Lichen amyloidosis associated with atopic dermatitis: clinical resolution with cyclosporine.

A 64-year-old Asian man with a history of refractory atopic dermatitis (AD) presented with severe generalized pruritus. Results of examination revealed erythematous, lichenified, crusted plaques and papules, mainly on the chest, abdomen, back, and extremities. In addition, numerous firm, skin-colored papules were found on the anterior shins (Figure 1). The patient stated that he first noticed these lesions approximately 2 years ago, after an extremely pruritic flare of his AD. They had not remitted since they first appeared. The patient reported no other medical problems and denied any family history of skin disease. The clinical differential diagnosis of the leg lesions included lichen amyloidosis (LA), lichen simplex chronicus, and lichen planus. A punch biopsy specimen of a papule was taken from the right leg for routine microscopic examination. Results of histological examination showed hyperkeratosis, acanthosis, pigment incontinence, and amorphous material in the papillary dermis consistent with amyloid (Figure 2). A histological diagnosis of LA was given. THERAPEUTIC CHALLENGE