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An intensely pruritic pebbled presentation.
Dermatol Online J. 2018 Mar 07; 24(2)DO

Abstract

Lichen amyloidosis (LA) is a form of primary localized cutaneous amyloidosis (PLCA) characterized by bilateral intensely itchy domed scaly hyperkeratotic papules. Lichen amyloidosis is rare and affects men more than women. It is uncommonly seen in the western world but more prevalent in Asia. These papules most typically affect the shins and occasionally the arms and torso. Lichen amyloidosis has been reported in association with autoimmune disorders and after prolonged exfoliation and friction of affected skin. We present a 40-year-old woman with LA. In LA, the characteristic histological finding is apple-green birefringence of Congo red-stained preparations observed under polarized light. However, this is not always strongly positive, as in our patient. Other findings may include eosinophilia, periodic acid-Schiff positivity, staining with thioflavin T, and metachromasia after staining with crystal violet or methyl violet. Treatment of LA is difficult and complete clinical remission is seldom achieved. Recent trials revealed beneficial outcomes with topical calcipotriol, phototherapy, acitretin, cyclophosphamide, and laser treatments. A combination of acitretin, antihistamines, topical steroids, and hydrocolloid dressings have been beneficial in our patient with LA.

Authors+Show Affiliations

Department of Dermatology, Barts Health NHS Trust, London, U.K. liviasoriano@doctors.org.uk.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

29630157

Citation

Soriano, Livia Francine, et al. "An Intensely Pruritic Pebbled Presentation." Dermatology Online Journal, vol. 24, no. 2, 2018.
Soriano LF, McGrath C, Hawthorne M, et al. An intensely pruritic pebbled presentation. Dermatol Online J. 2018;24(2).
Soriano, L. F., McGrath, C., Hawthorne, M., & Ekeowa-Anderson, A. L. (2018). An intensely pruritic pebbled presentation. Dermatology Online Journal, 24(2).
Soriano LF, et al. An Intensely Pruritic Pebbled Presentation. Dermatol Online J. 2018 Mar 7;24(2) PubMed PMID: 29630157.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - An intensely pruritic pebbled presentation. AU - Soriano,Livia Francine, AU - McGrath,Conn, AU - Hawthorne,Mark, AU - Ekeowa-Anderson,Arucha Linda, Y1 - 2018/03/07/ PY - 2018/03/05/received PY - 2018/03/05/accepted PY - 2018/4/10/entrez PY - 2018/4/10/pubmed PY - 2018/5/23/medline JF - Dermatology online journal JO - Dermatol. Online J. VL - 24 IS - 2 N2 - Lichen amyloidosis (LA) is a form of primary localized cutaneous amyloidosis (PLCA) characterized by bilateral intensely itchy domed scaly hyperkeratotic papules. Lichen amyloidosis is rare and affects men more than women. It is uncommonly seen in the western world but more prevalent in Asia. These papules most typically affect the shins and occasionally the arms and torso. Lichen amyloidosis has been reported in association with autoimmune disorders and after prolonged exfoliation and friction of affected skin. We present a 40-year-old woman with LA. In LA, the characteristic histological finding is apple-green birefringence of Congo red-stained preparations observed under polarized light. However, this is not always strongly positive, as in our patient. Other findings may include eosinophilia, periodic acid-Schiff positivity, staining with thioflavin T, and metachromasia after staining with crystal violet or methyl violet. Treatment of LA is difficult and complete clinical remission is seldom achieved. Recent trials revealed beneficial outcomes with topical calcipotriol, phototherapy, acitretin, cyclophosphamide, and laser treatments. A combination of acitretin, antihistamines, topical steroids, and hydrocolloid dressings have been beneficial in our patient with LA. SN - 1087-2108 UR - https://www.unboundmedicine.com/medline/citation/29630157/An_intensely_pruritic_pebbled_presentation_ L2 - http://escholarship.org/uc/item/6tp6f9c4 DB - PRIME DP - Unbound Medicine ER -