Lichen amyloidosis associated with chronic renal failure

A 58-year-old Japanese male visited the Department of Dermatology of Fukushima Medical University Hospital, complaining of itchy eruptions on his trunk and lower legs. The skin rash had previously been treated with topical antihistamine cream, but without improvement. He had a past history of diabetic nephropathy and has been received peritoneal dialysis for 9 months. The patient’s family history was noncontributory. Physical examination revealed a number of papulonodular eruptions on the trunk and hyperpigmented, keratotic, and firm papules and nodules on the lower parts of thighs and upper parts of shins (Fig. 1a and 1b). Skin biopsy taken from the left leg showed epidermal hyperkeratosis and deposition of amorphous eosinophilic substance in the papillary dermis, which was evident on Congo-red and antcytokeratin antibody 34βE12 staining (Fig. 2a-c). Immunohistochemical staining of the β2-microglobulin was negative. The clinical and histological findings confirmed lichen amyloidosis. We conducted half-side test by topical corticosteroid and moisturizing agent, in which the former was more effective. He achieved mild remission of symptoms in a period of one month.