relieve pruritus and flatten hyperkeratotic papules in 3 patients with lichen amyloidosis.^{[22, 23, 24]}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.^[25]

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.^[26] Koh et al reported successful clearance of amyloid deposition and near normalization of epidermal changes following a 6-month course of daily oral alitretinoin 30 mg in a 49-year-old woman with lichen amyloidosis and atopic dermatitis.^[27] Yew and Tey reported significant reduction in pruritus in 2 patients after administration of amitriptyline 10 mg for 6 weeks.^[28]

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. Sawamura et al reported satisfying improvement of lichen amyloidosis with pulsed dye laser. Both pruritus and the papular eruption of lichen amyloidosis improved.^[29]

Aoki and Kawana reported successful treatment of lichen amyloidosis of the auricular concha using electrodessication.^[30] Significant improvements were observed in lichen amyloidosis treated with carbon dioxide laser in 2 studies.^{[31, 32]}

Medication

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