MACULAR AMYLOIDOSIS

By Gary M. White, MD

Macular Amyloidosis


Macular Amyloidosis (MA) is caused by the deposition of an amorphous hyaline protein, restricted to the papillary dermis, without any systemic manifestations. For a related condition, see frictional melanosis.

Clinical

Dark brown patches which may have a reticulated or rippled pattern are typical. The back and shins are common sites, but widespread lesions may occur. Causes for pruritus should be sought, e.g., xerosis.

Treatment

The most valuable intervention is to convince the patient not to scratch! Spend a few moments asking about how they shower and how they care for their skin. Many patients scrub in the shower and/or use a brush to scrub the back. This they must stop!! Potent topical steroids used over several weeks may help flatten out the lesions and decrease pruritus. However, no matter how potent the steroid, the lesions will persist if the patient persists in scratching.

If any pruritus is from dry skin, then moisturizing immediately after the shower with an emolliating cream or ointment may help. No lotions please. UVB may be tried, here along with tacrolimus [J Pak Med Assoc. 2014 May;64(5):579-82]. Acitretin has been used. To reduce pigmentation, various lasers have shown significant benefit [Lasers Surg Med. 2015 Jul;47(5):388-95], e.g. the Q-switched Nd:YAG laser.

Additional Pictures

Two cases of macular amyloidosis of notalgia paresthetica. In the past, this was called "puzzling posterior pigmented pruritic patches". The patient's scratching causes the pigmentation.
Macular amyloidosis in notalgia paresthetica Macular Amyloidosis

The linear, rippled pattern of macular amyloidosis.
Macular amyloidosis Macular amyloidosis

Macular amyloidosis close up showing an irregular pattern.
Macular amyloidosis

RegionalDerm

Homepage | FAQs | Use of Images | Contact Dr. White


It is not the intention of RegionalDerm.com to provide specific medical advice, diagnosis or treatment. RegionalDerm.com only intends to provide users with information regarding various medical conditions for educational purposes and will not provide specific medical advice. Information on RegionalDerm.com is not intended as a substitute for seeking medical treatment and you should always seek the advice of a qualified healthcare provider for diagnosis and for answers to your individual questions. Information contained on RegionalDerm.com should never cause you to disregard professional medical advice or delay seeking treatment. If you live in the United States and believe you are having a medical emergency call 911 immediately.