FLORENCE, ITALY Recalcitrant lichen amyloidosis can be safely and effectively treated with dermabrasion in an office setting using tumescent anesthesia, William Y.M. Tang, M.D., said at the 13th Congress of the European Academy of Dermatology and Venereology.
Lichen amyloidosis is a rare, chronic condition characterized by profoundly pruritic yellow to reddish-brown hyperkeratotic papules symmetrically dispersed over the extremities and (sometimes) the trunk. Pathology reveals insoluble fibrillar protein, or amyloid. The condition is seen more frequently in males than females and is believed to be more common in people of Asian descent.
Management is difficult, said Dr. Tang, a Sai Ying Pung-based dermatologist with the social hygiene service in the government department of health in Hong Kong.
Dermabrasion has been described as an effective, long-lasting treatment modality, and Dr. Tang concurs. However, he said pain control is a substantial problem when dermabrasion is performed over the large areas of skin affected by lichen amyloidosis. General anesthesia is usually required.
In an attempt to determine whether the procedure could be done in an office setting, Dr. Tang performed it on five male patients aged 43-73 years who had lichen amyloidosis for 3-20 years on their shins (four patients) and/or forearms (three patients). They were not responsive to potent topical steroids, emollients, or oral antihistamines. Dr. Tang infiltrated standard tumescent anesthesia solution into the subcutaneous compartment through a 22-gauge spinal cannula in a fan-shaped manner to his patients' most severely pruritic regions. Treated areas ranged from 72 cm2 to 150 cm2 and required 42-113 mL of tumescent solution.
After 30 minutes, he performed dermabrasion using an electric motor-driven dermabrader fitted with a stainless, olive-shaped head with spiral cutting edges rotating at 20,000 rpm. "The [dermabrader] head was moved with even, light pressure across the skin surface to remove the epidermis down to the papillary dermis," he said. A paraffin gauze dressing was applied and a mild analgesic prescribed. Dressings were changed daily for 2-3 weeks until reepithelialization occurred.
"Itch reduction was immediate in all patients," Dr. Tang said. Patients also experienced symptomatic relief for the duration of follow-up, which in some patients lasted 21 months. All patients rated their results as cosmetically improved. Although a few papules returned in two of five patients, they were less pruritic than in the initial cases. No procedure-related complications were reported. Adverse events included mild cellulitis and hypopigmentation; the latter improved with time.
Dermabrasion using in-office tumescent anesthesia eased pain and resulted in immediate itch reduction. Photos courtesy Dr. William Y.M. Tang