Department of Dermatology, Hanyang University Hospital, Seoul, South Korea.
Dermatol Ther. 2017 Nov;30(6). doi: 10.1111/dth.12537. Epub 2017 Sep 14.
Lichen amyloidosis (LA) is characterized by the deposition of amyloid that may respond to chronic scratching that may be secondary to atopic dermatitis, stasis dermatitis, or interface dermatitis. Despite the development of several therapeutic strategies, including topical steroids, oral antihistamines, cyclosporine, and retinoids, an effective treatment for LA has not been established. A 49-year-old woman who has been treated irregularly for atopic dermatitis for 7 years presented with localized brownish papules on the left forearm and right elbow. They developed 3 months prior and were becoming more prominent despite of treatment with cyclosporine, oral antihistamines, and topical steroids for 5 months prior to presentation. A skin biopsy revealed amyloid deposition in the dermal papillae and the patient was diagnosed with LA associated with atopic dermatitis. A 6-month course of daily oral alitretinoin 30 mg produced marked improvement in the thickness and color of the hyperkeratotic papules without aggravation of the patient's atopic dermatitis. Histologic evaluation showed clearance of amyloid deposition and almost normalization of the epidermal changes. Herein, we report a case of LA treated with alitretinoin and suggest that it could be a potential treatment option for LA, especially in patients with inflammatory skin diseases including atopic dermatitis.
淀粉样变性病（LA）的特征是淀粉样物质的沉积，可能是由于特应性皮炎、淤滞性皮炎或界面性皮炎引起的慢性搔抓所致。尽管已经开发了几种治疗策略，包括局部类固醇、口服抗组胺药、环孢素和类视黄醇，但尚未确立有效的 LA 治疗方法。一位 49 岁的女性，患有特应性皮炎 7 年，不规则治疗，左前臂和右肘出现局部褐色丘疹。它们在 3 个月前出现，并在就诊前 5 个月接受环孢素、口服抗组胺药和局部类固醇治疗后变得更加突出。皮肤活检显示真皮乳头中有淀粉样物质沉积，患者被诊断为与特应性皮炎相关的 LA。每日口服阿利维 A 30mg，疗程 6 个月，使角化过度丘疹的厚度和颜色明显改善，而特应性皮炎无恶化。组织学评估显示淀粉样物质沉积清除，表皮变化几乎正常化。在此，我们报告一例用阿利维 A 治疗的 LA，并建议它可能是 LA 的一种潜在治疗选择，特别是在包括特应性皮炎在内的炎症性皮肤病患者中。
