Ozkaya-Bayazit E, Baykal C, Kavak A
Dermatologische Abteilung, Medizinischen Fakultät Istanbul der Universität.
Hautarzt. 1997 Jan;48(1):31-7. doi: 10.1007/s001050050543.
Macular amyloidosis (MA) and lichen amyloidosus (LA) are the two major variants of the primary cutaneous amyloidoses which present with severe and therapy resistant itching. Various therapeutic modalities such as antihistamines, intralesional injection or topical application of corticosteroids, etretinate, UVB irradiation and dermoabrasion have been employed with variable success. Recently, in a few case reports authors have observed encouraging beneficial clinical effects by using topical dimethyl sulphoxide (DMSO). In our study 10 patients with either MA or LA or biphasic amyloidosis were treated with a 50% solution of DMSO in water. 9 of them showed marked clinical improvement at the end of 6-20 weeks of treatment. Degranulation and depletion of the mast cells by DMSO is the most probable explanation for the rapid improvement of itching beginning within the first week of therapy. Remarkable flattening of the lichenoid papules which was obtained within 11 weeks of treatment is interpreted as a result of the improvement of itching and the related scratch effect. Histological examination after treatment revealed no disappearance of amyloid deposits in the papillary dermis. In the follow-up period relapses of itching and papules were observed. Therefore further studies are needed to find out the optimal procedure of therapy.
黄斑淀粉样变（MA）和苔藓样淀粉样变（LA）是原发性皮肤淀粉样变的两种主要类型，均表现为严重且难治性瘙痒。已采用多种治疗方式，如抗组胺药、皮损内注射或外用皮质类固醇、依曲替酯、紫外线B照射及皮肤磨削术，但疗效各异。最近，在一些病例报告中，作者观察到外用二甲基亚砜（DMSO）产生了令人鼓舞的有益临床效果。在我们的研究中，10例MA、LA或双相淀粉样变患者接受了50% DMSO水溶液治疗。其中9例在治疗6 - 20周结束时临床症状显著改善。DMSO导致肥大细胞脱颗粒和耗竭最有可能解释了治疗第一周内瘙痒迅速改善的原因。治疗11周内苔藓样丘疹明显变平被解释为瘙痒改善及相关搔抓效应的结果。治疗后组织学检查显示乳头真皮内淀粉样沉积物未消失。在随访期间观察到瘙痒和丘疹复发。因此，需要进一步研究以找出最佳治疗方案。
