Primary Localized Cutaneous Amyloidosis, Macular Type

Author(s): 
Peggy Lin, MD; Tania J. Phillips, MD, FRCPC

Department Editor
Tania Phillips, MD, FRCPC

Overall Learning Objectives: The physician or podiatrist participant will develop a rational approach to the evaluation and treatment of a variety of uncommon wounds and will have an increased awareness of the differential diagnosis of cutaneous wounds and the systemic diseases associated with these wounds.

Submissions: To submit a case for consideration in Diagnostic Dilemmas, e-mail or write to: Executive Editor, WOUNDS, 83 General Warren Blvd., Suite 100, Malvern, PA 19355, eklumpp@hmpcommunications.com

Completion Time: The estimated time to completion for this activity is 1 hour.

Target Audience: This CME/CPME activity is intended for dermatologists, surgeons, podiatrists, internists, and other physicians who treat wounds.

At the conclusion of this activity, the participant should be able to:
1. Discuss an interesting presentation of a leg ulcer.
2. Differentiate localized cutaneous amyloidosis from systemic amyloidosis.
3. Briefly discuss the difference between primary and secondary localized cutaneous amyloidosis.
4. Discuss the cutaneous amyloidoses with an emphasis on the more common macular and lichen forms.
5. Discuss management of this case of macular amyloidosis and leg ulcer.

Disclosure: All faculty participating in Continuing Medical Education programs sponsored by HMP Communications are expected to disclose to the program audience any real or apparent conflict(s) of interest related to the content of their presentation. Drs. Lin and Phillips disclose no financial conflicts.

Accreditation: HMP Communications is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. HMP Communications is approved by the Council on Podiatric Medical Education as a sponsor of continuing education in podiatric medicine.

Designation: HMP Communications designates this continuing medical education activity for 1 credit hour in Category 1 of the Physician’s Recognition Award of the American Medical Association. Each physician should claim only those hours he/she spent in the educational activity. HMP Communications designates this continuing education activity for .1 CEUs available to participating podiatrists.

Method of Participation: Read the article, take, submit, and pass post-test by September 15, 2003.

This activity has been planned and produced in accordance with the ACCME Essential Areas and Policies.

Release date: September 15, 2002
Expiration date: September 15, 2003

Presentation

A 62-year-old Hispanic woman presented with a history of intermittent ulcers on both lower extremities for two years prior to presentation. She complained of diffuse pruritus of her entire body, including itching in her legs, of which she admitted that she often scratched, causing small blisters filled with clear fluid. The pruritic blisters often progressed to painful ulceration, which had a history of slow healing and a minimal amount of drainage. Two-percent mupirocin ointment seemed to help heal her ulcers.

Her past medical history was significant for diabetes (20 years) for which she was taking oral hypoglycemic agents (glyburide and metformin). She had no history of deep venous thrombosis, cellulitis, surgery, or trauma to the legs. She denied arthritis, tobacco and alcohol use, hypertension, and cerebral or cardiovascular disease. Her past surgical history included appendectomy and hysterectomy. In addition to her oral hypoglycemic agents and occasional 2% Mupirocin ointment use, she was taking simvastatin. Her family history was negative for leg ulcers.

Physical Examination

Physical examination revealed a petite Hispanic woman with diffusely xerotic skin.

References: 

1. Lines RR, Hansen RC. A hyperpigmented, rippled eruption in a Hispanic woman. Arch Dermatol 1997;133:383–6.
2. Breathnach SM. Amyloid and amyloidosis. J Am Acad Dermatol 1988;18:1–16.
3. Brownstein MH, Hashimoto K. Macular amyloidosis. Arch Dermatol 1972;106:50–7.
4. Ahmed I, Charles-Holmes R, Black MM. An unusual presentation of macular amyloidosis. Br J Dermatol 2001;145(5):851–2.
5. Hicks BC, Weber PJ, Hashimoto K, Ito K, Koreman DM. Primary cutaneous amyloidosis of the auricular concha. J Am Acad Dermatol 1988;18:19–25.
6. Black MM, Jones EW. Macular amyloidosis: A study of 21 cases with special reference to the role of the epidermis in its histogenesis. Br J Dermatol 1971;84:199–209.
7. Wang CK, Lee JYY. Macular amyloidosis with widespread diffuse pigmentation. Br J Dermatol 1996;135(1):135–8.
8. An HT, Han KH, Cho KH. Br J Dermatol 2000;142(2):371–3.
9. Zaynoun S, Erabi M, Kurban A. Macular amyloidosis. Arch Dermatol 1973;108:583.
10. Breathnach SM. The cutaneous amyloidosis: Pathogenesis and therapy. Arch Dermatol 1985;121:470–5.
11. Mattheou-Valaki G, Ioannides D, Kapetis E, Minas A. Br J Dermatol 1996;135(3):489–91.



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