Localized axillary milia en plaque: a rare cutaneous case presentation of systemic amyloidosis

Abstract

Systemic AL amyloidosis is known to be associated with plasma cell dyscrasias, including multiple myeloma. The cutaneous manifestations of systemic AL amyloidosis are varied, but typically include waxy plaques or subcutaneous nodules. We report a woman who presented with bilateral eruptions of hyperpigmented plaques in her axillae, which were diagnosed as milia en plaque. She had a history of multiple myeloma, for which she was under the care of a haematologist. This is the first documented case, to our knowledge, of an eruption in the axillae being milia en plaque.

Nodules ulcerating into comedones overlying an indurated plaque

“…Milia en plaque describes the rare finding of densely grouped subepidermal keratinous cysts over an erythematous plaque. Some case reports have suggested a role for electromagnetic radiation in the pathogenesis of this condition 1 , 2 , 3 ; given that milia are thought to result from the obstruction of hair follicles or eccrine sweat ducts, radiotherapy may not only induce genetic damage to follicular stem cells but may promote occlusive structural changes, akin to radiation-induced strictures, to these adnexa as well. E. Nevus comedonicus – Incorrect.…”

“… 4 Continued documentation, however, has suggested localization to sites of prior insults, including those on the trunk and extremities. 1 , 3 , 4 E. Superior chest – Incorrect. Skin changes involving the superior chest, typically in a “V-shaped” distribution, classically result from photosensitive rashes including poikiloderma of Civatte and dermatomyositis.…”

“… 4 Continued documentation, however, has suggested localization to sites of prior insults, including those on the trunk and extremities. 1 , 3 , 4 …”

Primary Localized Cutaneous Nodular Amyloidosis Presenting as Milia: An Unusual Clinical Manifestation

“… 3 Milia are benign keratinous cysts most commonly found on the face, especially on the cheeks and eyelids. 4 Primary milia emerge spontaneously, and secondary milia result from skin disease or trauma. 5 Here, we report an unusual case of primary localized cutaneous nodular amyloidosis associated with recurrent milia that occurred after local trauma.…”