A new treatment for amyloid lichen skin

     Amyloid lichen (papular amyloidosis of the skin) as an independent disease was described as early as 1921. This is mesenchymal dysproteinosis, which is characterized by the deposition of amyloid only in the skin.

   Amyloid protein – it is a glycopeptide that includes a protein (F-component), plasma proteins and polysaccharides (P-component), as well as keratin conversion products (K-component). Familial cases have been reported. The disease often affects people over the age of 50. Local form of primary amyloidosis  is called Gutman's syndrome and manifests itself in several clinical forms: papular, nodular, spotty and secondary local. The most common form of skin amyloidosis is papular.

Clinical manifestations of amyloid lichen. Peculiarities of papules

    Eruptions on the skin appear symmetrically. Favorite localization of lichen – on the anterior surface of the legs, in the popliteal regions. Rash elements – multiple papules, which look like translucent dense plaques, slightly rising above the surface of the skin. Papules have a hemispherical configuration. Small grayish scales may appear on the papules. The papules are very closely adjacent to each other, but do not merge. The color of these papules ranges from flesh to pink. Lichen can be reddish, bluish or brown in color. Perhaps the appearance of verrucous lesions with hyperkeratosis. There is severe itching. The skin around the papules has a lot of scratching, bloody crusts and lichenification. The skin at the site of the lesion is very dense.

Basic diagnosis of cutaneous amyloid lichen

Lichen is diagnosed on the basis of clinical findings (presence of characteristic papules) and excruciating itching. On morphological examination, the papules are specifically stained Congo red.

In the papillary layer of the dermis with lichen, amyloid masses accumulate, which are stained yellow by the Van Gieson method, red - by Congo red, pink - by hematoxylin and eosin.

Amyloid lichen skin must be distinguished from lichen planus, lipoid proteinosis, lichen myxedema, and localized neurodermatitis.

Aspects of skin amyloid lichen treatment

    In the treatment of amyloid lichen, acitretin and chloroquine were previously prescribed according to the scheme. Glucocorticoid ointments under the dressing, antipruritic agents, ointments containing Naftalan oil, birch tar, Dorogov's antiseptic stimulator (ASD), ichthammol were locally prescribed. As you know, lichen is very difficult to cure, as the process is almost untreatable. Researchers have put a lot of time and effort into finding treatments and improving the quality of life of lichen patients.

   The results were not long in coming. Recently in Los Angeles they began to successfully treat amyloid lichen using laser treatment. At the latest, this is the first documented report of the successful use of fractional ablative laser in the treatment of amyloid lichen.

Clinical case of lichen treatment with laser technology

     A 60-year-old patient complained of excruciating itching of the skin of the lower extremities, which has been going on for 15 years. The patient has used various scrubs while bathing for many years. Papules were resistant to treatment with steroid ointments and salicylic acid. Family history without features.

   On examination, papules were observed, which were located symmetrically on the tibial surfaces of the lower extremities. Blood tests were within normal limits. Staining revealed pink homogeneous masses. The final diagnosis of amyloid lichen of the skin of the lower extremities was established and a decision was made to treat it with fractional ablative technology.

   The patient was treated with laser technology for 45 minutes using 2.5% lidocaine. At the end of the treatment, the patient was advised to take sun protection measures and apply a moisturizer. A week after laser treatment, the patient was recommended to use steroid ointments and keratolytic agents (salicylic acid). This topical treatment had to be done before the next laser treatment, which was done at 3-week intervals.     Significant improvement was noted already after the second course of treatment. The lesions became much smaller, itching and peeling were not so pronounced. After 6 sessions, the patient was cured  95% of rashes.

   Therefore, it was concluded that the best treatment for skin amyloid lichen is laser treatment. The laser reduces the production of amyloid by influencing the keratinization process. With the help of a laser, channels are created in the papillae of the dermis through which amyloid deposits are removed. No side effects were observed. To date, it is considered that the method is absolutely safe and effective in the treatment of amyloid lichen of the skin and in relieving itching of the skin from lichen.