Lichen amyloidosis is a persistent, pruritic eruption of multiple discrete hyperkeratotic papules, which may coalesce to form plaques, distributed principally on the shins.
The dermatologist is frequently faced with the dilemma of choosing the most effective treatment for this common type of Primary Localized Cutaneous Amyloidosis.
The medical approach to treatment has been described and the results are frequently equivocal or unsatisfactory. More commonly employed is the treatment. Lichen amyloidosis respond poorly or at best moderately well to topical steroids combined with systemic antihistamines, the most common treatment modality used.
The purpose of this study is to go the other direction and see if surgery has a role in the treatment of lichen amyloidosis, especially in those cases recalcitrant to topical treatment. Modalities to be undertaken are scalpel scraping, carbon dioxide laser ablation, dermabrasion and cutting electrocautery.
STUDY DESIGN: Prospective, Descriptive Study
STUDY SETTING: Tertiary Government Hospital (JRRMMC)
Patients selected were at least 18 years of age, clinically and histopathologically diagnosed with H&E and crystal violet stains as lichen amyloidosis.
Excluded in the study were pregnant patients, children, patients with other skin diseases involving the lower extremities and those with systemic disease that would impede wound healing.
Procedures done were thoroughly explained followed by written consent of subjects.
Total number of subjects was 9, 4 males and 5 females. Two were lost to follow-up. Age ranged between 30-75 years old,mean age of 54 years, median of 51 years.
Duration of lesions ranged from 2 to 10 years.
Three out of the 9 patients had controlled hypertension on maintenance medications.
Two were lost to follow-up.
All patients had no recurrence of papules at 12 weeks post-op using all the different types of modalities.
However, some patients had scarring and hyperpigmentation. Five patients had scarring secondary to cutting electrocautery and one secondary to carbon dioxide laser. Four patients had hyperpigmentation secondary to carbon dioxide laser while one patient developed hypopigmentation secondary to all the modalities.
Healing time of lesions ranged between 4-6 weeks (scalpel scraping, dermabrasion and carbon dioxide laser ablation) 10-12 weeks (cutting electrocautery).
Given the limitations of the study, we conclude that if surgery would be considered as a treatment option, scalpel scraping and dermabrasion would be most optimal since there was good wound healing and no incidence of scarring and hyperpigmentation.
However, a longer follow-up period should be done to monitor recurrence of the papules which is the more pressing concern of the patients and to observe if there would be further fading of the hyperpigmentation.