Published online Apr 6, 2023. doi: 10.12998/wjcc.v11.i10.2301
Peer-review started: December 4, 2022
First decision: February 7, 2023
Revised: February 18, 2023
Accepted: March 14, 2023
Article in press: March 14, 2023
Published online: April 6, 2023
Processing time: 115 Days and 22.7 Hours
Lichenoid amyloidosis (LA) is a subtype of primary cutaneous amyloidosis characterized by persistent multiple groups of hyperkeratotic papules, usually on the lower leg, back, forearm, or thigh. LA may be associated with several skin diseases, including atopic dermatitis (AD). The treatment of LA is considered to be difficult. However, as there is some overlap in the etiopathogenesis of LA and AD, AD treatment may also be effective for LA.
Case 1: A 70-year-old man was diagnosed with severe AD with LA based on large dark erythema and papules on the trunk and buttocks and dense hemispherical millet-shaped papules with pruritus on the extensor side of the lower limbs. He had a long history of the disease (8 years), with repeated and polymorphic skin lesions. Given the poor efficacy of traditional treatments, this patient was recommended to receive dupilumab treatment. At the initial stage, 300 mg was injected subcutaneously every 2 wk. After 28 wk, the drug interval was extended to 1 mo due to the pandemic. Follow-up observations revealed that the patient reached an Eczema Area Severity Index of 90 (skin lesions improved by 90% compared with the baseline) by the end of the study. Moreover, Investigator's Global Assessment score was 1, and scoring atopic dermatitis index and numeric rating scale improved by 97.7% and 87.5% compared with the baseline, respectively, with LA skin lesions having largely subsided. Case 2: A 30-year-old woman was diagnosed with severe AD with LA, due to dense and substantial papules on the dorsal hands similar to changes in cutaneous amyloidosis, and erythema and papules scattered on limbs and trunk with pruritus, present for 25 years. After 16 wk of dupilumab treatment, she stopped, and skin lesions completely subsided, without recurrence since the last follow-up.
Dupilumab shows rational efficacy and safety in the treatment of severe AD with LA, in addition to benefits in the quality of life of the patients.
Core Tip: Although cases of atopic dermatitis (AD) with lichenoid amyloidosis (LA) are not uncommon, there are few reports on the use of AD treatment for LA. In this paper, two adult patients with severe AD and LA are described. Treatment with dupilumab significantly improved the AD and LA skin lesions with no adverse reactions, confirming the efficacy and safety of dupilumab in the treatment of AD with LA, and providing a reference for clinically similar diseases.