Lichen Amyloidosus. Presented by the Staff, Department of Dermatology, Minneapolis Veterans Administration Hospital.
This 69-year-old white man began to develop a markedly pruritic papular eruption on his forearms and anterior tibial surfaces 15 years ago. The course has been chronic and unremitting. General health is good except for mild cardiac decompensation. Family history is negative.
Examination reveals brownish-red, firm papules arranged in plaques on the forearms and hard discrete flesh-colored papules on both anterior tibial surfaces.
The hemoglobin is 14.8 gm/100 cc. The white count is 8,450 with 39 neutrophils, 36 lymphocytes, 3 monocytes, 21 eosinophils, and 1 basophil. X-ray shows osteoblastic lesions of vertebral bodies L1 and L4 and the left ileum. Skin biopsies stained for amyloid revealed clumps in the subepidermal area.
The Nomland test was positive ten days after application. The eosinophilia has not been explained. There has been little response to topical steroids.
Discussion
Dr. Stephan
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