Case and research letter
Satisfactory Response to Narrowband UV-B Therapy in Generalized Lichen Amyloidosis
Liquen amiloide generalizado con respuesta satisfactoria a ultravioleta B de banda estrecha
J. Alonso-González
, M.T. Rodríguez-Granados, J. Toribio
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Departamento de Dermatología, Complejo Hospitalario Universitario, Facultad de Medicina, Santiago de Compostela, La Coruña, Spain
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Alonso-González, M.T. Rodríguez-Granados, J. Toribio" "autores" => array:3 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Alonso-González" "email" => array:1 [ 0 => "julio.alonso.gonzalez@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M.T." "apellidos" => "Rodríguez-Granados" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Toribio" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Departamento de Dermatología, Complejo Hospitalario Universitario, Facultad de Medicina, Santiago de Compostela, La Coruña, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding Author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Liquen amiloide generalizado con respuesta satisfactoria a ultravioleta B de banda estrecha" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1151 "Ancho" => 950 "Tamanyo" => 178519 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Extent of the skin condition before treatment. Inset: Detailed image of the lesions on the thigh.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Lichen amyloidosis (LA) is a form of primary localized cutaneous amyloidosis that is associated with pruritic skin-colored or hyperpigmented hyperkeratotic papules<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a>; these papules can coalesce to form plaques that often display a wavy pattern. The lesions are found mainly in the pretibial region, and generalized involvement is uncommon.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> Numerous approaches have been used to treat LA, although none has achieved a complete cure. We present a case of generalized LA that responded satisfactorily to narrowband UV-B therapy.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was a 69-year-old man with Fitzpatrick skin type III and a past history of insulin-dependent diabetes mellitus, arterial hypertension, and ischemic heart disease. He consulted for pruritic lesions on the trunk and extremities that had first appeared 4 years earlier and had been treated unsuccessfully with topical corticosteroids. A series of laboratory and additional tests were performed to screen for potential causes of the pruritus, and the patient did not present an underlying eczematous condition. Physical examination revealed slightly desquamating plaques formed of multiple hyperpigmented hemispheric papules, many of which had been eroded by scratching. The lesions affected the anterior and posterior surfaces of the arms and legs, abdomen, back, and buttocks, with a symmetrical bilateral distribution (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Histopathology revealed compact orthokeratotic hyperkeratosis, irregular acanthosis, and deposits in the papillary dermis that caused widening of the papillae with lateral shift of the epidermal ridges. The deposits were composed of acellular, amorphous eosinophilic material with abundant fissures caused by retraction; the material fluoresced green with thioflavin T (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). We thus confirmed the diagnosis of LA. Phototherapy with narrowband UV-B was started (3 times weekly). The initial dose was 0.35<span class="elsevierStyleHsp" style=""></span>J/cm<span class="elsevierStyleSup">2</span> (determined according to phototype), which was increased by 10% to 20% at each session. A significant reduction in the pruritus and progressive flattening of the papules in all the affected areas was observed from the initial sessions. Complete resolution of the lesions on the trunk and arms was achieved after 57 sessions and a cumulative dose of 109.27<span class="elsevierStyleHsp" style=""></span>J/cm<span class="elsevierStyleSup">2</span> (maximum dose, 2.33<span class="elsevierStyleHsp" style=""></span>J/cm<span class="elsevierStyleSup">2</span>) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The physical and symptomatic improvement persisted at the time of writing, after 4 months of follow-up, with no further treatment.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Treatment of LA is somewhat unsatisfactory. The different approaches tried include topical or intralesional corticosteroids, oral and topical dimethylsulfoxide, calcineurin inhibitors, oral retinoids, cyclophosphamide, dermabrasion, and neodymium:yttrium-aluminum-garnet laser therapy, as well as various phototherapy modalities.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Only 3 cases of LA treated satisfactorily with narrowband UV-B therapy have been reported to date.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–7</span></a> In 2 of those cases, LA was associated with refractory atopic dermatitis, and narrowband UV-B was combined with other treatments to improve the clinical condition.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> The third case involved a man with generalized LA whose lesions characteristically affected areas of the body with lower skin temperatures, sparing areas with higher temperatures. The patient's response to narrowband UV-B monotherapy was excellent.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The amyloid substance in LA is thought to originate from necrosis of the epidermal keratinocytes of the basal layers of the epidermis.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Narrowband UV-B therapy diminishes basal cell activity, thus reducing the production of amyloid.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Furthermore, narrowband UV-B has proven effective for the treatment of pruritus by suppressing the proliferation of keratinocytes and reducing apoptosis of keratinocytes and T cells and inflammation. In this way, it is possible to diminish or eliminate one of the factors that very probably induce and/or worsen LA. Other authors consider that the effectiveness of narrowband UV-B therapy is due to the marked elevation of the temperature in the booth, with the consequent increase in skin temperature and suppression of the heat-dependent synthesis of amyloid.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Grimmer et al.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> recently reported 2 cases of LA treated with a combination of psoralen-UV-A therapy and oral acitretin. The authors concluded that this modality was effective and practical and that its effects were maintained over time. Finally, a study that compared the efficacy of topical corticosteroids with UV-B phototherapy and topical psoralen-UV-A in patients with LA found better results, namely, diminished pruritus and a decrease in the number of skin lesions, in the areas treated with phototherapy.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">To our knowledge, we present the second case of LA not associated with other skin conditions and that responded satisfactorily to narrowband UV-B in monotherapy. Although further studies are necessary to define the exact mechanism of action and level of efficacy, we believe that narrowband UV-B therapy could represent a safe and effective alternative in the management patients with generalized LA lesions.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Alonso-González J, et al. Liquen amiloide generalizado con respuesta satisfactoria a ultravioleta B de banda estrecha. Actas Dermosifiliogr. 2013;104:527–9.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1151 "Ancho" => 950 "Tamanyo" => 178519 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Extent of the skin condition before treatment. Inset: Detailed image of the lesions on the thigh.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 552 "Ancho" => 900 "Tamanyo" => 120051 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Compact orthokeratotic hyperkeratosis, irregular acanthosis, and deposits in the papillary dermis that caused widening of the papillae with lateral shift of the epidermal ridges (hematoxylin-eosin, original magnification x100). Inset: Deposits of amyloid material in the papillary dermis showing green fluorescence (thioflavin T, original magnification x200).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1141 "Ancho" => 950 "Tamanyo" => 176533 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Improvement in lesions after completing treatment with narrowband UV-B therapy (57 sessions). Inset: Detail of the lesions on the thigh.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Liquen amiloide con buena respuesta a corticoterapia tópica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Larumbe" 1 => "M.E. del Prado" 2 => "M. Teresa Dachary" 3 => "C. Ros" 4 => "M.P. Grasa" 5 => "F.J. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 14 | 14 | 28 |
| 2024 Octubre | 113 | 31 | 144 |
| 2024 Septiembre | 110 | 22 | 132 |
| 2024 Agosto | 155 | 59 | 214 |
| 2024 Julio | 136 | 42 | 178 |
| 2024 Junio | 115 | 30 | 145 |
| 2024 Mayo | 105 | 40 | 145 |
| 2024 Abril | 92 | 18 | 110 |
| 2024 Marzo | 115 | 33 | 148 |
| 2024 Febrero | 91 | 36 | 127 |
| 2024 Enero | 101 | 41 | 142 |
| 2023 Diciembre | 93 | 20 | 113 |
| 2023 Noviembre | 106 | 30 | 136 |
| 2023 Octubre | 130 | 24 | 154 |
| 2023 Septiembre | 121 | 29 | 150 |
| 2023 Agosto | 93 | 15 | 108 |
| 2023 Julio | 94 | 39 | 133 |
| 2023 Junio | 84 | 24 | 108 |
| 2023 Mayo | 133 | 34 | 167 |
| 2023 Abril | 139 | 23 | 162 |
| 2023 Marzo | 124 | 38 | 162 |
| 2023 Febrero | 141 | 27 | 168 |
| 2023 Enero | 68 | 27 | 95 |
| 2022 Diciembre | 61 | 47 | 108 |
| 2022 Noviembre | 42 | 23 | 65 |
| 2022 Octubre | 41 | 24 | 65 |
| 2022 Septiembre | 97 | 44 | 141 |
| 2022 Agosto | 55 | 41 | 96 |
| 2022 Julio | 38 | 36 | 74 |
| 2022 Junio | 43 | 36 | 79 |
| 2022 Mayo | 110 | 46 | 156 |
| 2022 Abril | 130 | 52 | 182 |
| 2022 Marzo | 124 | 63 | 187 |
| 2022 Febrero | 127 | 33 | 160 |
| 2022 Enero | 139 | 59 | 198 |
| 2021 Diciembre | 60 | 34 | 94 |
| 2021 Noviembre | 75 | 44 | 119 |
| 2021 Octubre | 80 | 62 | 142 |
| 2021 Septiembre | 83 | 33 | 116 |
| 2021 Agosto | 108 | 51 | 159 |
| 2021 Julio | 82 | 41 | 123 |
| 2021 Junio | 94 | 41 | 135 |
| 2021 Mayo | 75 | 48 | 123 |
| 2021 Abril | 252 | 75 | 327 |
| 2021 Marzo | 148 | 42 | 190 |
| 2021 Febrero | 77 | 41 | 118 |
| 2021 Enero | 56 | 31 | 87 |
| 2020 Diciembre | 50 | 22 | 72 |
| 2020 Noviembre | 62 | 24 | 86 |
| 2020 Octubre | 49 | 16 | 65 |
| 2020 Septiembre | 70 | 18 | 88 |
| 2020 Agosto | 38 | 26 | 64 |
| 2020 Julio | 32 | 20 | 52 |
| 2020 Junio | 45 | 31 | 76 |
| 2020 Mayo | 27 | 16 | 43 |
| 2020 Abril | 35 | 18 | 53 |
| 2020 Marzo | 26 | 16 | 42 |
| 2020 Febrero | 4 | 2 | 6 |
| 2020 Enero | 4 | 1 | 5 |
| 2019 Diciembre | 6 | 3 | 9 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Septiembre | 8 | 0 | 8 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 4 | 11 | 15 |
| 2019 Junio | 6 | 11 | 17 |
| 2019 Mayo | 5 | 23 | 28 |
| 2019 Abril | 3 | 1 | 4 |
| 2019 Marzo | 2 | 7 | 9 |
| 2019 Febrero | 3 | 0 | 3 |
| 2019 Enero | 2 | 0 | 2 |
| 2018 Diciembre | 0 | 5 | 5 |
| 2018 Noviembre | 2 | 0 | 2 |
| 2018 Octubre | 3 | 0 | 3 |
| 2018 Septiembre | 2 | 0 | 2 |
| 2018 Abril | 0 | 1 | 1 |
| 2018 Febrero | 33 | 3 | 36 |
| 2018 Enero | 67 | 7 | 74 |
| 2017 Diciembre | 50 | 6 | 56 |
| 2017 Noviembre | 44 | 5 | 49 |
| 2017 Octubre | 49 | 3 | 52 |
| 2017 Septiembre | 84 | 3 | 87 |
| 2017 Agosto | 55 | 5 | 60 |
| 2017 Julio | 104 | 11 | 115 |
| 2017 Junio | 109 | 8 | 117 |
| 2017 Mayo | 63 | 8 | 71 |
| 2017 Abril | 67 | 8 | 75 |
| 2017 Marzo | 58 | 25 | 83 |
| 2017 Febrero | 50 | 9 | 59 |
| 2017 Enero | 33 | 11 | 44 |
| 2016 Diciembre | 60 | 5 | 65 |
| 2016 Noviembre | 80 | 4 | 84 |
| 2016 Octubre | 115 | 13 | 128 |
| 2016 Septiembre | 186 | 7 | 193 |
| 2016 Agosto | 104 | 19 | 123 |
| 2016 Julio | 56 | 8 | 64 |
| 2016 Junio | 11 | 5 | 16 |
| 2016 Mayo | 7 | 5 | 12 |
| 2016 Abril | 2 | 13 | 15 |
| 2016 Marzo | 6 | 1 | 7 |
| 2016 Febrero | 7 | 2 | 9 |
| 2016 Enero | 9 | 9 | 18 |
| 2015 Diciembre | 4 | 1 | 5 |
| 2015 Noviembre | 14 | 1 | 15 |
| 2015 Octubre | 22 | 10 | 32 |
| 2015 Septiembre | 9 | 2 | 11 |
| 2015 Agosto | 7 | 4 | 11 |
| 2015 Julio | 137 | 10 | 147 |
| 2015 Junio | 58 | 6 | 64 |
| 2015 Mayo | 68 | 7 | 75 |
| 2015 Abril | 50 | 8 | 58 |
| 2015 Marzo | 65 | 4 | 69 |
| 2015 Febrero | 62 | 6 | 68 |
| 2015 Enero | 52 | 2 | 54 |
| 2014 Diciembre | 59 | 4 | 63 |
| 2014 Noviembre | 34 | 3 | 37 |
| 2014 Octubre | 53 | 9 | 62 |
| 2014 Septiembre | 51 | 7 | 58 |
| 2014 Agosto | 28 | 4 | 32 |
| 2014 Julio | 32 | 8 | 40 |
| 2014 Junio | 43 | 6 | 49 |
| 2014 Mayo | 36 | 8 | 44 |
| 2014 Abril | 43 | 3 | 46 |
| 2014 Marzo | 55 | 6 | 61 |
| 2014 Febrero | 31 | 9 | 40 |
| 2014 Enero | 27 | 10 | 37 |
| 2013 Diciembre | 23 | 9 | 32 |
| 2013 Noviembre | 17 | 4 | 21 |
| 2013 Octubre | 10 | 5 | 15 |
| 2013 Septiembre | 1 | 2 | 3 |
| 2013 Agosto | 2 | 4 | 6 |
| 2013 Julio | 5 | 3 | 8 |
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