By Gary M. White, MD
Lichen amyloidosis is a thickening of the skin from chronic rubbing/scratching in which keratinocyte products generate amyloid in the dermis. See also macular amyloidosis.
Confluent, pruritic, brown papules of the shins forming plaques with a linear or rippled pattern is characteristic. Nonpalpable macular amyloidosis may also occur. There is good evidence that lichen amyloidosis, macular amyloidosis and biphasic amyloidosis are all manifestations of the same process. Scratching or some type of rubbing is almost always present. Many patients have other diseases associated with pruritus, e.g. atopy, stasis dermatitis.
The first intervention is to discuss scratching. Do they? If so, when and how? Hands? A brush? Are there triggers? Is it just a habit? Emphasize the importance of not scratching and treat the itch. Dry skin should be prevented with daily moisturization after the shower. A potent topical steroid as well is very helpful. If prescribed, make sure the steroid is applied directly to the skin after the shower and not diluted with any moisturizer. If leg swelling is present, support hose may be needed. In case of severe pruritus, UVB may be helpful. In one report, acitretin 25 mg/day combined with topical clobetasol was very effective [Indian Dermatol Online J. 2014 Dec; 5: S92–S94]. Oral alitretinoin 30 mg/day was effective. The one time application of an 8% capsaicin patch (Qutenza) for 60 minutes directly over affected skin resulted in dramatic decrease in pruritus and clinical appearance in 2 patients over several months [JEADV 2016;30;1236].
The patient should be told that even when successfully treated, the color often takes months to fade. For a similar approach to treatment, see macular amyloidosis.
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