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Pálla S, Kuroli E, Tóth EA, Hidvégi B, Holló P, Medvecz M. Primary Localized Cutaneous Amyloidosis in Central Europe: A Retrospective Monocentric Study on Epidemiology and Therapy. J Clin Med 2023; 12:7672. [PMID: 38137741 PMCID: PMC10743860 DOI: 10.3390/jcm12247672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
Amyloid deposits can be the cause of many chronic diseases. Primary localized cutaneous amyloidosis (PLCA) is a chronic dermatologic condition with amyloid deposits in the papillary dermis. The most common types of the keratinocyte-derived form of PLCA include macular (MA), lichen (LA), and biphasic (BA) amyloidosis. The estimated prevalence of PLCA in the Asian population is 0.98/10,000, which is higher than in the European population; thus, epidemiologic data on PLCA in the Caucasian population are limited. We performed a retrospective single-center study analyzing epidemiologic characteristics of a Central European PLCA population. Epidemiologic data regarding age, sex, skin phototype (Fitzpatrick scale I-VI), disease duration, comorbidities, history of atopy, and family history of PLCA were collected. Clinical characteristics, localization of PLCA lesions, applied therapies and treatment outcomes were also analyzed. Dermoscopic characteristics were also evaluated. A total of 41 patients diagnosed with PLCA were included, with 22 presenting with macular, 18 with lichen, and 1 with biphasic amyloidosis. The male/female ratio was 16/25, and mean age at diagnosis was 54.6 ± 15.2 years (range 27-87 years). The mean age at the onset of PLCA was 53 ± 16.1 years (range 19-79 years) in MA, 46.7 ± 18.2 years (range 14-73 years) in LA, and 26 years in BA. The interscapular region in MA and the extensor surface of the lower extremities in LA proved to be localization-related areas. In our center, a wide range of therapeutic options was applied, with the most prescribed being topical corticosteroids in all types of PLCA. We presented a retrospective, monocentric study on the epidemiology of PLCA in the Central European region. By examining the medical data of a significant number of PLCA patients, we compared our epidemiologic data with that of the Asian PLCA population. Due to the rarity of the condition, further randomized controlled trials and guidelines are needed to improve therapeutic outcomes.
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Affiliation(s)
- Sára Pálla
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary
| | - Enikő Kuroli
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary
- Department of Pathology and Experimental Cancer Research, Semmelweis University, 1085 Budapest, Hungary
| | - Eszter Alexa Tóth
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary
| | - Bernadett Hidvégi
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary
| | - Péter Holló
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary
| | - Márta Medvecz
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary
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Lin YL, Chu GY. Successful Treatment of Poikiloderma-Like Cutaneous Amyloidosis: A Case Report and Literature Review. Indian J Dermatol 2021; 66:434-437. [PMID: 34759414 PMCID: PMC8530065 DOI: 10.4103/ijd.ijd_764_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Yi-Liang Lin
- Department of Dermatology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Gong-Yau Chu
- Department of Dermatology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,Department of Dermatology, Kang-Ning General Hospital, Taipei, Taiwan E-mail:
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Primary Localized Cutaneous Amyloidosis of Keratinocyte Origin: An Update with Emphasis on Atypical Clinical Variants. Am J Clin Dermatol 2021; 22:667-680. [PMID: 34286474 DOI: 10.1007/s40257-021-00620-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 01/19/2023]
Abstract
Amyloid is a protein derived from at least 20 different substances. Once misfolded, it results in a group of cutaneous and systemic conditions. Primary localized cutaneous amyloidosis of keratinocyte origin is a very common subtype that can manifest either as lichen or macular amyloidosis, lacking systemic involvement. Lichen amyloidosis often presents as multiple hyperpigmented papules on the lower extremities whereas macular amyloidosis is classically characterized by dark brown rippled macules on the interscapular area. Review of the literature reveals that in addition to the classical presentation of primary localized cutaneous amyloidosis there exists a plethora of various manifestations that can be grouped into either geographic or morphologic categories. This review provides clinicians with the intimate knowledge of these presentations and summarizes the available treatment modalities.
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Man With Bumps on His Shin. Ann Emerg Med 2018; 71:168-182. [PMID: 29447859 DOI: 10.1016/j.annemergmed.2017.07.490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Indexed: 11/21/2022]
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Ma H, Su X, Zhu G, Yin S, Lu C, Lai W. Primary localized cutaneous amyloidosis with lichen and poikiloderma-like lesions and an excellent response to systemic acitretin. An Bras Dermatol 2017; 91:661-663. [PMID: 27828646 PMCID: PMC5087231 DOI: 10.1590/abd1806-4841.20164316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 01/26/2015] [Indexed: 11/21/2022] Open
Abstract
Primary localized cutaneous amyloidosis is a skin-limited amyloidosis that does
not involve internal organs. It is clinically subclassified into 3 general
categories and some rare variants. However, there is considerable overlap within
the classification. Though there are a variety of therapeutic measures, the
treatment is often unsatisfactory, particularly when the disease is severe and
extensive. We describe a rare case of primary localized cutaneous amyloidosis
with lichen and poikiloderma-like lesions that showed an excellent response to
systemic acitretin.
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Affiliation(s)
- Han Ma
- Third Affiliated Hospital, Sun Yat-sen University - Guangdong, China
| | - Xiangyang Su
- Third Affiliated Hospital, Sun Yat-sen University - Guangdong, China
| | - Guoxing Zhu
- Third Affiliated Hospital, Sun Yat-sen University - Guangdong, China
| | - Songchao Yin
- Third Affiliated Hospital, Sun Yat-sen University - Guangdong, China
| | - Chun Lu
- Third Affiliated Hospital, Sun Yat-sen University - Guangdong, China
| | - Wei Lai
- Third Affiliated Hospital, Sun Yat-sen University - Guangdong, China
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Amyloidosis: A story of how inframammary erosions eclipsed inconspicuous periorbital ecchymoses. Int J Womens Dermatol 2016; 2:18-22. [PMID: 28491996 PMCID: PMC5412114 DOI: 10.1016/j.ijwd.2015.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 11/27/2015] [Accepted: 11/28/2015] [Indexed: 11/23/2022] Open
Abstract
Systemic amyloidosis is a rare disease that can be rapidly progressive due to widespread organ involvement. There are well-described renal, cardiac, pulmonary, neurological, and dermatologic findings. Here, we outline one patient's experience with the condition from presentation to making the diagnosis. She presented with pathognomonic dermatologic findings including pinch purpura and ecchymoses found in the skin folds.
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Gérard E, Ly S, Cogrel O, Pham-Ledard A, Fauconneau A, Penchet I, Ouhabrache N, Vergier B, Beylot-Barry M. [Primary localized cutaneous nodular amyloidosis: A diagnostic and therapeutic challenge]. Ann Dermatol Venereol 2015; 143:134-8. [PMID: 26724842 DOI: 10.1016/j.annder.2015.10.596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 10/12/2015] [Accepted: 10/29/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Nodular primary localized cutaneous amyloidosis (PLCA) is a rare subtype of localized cutaneous amyloidosis in which amyloid protein is derived from immunoglobulin light chains. Follow-up for progression to systemic amyloidosis or autoimmune disease is mandatory. No consensus exists regarding treatment. PATIENTS AND METHODS We report a case of nodular PLCA in a 49-year-old man, presenting as an asymptomatic nodule of the nose. Skin biopsy revealed diffuse deposition of amyloid associated with plasmocyte proliferation. Monotypic kappa light-chain restriction was observed. Extensive systemic evaluation, including bone marrow biopsy and PET scan, was negative. Protein electrophoresis and immunofixation in serum and urine were normal. The nodule was treated with radiotherapy but there was no response. Mohs micrographic surgery (MMS) was performed with no recurrence at 6 months of follow-up. No systemic progression was observed one year after the initial diagnosis. DISCUSSION Since nodular PLCA may have a cutaneous presentation similar to that of primary systemic amyloidosis, evaluation for systemic amyloidosis is necessary. Treatment of amyloidosis is difficult. Radiotherapy appears ineffective in treating this type of primary cutaneous amyloidosis, and surgical treatment, where possible, is a good option, especially with MMS, which allows both controlled excision and minimal margins.
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Affiliation(s)
- E Gérard
- Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, rue Jean-Burguet, 33076 Bordeaux, France
| | - S Ly
- Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, rue Jean-Burguet, 33076 Bordeaux, France
| | - O Cogrel
- Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, rue Jean-Burguet, 33076 Bordeaux, France
| | - A Pham-Ledard
- Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, rue Jean-Burguet, 33076 Bordeaux, France
| | - A Fauconneau
- Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, rue Jean-Burguet, 33076 Bordeaux, France
| | - I Penchet
- Service d'anatomopathologie, hôpital Haut-Lévêque, CHU de Bordeaux, avenue de Magellan, 33604 Pessac, France
| | - N Ouhabrache
- Service de radiothérapie, hôpital Haut-Lévêque, CHU de Bordeaux, avenue de Magellan, 33604 Pessac, France
| | - B Vergier
- Service d'anatomopathologie, hôpital Haut-Lévêque, CHU de Bordeaux, avenue de Magellan, 33604 Pessac, France
| | - M Beylot-Barry
- Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, rue Jean-Burguet, 33076 Bordeaux, France.
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Suranagi VV, Siddramappa B, Bannur HB, Patil PV, Davangeri RS. Bullous variant of familial biphasic lichen amyloidosis: a unique combination of three rare presentations. Indian J Dermatol 2015; 60:105. [PMID: 25657431 PMCID: PMC4318037 DOI: 10.4103/0019-5154.147868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 55-year-old man presented with multiple, itchy papules and macules on the trunk and extremities. Histopathologic examination of biopsy specimens taken from three different lesions showed a subepidermal blister with amyloid deposits in the dermal papillae. No systemic disease or involvement of other organs was detected. The clinical and histological findings were compatible with a bullous variant of lichen amyloidosis (LA). Primary cutaneous localized amyloidosis usually presents with papular, macular or nodular lesions. Bullous lesions associated with LA are very rare. Furthermore, patient had seven other members in the family with similar lesions, which is also a rare occurrence. We report a case with a rare combination of biphasic, bullous variant of familial LA.
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Affiliation(s)
| | - Bs Siddramappa
- Department of Pathology, J N Medical College, Belgaum, Karnataka, India
| | | | - Prakash V Patil
- Department of Pathology, J N Medical College, Belgaum, Karnataka, India
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Anaya-Saavedra G, Ramírez-Amador V, Valencia-Mayoral P. Oral primary localized amyloidosis in HIV-infected patients: the oral face of a described skin lesion. Int J STD AIDS 2015; 26:1049-51. [PMID: 25586447 DOI: 10.1177/0956462414566254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 12/07/2014] [Indexed: 11/16/2022]
Abstract
Oral primary localized amyloidosis should be considered in the diagnosis of oral white lesions such as hyperplastic candidosis, lichen planus and lichenoid reactions; it is not associated with antiretroviral therapy use, systemic involvement or malignant transformation.
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Affiliation(s)
- Gabriela Anaya-Saavedra
- Oral Pathology and Medicine Postgraduate Program, Universidad Autónoma Metropolitana-Xochimilco, Mexico City, Mexico
| | - Velia Ramírez-Amador
- Oral Pathology and Medicine Postgraduate Program, Universidad Autónoma Metropolitana-Xochimilco, Mexico City, Mexico
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Westermark P. Localized Amyloidoses and Amyloidoses Associated with Aging Outside the Central Nervous System. CURRENT CLINICAL PATHOLOGY 2015. [DOI: 10.1007/978-3-319-19294-9_7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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LaChance A, Phelps A, Finch J, Lu J, Elaba Z, Rezuke W, Murphy MJ. Nodular localized primary cutaneous amyloidosis: a bullous variant. Clin Exp Dermatol 2014; 39:344-7. [DOI: 10.1111/ced.12305] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2013] [Indexed: 11/26/2022]
Affiliation(s)
- A. LaChance
- Division of Dermatopathology; Department of Dermatology; University of Connecticut Health Center; Farmington CT USA
| | - A. Phelps
- Division of Dermatopathology; Department of Dermatology; University of Connecticut Health Center; Farmington CT USA
| | - J. Finch
- Division of Dermatopathology; Department of Dermatology; University of Connecticut Health Center; Farmington CT USA
| | - J. Lu
- Division of Dermatopathology; Department of Dermatology; University of Connecticut Health Center; Farmington CT USA
| | - Z. Elaba
- Department of Pathology; Hartford Hospital; Hartford CT USA
| | - W. Rezuke
- Department of Pathology; Hartford Hospital; Hartford CT USA
| | - M. J. Murphy
- Division of Dermatopathology; Department of Dermatology; University of Connecticut Health Center; Farmington CT USA
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Nofal A, Salah E. Acquired poikiloderma: Proposed classification and diagnostic approach. J Am Acad Dermatol 2013; 69:e129-40. [DOI: 10.1016/j.jaad.2012.06.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Revised: 05/25/2012] [Accepted: 06/11/2012] [Indexed: 02/08/2023]
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Qiao J, Fang H, Yao H. Amyloidosis cutis dyschromica. Orphanet J Rare Dis 2012; 7:95. [PMID: 23234252 PMCID: PMC3554482 DOI: 10.1186/1750-1172-7-95] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 11/30/2012] [Indexed: 11/10/2022] Open
Abstract
Background Amyloidosis cutis dyschromica is a rarely documented variant of cutaneous amyloidosis. To date, only 26 cases have been reported. Objective The purpose of this study was to improve the clinical and histopathological data for this variant of amyloidosis and to highlight the immunohistochemical features of the disease. The published cases were also reviewed. Methods We performed a retrospective review of patients with amyloidosis cutis dyschromica in a single centre. The clinical, histopathological and immunohistochemical features were documented and analysed. Observations We described 10 cases of amyloidosis cutis dyschromica. Six of them were female. Five patients were from the same family, and the other 5 were sporadic. The distinguishing features of the clinical presentation included generalised mottled hyper- and hypopigmented macules, which were asymptomatic or mild pruritic. The typical onset of the lesions occurred in childhood (n = 7) and occasionally after puberty (n = 3). No evidence of systemic amyloidosis deposition was observed in these cases of amyloidosis cutis dyschromica. Amyloid deposits were observed in the papillary dermis and were positive for the Congo red stain. An immunohistochemical study showed that the amyloid expresses cytokeratins CK34βE12 and CK5/6. Conclusions We described the largest series of amyloidosis cutis dyschromica to date and reviewed the published patients. This rare disease is featured by generalised mottled hyper- and hypopigmented lesions, and it is a rare variant of primary cutaneous amyloidosis without evidence of systemic amyloid deposition. Positive staining for the cytokeratins CK34βE12 and CK5/6 in amyloidosis cutis dyschromica suggests that the amyloid is derived from keratinocytes.
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Affiliation(s)
- Jianjun Qiao
- Department of Dermatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, No, 79, Qingchun Road, Hangzhou, 310003, Zhejiang Province, China
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