AMYLOIDOSIS ----------- Any suggestions for a 66 year old male patient I saw last week with systemic amylodosis - although he has significant proteinuria and Any suggestions for a 66 year old male patient I saw last week with systemic amylodosis - although he has significant proteinuria and moderate anemia the major problem for him is the pruritus (an interesting point which must be made over and over again - whatever the insurance companies think of our value, the patients do understand it) - before he came to me he was seen by many of our colleagues who have used all types of topical steroids and many antihistamines without success Irwin Freedberg --------------- Besides UV as suggested, I have a faint memory of retinoids in systemic amyloidosis. I have found they atleast help in cutaneous amyloidosis, where PUVA works extremely well-ablates the lesions and the itch. You might experiment with the narcotic antagonists, as they are quite safe, and come in several different formulations at this time-possilbly even as a patch. This is a great case for Haines Ely-maybe one of his old treatises mentions pruritis. Wouldn't it be amazing if in his honor Trental would work in whatever cascade is involved in the pruritis-of course I would be game to try it if there were free samples around. Cholestyramine works in DH itch, in a way not related to bile acids etc. It extinguished the itch and lesions in a patient of mine who had a not so occult squamous cell metastatic, which was the etiology of the DH some how. Empirically try it as well? Diane Thaler ------------ We have a 50 year old woman of asian Indian extraction with Lichen Amyloidosis and no remarkable systemic findings. It is on the lower legs and has been resistant to Topical steroids including Temovate with occlusion. Does anyone have any therapeutic suggestions--it is very uncomfortable to her. John Uhlemann ----------- Intralesional steroids always have worked for me. Usually done monthly with Kenalog 10mg/cc, up to 2cc at a time. gary salenger ---------- Lichen Amyloidosis - Cordran (Drenison, flurandrenolide) Tape works well, and protects the skin while keeping it hydrated. Kevin C. Smith MD FRCPC ----------- I tried everything in the world on a lovely young woman in her 20's, and the only thing that worked, and absolutely, was PUVA. We sunscreened the rest of her body. Diane Thaler ---------- You could try topical retinoic acid with topical corticosteriods. Another alternative is low dose cyclophosphamide (50mg p.o. daily), for 6 months to a year or till the therapeutic response plateaus. Friction has been known to aggravate the condition some times. Advise the patient to avoid using a pumice stone or body sponge while bathing, in case she does so. If medical treament fails, the papular lesions could be dermabraded. Belinda Vaz ---------- We find Tigason (etretinate) 0.5-1.0 mg/kg/day in divided dose works effectively in several cases recently. Patients usually respond within 4-6 weeks. We are now collecting a series of cases. It is a rather common disease herein Taiwan. Though excoriation and rubbering worsens the disease, certain races (including Orientals) are more susceptible to cutaneous amyloid formation. Endogenous factors may play a more important role than exogenous. An well-written book with in-depth information concerning amyloidosis was written by professor Chu-Kwan Wong in Taiwan several years ago. Maybe you can find it in your medical library. We usually treat the patient with topical potent steroid and or Retin-A 0.05% in the beginning. It works fairly well for most patients, however, it usually takes several weeks to respond. Remember to instruct patients not to "rub in" the medication since many of them believe rubbing enhances drug absorption. For those recalcitrant cases, dermabrasion helps, not to wonder,it recurs often. We recently find Tigason (etretinate)0.5-1.0 mg/kg/day helps as I mentioned before. I have'nt try PUVA before. I would like to try it in the near furture. I don't think it is a form of Atopy, at least of my experience in Chinese patients. Are there any reports mentioned about this? Tak-Wah Wong M.D. --------- Lichen amyloidosis responds to topical DMSO. The stuff is sold in health food stores and veteranary supply houses here in the USA. I rearely recommend this except in lichen amyloidis of the shins. It works. Aplly BID. Haines Ely --------