Macular Amyloidosis

SIR,—We refer to the article on Macular Amyloidosis by Black and Wilson Jones in the March issue of the British Journal of Dermatology and were particularly interested to read their postulate that Amyloidosis might be a secondary phenomenon to epidermal damage. We have had 3 patients who initially presented with photodermatitis and 1 patient with drug induced generalized exfoliative dermatitis, who developed macular amyloidosis months after the primary disease process was brought under control. Interestingly all of them complained of moderate pruritus after the original rash had completely cleared. Over the months the reticulate macular pigmentation characteristic of the disease began to appear, over the back, shoulders, arms, forearms and lower legs. In 1 patient the macular element has become papular. Lichen Amyloidosis is a common condition, in multi-racial Singapore (Leong et al. 1969). No clear-cut association with preceding infiammation of the skin is obtainable in the vast majority of our cases. However the appearance in these 4 patients of amyloidosis following epidermal damage lends support to the hypothesis put forward by Black and Wilson Jones.