Primary Cutaneous Amyloidosis Research Articles

Lichen Amyloidosis in an Atopic Patient Treated with Dupilumab: A New Therapeutic Option

Lichen amyloidosis (LA) is a type of cutaneous amyloidosis characterized by brownish hyperkeratotic and itchy papules on the lower leg, back, forearm, or thigh. It is associated with itching and atopic dermatitis (AD) according to an etiopathogenetic mechanism that has not yet been fully elucidated. Currently, the available therapies for this condition include oral antihistamines, laser, cyclosporine, topical corticosteroids, and phototherapy, but, in light of the overlap with AD, Dupilumab may also be indicated. We report the case of a female, 52 years old, who had been suffering from AD and LA for about 27 years. She had lesions attributable to both diseases on the trunk and lower limbs associated with severe itching and had proved resistant to cyclosporine therapy. It was decided to opt for Dupilumab with the induction of 2 fl of 300 mg and maintenance with 1 fl every other week. The therapy proved to be effective, returning a total resolution of both diseases one year after the beginning of the treatment. Dupilumab demonstrated efficacy and safety in the LA related to AD and led to clinical and quality of life improvements in this patient. Therefore, Dupilumab should be considered when treating LA. Further studies should be conducted focusing on the efficacy of the drug on LA (whether or not related to AD), changes in the skin lesions after discontinuation, and the safety of long-term application.

A case of cutaneous nodular amyloidosis in an adolescent patient.

A case of cutaneous nodular amyloidosis in an adolescent patient.

Cutaneous amyloidosis in a patient with systemic amyloidosis due to multiple myeloma

Cutaneous manifestations in systemic amyloidosis secondary to multiple myeloma or AL amyloidosis are seen in approximately 15%-40% of patients with systemic amyloidosis. Cutaneous involvement has a preference for skin folds, retroauricular region, eyelids, neck and the axilla and may present in the form of purpura, domed papules or nodes resembling isolated nodular amyloidosis. Congo red staining remains the gold standard for diagnosis, revealing amyloid fibrils with apple-green birefringence in the polarized microscopy. It is noteworthy that patients may sometimes present with non-specific skin changes, suggestive of depositional disease, such as alopecia or nail dystrophy. Herein, we present a patient with systemic amyloidosis, who exhibited red-brown macules coalescing into a rippled pattern in the extremities, amyloid nodules in the peri-auricular region and dystrophic nails, findings that were attricuted to cutaneous amyloidosis in the context of systemic amyloidosis.

Dermoscopy of Primary Localized Cutaneous Nodular Amyloidosis.

Dermoscopy of Primary Localized Cutaneous Nodular Amyloidosis.

Efficacy of topical gabapentin in women with primary macular amyloidosis: A side-by-side triple-blinded randomized clinical trial.

Primary cutaneous macular amyloidosis (PCMA) is a chronic pruritic cutaneous disease characterized by heterogeneous extracellular deposition of amyloid protein in the skin. This study aimed to evaluate the efficacy of topical 6% gabapentin cream for the treatment of patients with PCMA. In this triple-blind clinical trial, a total of 34 patients, who were diagnosed with PCMA, treated using two different strategies of topical gabapentin as the active group and vehicle cream as the control group. Pruritus score reduction in both groups was statistically significant compared with the baseline value (p < 0.001). There was a significant pigmentation score reduction in intervention group compared with control group after 1 month of the study (p < 0.001). The differences of pigmentation score changes between the groups were not significant at month 2 (p = 0.52) and month 3 (p = 0.22). The results of this study suggest that topical gabapentin cream may be effective as a topical agent in the treatment of pruritus associated with PCMA without any significant adverse effects. It is recommended to perform similar studies with a larger sample size and longer duration in both sexes.

MANAGEMENT OF LICHEN AMYLOIDOSIS THROUGH AYURVEDA: A CASE STUDY

Lichen Amyloidosis is a chronic pruritic skin disorder of unknown origin characterized by Amyloid deposition in skin. Excessive scratching and consistent friction between skin can damage the epidermis of skin leading to extracellular protein accumulation which creates papules and rashes. A case of 74-year male patient presented with blackish papules associated with itching in bilateral shin region with no relevant family history and was diagnosed as Lichen Amyloidosis. As per Ayurveda on basis of Dosha, Kaphavataja Kushta i.e., Kitibha Kusta can be corelated to Lichen Amyloidosis. In conventional treatment as there is no known cure for amyloidosis, in the present case, treatment was planned based on the principles of Kusta chikitsa depending on Dosha dominence. Snehana, Swedana, Virechana and Shamana treatment was followed. Treatment shows marked improvement from symptoms which proves that Dosha/Lakshana based approach has good outcomes in chronic disorders of unknown origin also.

Evaluation and comparison of Q-switched Nd: YAG laser 1064 nm and Er: YAG laser 2940 nm in the treatment of macular amyloidosis.

Macular amyloidosis (MA) is one of the most common types of primary localized cutaneous amyloidosis (PLCA), distributed predominantly over the trunk and extremities. Due to the vast therapeutic options, this study aims to compare the effectiveness of Q-switched Nd: YAG laser 1064 nm and Er: YAG laser 2940 nm in treating MA. This clinical trial was performed in 2020-2021 on 33 women with MA. In each patient, the lesion was randomly divided into two areas, A and B. Area A underwent four treatment sessions with 4-week intervals of Q-switched Nd: YAG laser 1064 nm. Area B underwent four treatment sessions with an Er: YAG laser 2940 nm at 4-week intervals. Degree of basal pigmentation and degree of pigmentation after treatment, pruritus intensity, before and after the treatment, and patient and physicians' satisfaction were measured and compared. The pruritus in patients improved significantly after the study (P < 0.001), but no significant differences could be observed between the two groups regarding the improvements (P > 0.05). We also found no significant differences between the two groups of patients regarding patient and physicians' satisfaction rates (P > 0.05). The use of both Q-switched Nd: YAG laser and Er: YAG laser resulted in improvements in terms of pruritus, patient and physicians' satisfaction, and total improvement in pigmentation of the lesions.

A prospective interventional study on efficacy of fractional carbon dioxide laser in primary cutaneous macular amyloidosis

Background: Macular amyloidosis (MA) represents a common variant of primary localized cutaneous amyloidosis (PLCA). Many therapeutic modalities, including topical and systemic medications, phototherapy, photochemotherapy, dermabrasion, and lasers have been suggested for PLCA with variable efficacy. Over the past decade, several studies have reported successful treatment of PLCA with different types of lasers. Aim: To evaluate the efficacy and safety profile of fractional carbon dioxide laser (FrCO2) in primary cutaneous MA. Methods: Using the consecutive sampling technique, 30 clinically confirmed cases of MA aged 18 years and above attending the dermatology out-patient department were recruited for a prospective, single group, interventional study. Each patient received three sessions with 4 weeks interval and then subsequently monitored for 20 weeks. The degree of pigmentation, rippling, itching, overall progress, and patient satisfaction were graded and compared for each patient. SPSS software version 23.0 was used for data analysis. Results: There was a statistically significant (P &lt; 0.001) improvement in the mean percentage of the degree of pigmentation, itching (P &lt; 0.001), and rippling scores (P = 0.03). Marked patient satisfaction was noted at 20 weeks. The excellent safety profile was noted. Conclusion: Our study has shown a positive response to treating MA with FrCO2 laser. Patients were highly satisfied, as there was a significant reduction in itching, pigmentation, and area of the skin lesion with no significant side effects. Our study points towards better efficacy of FrCO2 laser in MA with a good safety profile and better patient satisfaction.

A prospective comparative study of efficacy and safety of 15% trichloroacetic acid peel, 35% glycolic acid peel and Q-switched Nd-YAG laser in patients of macular amyloidosis.

The unappealing appearance of skin in macular amyloidosis (MA) interferes with the patient's quality of life, and treating the condition has been challenging. To compare the efficacy and safety of 15% trichloroacetic acid (TCA) peel, 35% glycolic acid (GA) peel, and Q-switched Nd-YAG Laser in MA. Open, prospective study was conducted over 2 years, where after fulfilling the criteria, randomization was done into three groups. Group A: 15% TCA peel; Group B: 35% GA peel; Group C: Q-switched Nd-YAG Laser. Procedures were repeated at monthly intervals for six sittings. On each visit, patients were scored on the following parameters: color score, visual analog score (VAS), physician global assessment (PGA) scale, subjective improvement, and adverse effects. A total of 75 patients (25 patients in each group) completed the treatment. The mean age of study-population was 35.68 ± 9.8 years, with female to male ratio of 11.5:1. The mean change in color score (1.68) was more by Group A, followed by Group C (1.4), followed by Group B (1.16). Similar results were noted by subjective improvement, VAS, and PGA. Adverse events were more in Group A, followed by Group C, followed by Group B. No patient showed permanent adverse events. TCA-peel showed superior results over Nd-YAG laser and glycolic-acid peel. TCA-peel being cost-effective with excellent acceptability should be considered a treatment modality.

Primary Localized Cutaneous Amyloidosis in Central Europe: A Retrospective Monocentric Study on Epidemiology and Therapy.

Amyloid deposits can be the cause of many chronic diseases. Primary localized cutaneous amyloidosis (PLCA) is a chronic dermatologic condition with amyloid deposits in the papillary dermis. The most common types of the keratinocyte-derived form of PLCA include macular (MA), lichen (LA), and biphasic (BA) amyloidosis. The estimated prevalence of PLCA in the Asian population is 0.98/10,000, which is higher than in the European population; thus, epidemiologic data on PLCA in the Caucasian population are limited. We performed a retrospective single-center study analyzing epidemiologic characteristics of a Central European PLCA population. Epidemiologic data regarding age, sex, skin phototype (Fitzpatrick scale I-VI), disease duration, comorbidities, history of atopy, and family history of PLCA were collected. Clinical characteristics, localization of PLCA lesions, applied therapies and treatment outcomes were also analyzed. Dermoscopic characteristics were also evaluated. A total of 41 patients diagnosed with PLCA were included, with 22 presenting with macular, 18 with lichen, and 1 with biphasic amyloidosis. The male/female ratio was 16/25, and mean age at diagnosis was 54.6 ± 15.2 years (range 27-87 years). The mean age at the onset of PLCA was 53 ± 16.1 years (range 19-79 years) in MA, 46.7 ± 18.2 years (range 14-73 years) in LA, and 26 years in BA. The interscapular region in MA and the extensor surface of the lower extremities in LA proved to be localization-related areas. In our center, a wide range of therapeutic options was applied, with the most prescribed being topical corticosteroids in all types of PLCA. We presented a retrospective, monocentric study on the epidemiology of PLCA in the Central European region. By examining the medical data of a significant number of PLCA patients, we compared our epidemiologic data with that of the Asian PLCA population. Due to the rarity of the condition, further randomized controlled trials and guidelines are needed to improve therapeutic outcomes.

A clinico-epidemiological study of different dermoscopic patterns in hyperpigmented facial lesions in a tertiary care centre

Abstract Introduction: Facial pigmentation is a common presentation of patients attending dermatology out patient department (OPD) and is of great concern to patients. Facial pigmentation may be multifactorial and is only rarely diagnosed accurately by a detailed history and clinical examination. Pigmentary disorders cause psychological distress and negatively impact the quality of life of an individual. Aims and Objectives: (1) To study different dermoscopic patterns in facial melanosis. (2) To estimate the frequency of different dermoscopic patterns. Materials and Methods: Patients with facial hyperpigmentation attending the dermatology OPD were recruited after taking their written consent. A detailed history was taken to collect demographic data. Clinical examination and dermoscopy were done in all patients. Biopsy was done as and when required. Descriptive statistics has been used to describe the quantitative data. Qualitative data were presented as frequency and percentage for clinical and dermoscopic patterns. Results: The study included 100 patients with 15 different facial melanoses. The most common age group affected was 21–40 years in 53 (53%) cases. The female-to-male ratio was 1.63:1. Melasma was reported as the most common cause of facial melanosis constituting 49 (49%) of the total cases. Out of the total melasma cases, epidermal melasma constituted 22 (45%) cases, dermal melasma constituted four (4%) cases and mixed melasma constituted 23 (47%) cases. Other cases included were lichen planus pigmentosus (14; 14%), facial acanthosis nigricans (14; 14%), periorbital hyperpigmentation (7; 7%), post-inflammatory hyperpigmentation (4; 4%), exogenous ochronosis (2; 2%), lentigines (2; 2%), frictional melanosis (2;2%), and one case each of Becker’s nevus, nevus of Ota, olanzapine-induced hyperpigmentation, Riehl’s melanosis, macular amyloidosis, and tanning. Conclusions: Melasma was reported as the most common cause of facial melanosis. The most common dermoscopic feature was accentuated pseudopigment network. The study is beneficial in understanding the different clinical and dermoscopic patterns of facial melanosis, thus helping the physician to effectively manage the conditions and reduce the need of biopsy. Limitations: (1) A small sample size. (2) Histopathological correlation was not done in all cases.

Dermatoscopy of primary localised cutaneous amyloidosis - A cross-sectional study in a setting of South Asian public dermatology department.

Amyloidosis, deposition of misfolded protein in body, is a fairly common condition. The deposition of misfolded proteins in skin which occurs in absence of systemic comorbidities, namely Primary Cutaneous Amyloidosis (PCA) is also a well-known entity in skin of colour patients of Asian subcontinent. Primary Cutaneous Amyloidosis is usually diagnosed with good clinical acumen and typical clinical phenotype and involved site. Dermoscope has been used as an adjunct non-invasive tool to confirm cases with diagnostic uncertainty and in those in whom biopsy is deferred. Typical dermoscopic features of PCA helps differentiate it from other pigmentary dermatoses and avoids unwanted invasive biopsies and investigations especially in resource poor settings with financial constraints. This study aims to identify and corroborate clinically, typical dermoscopic features in PCA in 42 patients which includes Macular Amyloidosis (MA) and Papular Amyloidosis (PA) predominantly in skin of colour patients from government based hospital of a south east Asian country. Patients with classic clinical features of PCA were selected. Primary Cutaneous Amyloidosis was subclassified into MA or PA and their corresponding clinically corroborative dermoscopic features were enlisted respectively. All patients (treatment naïve and previously treated), who consented to participate in the study were included. Patients were diagnosed based on the prototypical clinical features. Dermoscopy was done using DermLite III DL3N Polarised and Fluid Dermoscope w/PigmentBoost Brand (3Gen, DermLite LLC, San Juan Capistrano, CA, USA) and images were obtained to create digital dermoscopy system by attaching camera-equipped mobile device via an optional connection kit (Redmi Note 11, MIUI version 13.0.5, CHINA) and the findings were enlisted concurrently. In this study of dermoscopic findings of PCA, 42 patients were evaluated for their clinical lesions along with its corroboration with the dermoscopic features. Macular Amyloidosis was seen in 30 patients and 12 patients had typical cutaneous phenotypic and dermoscopic feature of PA. The most common dermoscopic finding seen in patients with MA was shiny to dull white, circular or oval central hub surrounded with halo of light brown dots. Most common configuration of brownish pigmentation around central hub was fine streak type. Also eccrine clues were seen in some cases of MA, which was a unique finding. Similarly in the PA subtype, the central hub was replaced by scar like structureless translucent white area surrounded by brownish black dot like structures, especially in those with large and thick plaques. Dermoscopic findings of PCA and their clinical corroboration is a much-needed aspect in treating patients with pigmentary disorders and in those with skin of colour, especially in developing countries. Utilization of dermoscope in clinical settings of low income countries and in government based hospitals will decrease the add on economic burden of invasive diagnostic modalities like biopsy and other inadvertent tests done to rule out pigmentary conditions.

Generalized lichen amyloidosis in a pregnant woman: Coincidence or association

A 32-year-old Thai woman in her first pregnancy presented with multiple hyperpigmented, hyperkeratotic, pruritic, discrete papules coalescing to form plaques with a rippled pattern on the extensor surfaces of upper and lower limbs, back, chest, and abdomen. Her mother had a similar history. Histopathology of the lesion revealed a diagnosis of lichen amyloidosis, confirmed by the Congo red stain. The lesions had started one year prior and had remained stable before pregnancy; however, they became widespread after pregnancy. Thus, prompting the question as to whether this was a coincidence or if the pregnancy had exacerbated the condition. In this case report, we will discuss our approach to this patient and our opinions concerning the relationship between pregnancy and lichen amyloidosis.

Characterization of Epidermal Function in Individuals with Primary Cutaneous Amyloidosis.

To compare epidermal biophysical properties, indicators of epidermal function, in individuals with and without primary cutaneous amyloidosis (PCA). This study incorporated 189 patients with PCA and 166 healthy individuals. The GPSkin Barrier was employed to measure transepidermal water loss (TEWL) rates and hydration levels of the stratum corneum. The Sebumeter and the Skin pH Meter were utilized to determine the skin surface's sebum content and pH, respectively. The severity of pruritus in participants was evaluated using the visual analog scale (VAS). Compared to the control group without PCA, individuals with PCA displayed a notable increase in skin surface pH and TEWL and a decrease in the hydration levels of the stratum corneum (p<0.0001 for all parameters). Additionally, the sebum content was markedly lower in those with PCA than in the controls (p<0.0001). Of particular note, both TEWL and skin surface pH at the lesion sites on the back and the shin were more elevated in lichenoid amyloidosis (LA) and in macular amyloidosis (MA), whereas hydration levels of the stratum corneum and sebum levels were diminished in LA compared to MA (p<0.05). In conclusion, both hydration levels of the stratum corneum and sebum content exhibited an inverse relationship with pruritus severity, whereas TEWL and skin surface pH demonstrated a positive correlation with pruritus intensity. The function of the epidermis is compromised in individuals diagnosed with PCA. However, the mechanisms underlying these changes await further investigation.

CT showed multiple pulmonary balloon lesions with intermediate balloon calcification in a case of nodular pulmonary amyloidosis: A case report.

Amyloidosis is a rare disease characterized by the misfolding of autologous proteins and extracellular deposition of fibrils, which can involve 1 or more vital organs in the body. Nodular pulmonary amyloidosis with extensive pulmonary cysts is even less common. This study discusses the diagnosis and treatment of a case of pulmonary nodular amyloidosis with extensive pulmonary cysts and calcification in the middle of the cysts on chest computed tomography, and reviews the related literature. We hope that this rare case will raise awareness of this disease among clinicians. Multiple pulmonary nodules and cysts were found on computed tomography of the chest, and the patient was eager to further clarify the nature of the nodules and the next treatment plan. Amyloidosis of pulmonary nodules. Since the patient's primary lesion was outside the bronchial lumen near the hilum, we opted for endobronchial ultrasound-guided tunnel biopsy to obtain pathological specimens, and confirmed the diagnosis of nodular pulmonary amyloidosis. After a definite diagnosis, the patient was regularly followed without any specific treatment. For patients with multiple pulmonary nodules combined with extensive pulmonary cysts, we also need to be alert to the possibility of pulmonary nodule amyloidosis. Secondly, when the main lesion is located outside the bronchial cavity near the hilum of the lung, the method of pathological tissue biopsy should also consider endobronchial ultrasound-guided tunnel biopsy.

EXPLORING MACULAR AMYLOIDOSIS IN PHOTOEXPOSED AREAS: CLINICAL AND HISTOLOGICAL INSIGHTS

Macular amyloidosis is a dermatological condition characterized by the deposition of amyloid proteins in the skin, particularly in photoexposed areas. This study offers clinical and histological insights into macular amyloidosis, focusing on its presentation, diagnosis, and histopathological features. A comprehensive review of clinical cases and histological specimens was conducted, highlighting common clinical manifestations and characteristic histological findings associated with macular amyloidosis. The study sheds light on the pathogenesis and etiology of the condition, exploring the role of chronic sun exposure and genetic predisposition. Additionally, diagnostic challenges and therapeutic options for macular amyloidosis are discussed, emphasizing the importance of accurate diagnosis and multidisciplinary management approaches.

A clinical case of familial cutaneous amyloidosis

Amyloidosis is a rare metabolic disease associated with the formation of an abnormal amyloid protein and has a complex mechanism of development in which hereditary, endocrine, enzyme and immune factors are involved. There are several types of amyloid, the main of which are AL a derivative of the light chains of immunoglobulins, AA a derivative of the acute phase of protein -globulin and amyloid associated with keratin AK. Amyloidosis can be systemic, with damage to various organs and tissues and localized (local). With localized amyloidosis of the skin, amyloid AK is mainly determined, with a nodular plaque variant amyloid AK and AL. Amyloidosis of the skin mainly has a benign course, however, in 510 % of patients with a nodularplaque variant of cutaneous amyloidosis, in the future amyloid changes in internal organs are formed, therefore this variant is potentially systemic.&#x0D; A clinical case of familial cutaneous amyloidosis in a mother and a daughter is described. The disease began in the mother at the age of 58, in the daughter at 37 years old without any obvious reasons. In the mother, the cutaneous pathological process had a more pronounced character with the formation of multiple dense brownish-brown nodes in the hips and shins,1,52,0 cm in diameter, merging into large bumpy plaques with excoriations, serous-hemorrhagic crusts and small-plate peeling on the surface. In the daughter, single nodes with a diameter of 1,01,5 cm, with clear boundaries, without a tendency to merge, were observed on the back surface of the shins.&#x0D; Histological and ultrasonic examination was used to confirm the diagnosis. Despite the fact that amyloidosis is difficult to treat, a positive dynamics resulting from the therapy was noted quite quickly in both women. Given the fact that nodular plaque amyloidosis of the skin may precede the systemic amyloidosis, both women need to undergo a follow-up observation from a therapist to monitor the general condition and a timely detection and correction of internal organ damage.

DP25 Widespread subcutaneous nodular kappa light chain amyloidosis

Abstract A 69-year-old woman was referred to the dermatology department for evaluation of multiple widespread subcutaneous lesions involving the neck, torso and limbs. These lesions, initially diagnosed in the community as lipomas, had been slowly progressing in size and number for 3 years. She had remained systemically well. Her only medical history was essential thrombocythaemia. She took no regular medication. On examination, there were multiple subcutaneous lesions appreciated on palpation with no overlying epidermal change. The patient was experiencing pain in a sciatic distribution. Magnetic resonance imaging of the femur showed a 12-cm enhancing area of subcutaneous nodularity encasing the sciatic nerve. Computed tomography of the chest, abdomen and pelvis showed multiple subcutaneous, ill-defined, soft tissue lesions of the anterior abdominal wall with no lymphadenopathy or organ abnormality. Deep incisional biopsies from two separate locations were completed. There was an unremarkable epidermis and dermis. In the subcutaneous fat, the septae appeared thickened alongside thickened elastic fibres and a prominent multifocal granulomatous reaction with a high degree of elastophagocytosis. There were multifocal aggregates of plasma cells that displayed no cytological atypia. In situ hybridization showed strong kappa light chain restriction. Plasma protein electrophoresis was completed and confirmed a paraprotein band in the gamma region of IgM kappa. Full blood count revealed a high platelet count (585 × 109 cells L–1) but was otherwise unremarkable alongside normal renal and liver function, bone profile, lactate dehydrogenase, B2 microglobulin, Bence–Jones proteins and infection screen. A Congo red stain was performed on the original histological samples. This showed apple green birefringence under polarized light-confirming amyloid. Haematology completed a bone marrow biopsy, which was normal. Referral to the National Amyloid Centre was made. Serum amyloid P scan showed no visceral involvement. A diagnosis of subcutaneous amyloid kappa light chain subtype (AL) was made. The patient has since commenced rituximab, bortezomib (Velcade®), cyclophosphamide and dexamethasone (R-VCD) chemotherapy at 4-weekly intervals over a 4-month period. Primary localized cutaneous amyloidosis is characterized by extracellular deposition of amyloid protein in the skin without evidence of systemic involvement and is often subtyped into macular, papular and nodular. Amyloidoma (tumoral amyloidosis) is rare and defined as a solitary localized deposit of amyloid. There are only four case reports in the literature of multiple subcutaneous amyloid deposits, and only one of these cases was of AL (light chain) vs. amyloid A (AA) subtype. This case showed nodules restricted to the neck (Nguyen TU, Oghalai JS, McGregor DK et al. Subcutaneous nodular amyloidosis: a case report and review of the literature. Hum Pathol 2001; 32:346–8). To our knowledge, this is the first case of widespread kappa light chain subcutaneous amyloidosis.

PD14 Audit of urgent phototherapy referrals

Abstract The British Association of Dermatologists’ (BAD) phototherapy guidelines state that patients referred urgently for phototherapy should start treatment within 3 weeks of referral and that if the patient is considered to require treatment urgently, then it should be started as soon as possible, to reduce patient discomfort and avoid the need for hospital admission. The prepandemic waiting time for urgent referrals, according to an audit in March 2021, was 6 weeks, but this time was even longer postpandemic. During the COVID-19 pandemic lockdown, the phototherapy service was suspended and then resumed in reduced capacity in our unit. The pandemic is also likely to have affected disease severity and patient’s concerns about treatment with systemic options. Our audit objective was to identify the time taken between referral to treatment start time for urgent referrals. Secondary objectives were to identify whether there was any prevalence of certain disease categories in deciding upon urgent referrals, and to identify if severity assessment scores were checked prior to urgent referrals by referring clinicians as per local guidelines. The audit was conducted retrospectively by including all urgent phototherapy referrals for 6 months between January and June 2022. Sixty-four urgent referral forms were analysed. The time taken between referral to treatment start time was 12 months. The majority of the urgent referrals (73%) were for eczema, 16% for psoriasis and 5% for mycosis fungoides. Other conditions such as polymorphic light eruptions, lichen planus and macular amyloidosis totalled 6% of referrals. Only 26% of referrals had documented disease severity scores. Thirty per cent of the referrals were &amp;lt; 18 years of age; young adults (19–25 years) accounted for 19% of referrals. Time taken between referral to treatment start time was 12 months, which significantly exceeded BAD standards. A number of factors affected this, including the impact of the COVID-19 lockdown on services and treatment capacity, patient choices and escalation of disease severity in lockdown, increased referrals with severe skin disease, preference in certain age groups such as children, and psychosocial factors. Patients with severe skin disease needing urgent treatment should be carefully triaged to receive treatment urgently, to avoid admission. Clinicians should assess this appropriately on a case-by-case basis and document disease severity scores and impact of skin disease in all urgent referrals.

Papular interstitial elastolytic giant cell granuloma concomitant with lichen amyloidosus in a type II diabetes patient

AbstractThe papular variant of elastolytic giant cell granuloma (EGCG) is a rare variant of EGCG, and it is occasionally associated with metabolic comorbidities, including diabetes mellitus (DM). Although the mechanisms of developing EGCG are still unknown, one of the possible mechanisms for ECGC developing in a DM patient might be explained by hyperglycaemia‐induced inflammation. In this report, we described a case of papular interstitial EGCG mainly composed of matrix metalloproteinase (MMP)‐9 bearing cells, concomitant with lichen amyloidosus in a type II DM patient.