Weyers W, Weyers I, Bonczkowitz M, Diaz-Cascajo C, Schill W B
Center for Dermatopathology, Freiburg, Germany.
J Am Acad Dermatol. 1997 Dec;37(6):923-8. doi: 10.1016/s0190-9622(97)70066-5.
Lichen amyloidosus (LA) is generally said to be a pruritic type of amyloidosis of unknown cause. Histopathologically, it is characterized by epidermal changes of lichen simplex chronicus and by deposits of amyloid in the papillary dermis that are derived from keratin peptides of necrotic keratinocytes. Chronic scratching is responsible for the development of lichen simplex chronicus and may lead to necrosis of individual keratinocytes.
Our purpose was to evaluate whether chronic scratching may also be responsible for the formation of amyloid in LA.
We studied patients with LA in regard to histopathologic findings, onset of pruritus, associated diseases, and response to treatment.
In most cases, pruritus had preceded the skin lesions. Eight of nine patients suffered from diseases other than LA that may be associated with pruritus. Histopathologically, amyloid was confined to areas that also showed signs of lichen simplex chronicus. Systemic treatment with sedating antihistamines and intense local treatment with corticosteroids were found to be effective.
LA is considered to be a variant of lichen simplex chronicus in which scratching leads to necrosis of keratinocytes and eventually to the formation of amyloid in the papillary dermis. Because chronic scratching seems to be the cause and not the result of the deposits of amyloid, treatment should be directed at the amelioration of pruritus.
淀粉样变苔藓（LA）通常被认为是一种病因不明的瘙痒性淀粉样变性。在组织病理学上，其特征为慢性单纯性苔藓的表皮改变以及乳头真皮层中源自坏死角质形成细胞角蛋白肽的淀粉样蛋白沉积。慢性搔抓是慢性单纯性苔藓形成的原因，可能导致单个角质形成细胞坏死。
我们的目的是评估慢性搔抓是否也是LA中淀粉样蛋白形成的原因。
我们研究了LA患者的组织病理学表现、瘙痒发作情况、相关疾病以及治疗反应。
在大多数情况下，瘙痒先于皮肤病变出现。9名患者中有8名患有除LA外可能与瘙痒相关的疾病。在组织病理学上，淀粉样蛋白局限于也显示慢性单纯性苔藓体征的区域。发现使用镇静性抗组胺药进行全身治疗以及使用皮质类固醇进行强化局部治疗是有效的。
LA被认为是慢性单纯性苔藓的一种变体，其中搔抓导致角质形成细胞坏死，最终导致乳头真皮层中淀粉样蛋白的形成。由于慢性搔抓似乎是淀粉样蛋白沉积的原因而非结果，治疗应针对瘙痒的改善。
