Remission of Lichen Amyloidosus after Treatment with Acitretin

Lichen amyloidosus Retinoids Apoptosis Norbert Reider, MD, Department of Dermatology, University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck (Austria) In September 1993, a 72-year-old woman presented at our Department with an eruption of reddish brown, coalescent, hyperkeratotic, extremely pruritic papules of her thighs (fig. 1), the extensor surfaces of both forearms and the lumbosacral area. These lesions had been present for almost 2 years, previous treatment with topical cortico-steroids had proven ineffective. The skin was otherwise unaffected. Physical examination and laboratory tests including blood count, liver and kidney function tests were within the normal range. Histology revealed a papillomatous epidermis and globular eo-sinophilic deposits of the papillary dermis which showed green birefringence under polarized light in Congo red sections and which were also positive for thioflavin T. By direct immunofluorescence, they appeared as aggregated cytoid bodies reacting with anti-IgM and complement C3 antibodies as well as antibodies specific for keratin (Boehringer), vitronecting (Quidel Q) and serum amyloid P (Atlantic Antibodies). Acitretin treatment was initiated at a dose of 30 mg daily (0.7 mg/ kg body weight). Pruritus greatly improved during the subsequent weeks, the lesions of the forearms became flattened, those of the rest of the body cleared almost completely. Acitretin was therefore tapered after 6 weeks and withdrawn after 3 months. As a side effect, moderate dryness of eyes and lips was noted. Laboratory tests including blood lipids remained normal. During an almost 3-year clinical follow-up, no relapse was observed. A control biopsy, taken 6 months after the end of therapy from the previously affected thigh, revealed normal skin. By direct immunofluorescence, only scarce cytoid bodies were detected in the papillary dermis. Localized amyloidosis is notoriously resistant to therapy. Macular and papular amyloidosis responds poorly to topical steroid. Derm-abrasion may relieve pruritus and result in flattening of the lesions, but the cosmetic outcome is not always satisfactory [ 1 ]. Reported beneficial effects of dimethyl sulfoxide [2, 3] or UVB irradiation [4] appear doubtful. Nodular amyloidosis may require surgical or carbon dioxide laser treatment [5]. In the late 1980s, retinoids were tried in lichen amyloidosus with equivocal results in a total of 9 cases described in