Lichen amyloidosus: A consequence of scratching

Weyers, Wolfgang; Weyers, Imke; Bonczkowitz, Matthias; Díaz‐Cascajo, Carlos; Schill, Wolf‐Bernhard

doi:10.1016/s0190-9622(97)70066-5

Cited by 88 publications

(79 citation statements)

References 28 publications

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“…8,9 Yet, as it was the case in our patient, mildly or non-pruritic cases have also been described. 9,13 In such patients other factors, for instance a locus located on the short arm of chromosome 1, has been suggested to be involved in the pathogenesis. 9,14 The diagnosis of LA depends on the clinical and histopathological findings.…”

Section: Discussionmentioning

confidence: 99%

The Association of Rheumatoid Arthritis with Lichen Amyloidosis: Case Report

Özcan¹,

Kocaağa²,

Utku³

et al. 2015

Turkiye Klinikleri J Case Rep

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Section: Discussionmentioning

confidence: 99%

The Association of Rheumatoid Arthritis with Lichen Amyloidosis: Case Report

Özcan¹,

Kocaağa²,

Utku³

et al. 2015

Turkiye Klinikleri J Case Rep

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“…2 The amyloid deposits in patients with lichen amyloidosis are mainly restricted to the upper dermis and arise because of focal epidermal damage with subsequent conversion of necrotic keratinocytes into amyloid in the papillary dermis. 5 The condition persists for many years with intensive pruritus, but an asymptomatic variant has also been reported in the literature. 6,7 Treatment options include potent topical steroids under occlusion, intralesional steroids, topical dimethylsulfoxide and etretinate.…”

Section: Medical Institute Of the Ministry Of The Interior (Mvr-sofiamentioning

confidence: 97%

“…2 Although the etiology is not fully understood, chronic irritation to the skin has been proposed as possible etiological factor. 5 Chronic scratching is considered to be a cause of damage to keratinocytes in lichen amyloidosis. 2 The amyloid deposits in patients with lichen amyloidosis are mainly restricted to the upper dermis and arise because of focal epidermal damage with subsequent conversion of necrotic keratinocytes into amyloid in the papillary dermis.…”

Section: Medical Institute Of the Ministry Of The Interior (Mvr-sofiamentioning

confidence: 99%

Lichen amyloidosis associated with rheumatoid arthritis: unique presentation in a Bulgarian patient

2017

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An 80-year-old Caucasian female patient presented with a two-year history of intensively itching skin rash located on her left lower leg and mild swelling of the proximal interphalangeal and metacarpophalangeal joints, accompanied by morning stiffness around these joints, lasting at least one hour before maximal improvement (Figures 1A and 1B). She reported having had a long-lasting medical history of accompanying diseases that had been controlled with medicines. These conditions included arterial hypertension, hypothyroidism, chronic pyelonephritis, angina pectoris and primary glaucoma. There was no family history of cutaneous disorders.Presence of intensively pruritic erythematous papules located on the left pretibial surface was established clinically (Figures 1A and 1B). Symmetrical soft-tissue swelling around the small joints was also observed, but no rheumatoid nodules were seen. The laboratory blood tests did not reveal any abnormalities in the complete or differentiated blood count. The kidneys and liver showed normal functioning. The rheumatoid factor was 827 u/ml (reference values: less than 40-60 u/ml). Presence of periarticular osteopenia in the interphalangeal and metacarpophalangeal joints was established radiographically. A diagnosis of seropositive rheumatoid arthritis was made, which met most of the criteria postulated by the committee of the American Rheumatism Association.Immunological testing for antinuclear antibody (ANA) and Scl 70 was negative. The cutaneous pathological changes presented required a wide spectrum of differential diagnoses, including pretibial myxedema, necrobiosis lipoidica, the small papular form of cutaneous sarcoidosis, T-cell lymphoma, lichen ruber planus and Arndt-Gottron scleromyxedema.Histopathological evaluations on skin biopsies revealed hyperkeratosis, focal acanthosis, subepithelial structures that stained pink with hematoxylin-eosin and mild to moderate mononuclear infiltrate around single vessels (Figure 2A). Subepithelial Congo red-positive deposits were also observed ( Figures 2B and 2C), which showed blue-green birefringence under polarized light.The findings were characteristic of amyloid deposition and a diagnosis of lichen amyloidosis was made. No clinical or laboratory evidence of systemic amyloidosis was presented. Systemic therapy consisting of bilastine (20 mg daily) and acitretin (15 mg daily) was started, with topical application of 0.1% mometasone furoate cream, which produced a satisfactory therapeutic response. The patient was referred to a rheumatological unit for further therapy with biological agents.Localized cutaneous amyloidosis encompasses several conditions characterized by deposition of amyloid or amyloid-like proteins in the dermis, including macular amyloidosis and lichen amyloidosis.1 Nodular localized cutaneous amyloidosis is another condition in this group: it is the rarest type and distinct from the other two. In this type, plasma cells produce immunoglobulin light chains that are precursors to the amyloid fibril protein called am...

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“…Degenerated or apoptotic keratinocytes shed into the dermis are phagocytosed by histiocytes or fibroblasts and the aggregated keratin filaments are converted into amyloid. Amyloid fibrils may also be secreted by damaged or stimulated basal cells and produced at the dermo-epidermal interface (2,12). PCA is a chronic progressive skin disorder with disabling course and unsatisfactory treatment.…”

Section: Case Reportmentioning

confidence: 99%

“…The spectrum of clinical presentation of PCA includes macular hyperpigmented, nodular and papular (lichenoid) forms (2)(3)(4). Lichen amyloidosis is a form of primary localized cutaneous amyloidosis that is associated with pruritic skin-colored or hyperpigmented hyperkeratotic papules (5).…”

Section: Introductionmentioning

confidence: 99%

Ultraviolet-A1 phototherapy in the treatment of primary diffuse cutaneous amyloidosis: an additional phototherapy regimen for cutaneous amyloidosis with review of treatment options

Maurelli¹

2015

cderm

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SummaryPrimary cutaneous amyloidosis (PCA) is a chronic pruritic skin disorder of unknown origin. We report on the case of a 48-year-old Indian woman with diffuse biphasic amyloidosis in which UVA1 phototherapy resulted in marked improvement of skin lesions and pruritus. UVA1 phototherapy was administered as monotherapy five times a week for 3 weeks with an exposure at a single dose of 130 J/cm 2 resulting in a cumulative UVA1 dose of 1950 J/cm 2 . After treatment, the skin appeared less pigmented with flattened papules, and the histology revealed the disappearance of amyloid deposits and the presence of melanophages in the dermis. A comprehensive review of the literature on the treatment options for PCA showed no controlled trials available. However, case series indicated phototherapy (UVB, narrow band UVB, photochemotherapy) as the most successful treatment.

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Lichen amyloidosus: A consequence of scratching

Cited by 88 publications

References 28 publications

The Association of Rheumatoid Arthritis with Lichen Amyloidosis: Case Report

The Association of Rheumatoid Arthritis with Lichen Amyloidosis: Case Report

Lichen amyloidosis associated with rheumatoid arthritis: unique presentation in a Bulgarian patient

Ultraviolet-A1 phototherapy in the treatment of primary diffuse cutaneous amyloidosis: an additional phototherapy regimen for cutaneous amyloidosis with review of treatment options

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