In considering retinoids in this setting, their role in the management of hyperkeratotic and hyperproliferative disorders has been well recorded. Furthermore, retinoids’ antiinflammatory potential could help augment the effect of topical corticosteroids. Retinoids may reduce inflammation through the inhibition of immunoregulatory transcription factors, proinflammatory cytokines, and leukocyte recruitment.3 An improved anti-inflammatory response could reduce keratinocyte apoptosis and amyloid formation.
Currently, limited evidence exists supporting a definitive regimen in the management of lichen amyloidosis. Randomized controlled trials are needed to identify the appropriate treatment approach.4 The case presented suggests that a fixed combination of halobetasol-tazerotene therapy could be an effective off-label treatment in the management of lichen amyloidosis, as well as be an acceptable candidate for future trials. The synergistic effects of a topical corticosteroid and a topical retinoid reduce inflammation, and thus, decrease amyloid production. Furthermore, the addition of a retinoid reduces hyperkeratosis and epidermal acanthosis. Future well-controlled clinical studies would be needed to fully appreciate the potential.
Currently, limited evidence exists supporting a definitive regimen in the management of lichen amyloidosis. Randomized controlled trials are needed to identify the appropriate treatment approach.4 The case presented suggests that a fixed combination of halobetasol-tazerotene therapy could be an effective off-label treatment in the management of lichen amyloidosis, as well as be an acceptable candidate for future trials. The synergistic effects of a topical corticosteroid and a topical retinoid reduce inflammation, and thus, decrease amyloid production. Furthermore, the addition of a retinoid reduces hyperkeratosis and epidermal acanthosis. Future well-controlled clinical studies would be needed to fully appreciate the potential.
DISCLOSURES
The authors declare that there is no conflict of interest.
REFERENCES
1. Shimoda Y, Sato Y, Hayashida Y, et al. Lichen amyloidosus as a sweat gland/ duct-related disorder: resolution associated with restoration of sweating disturbance. Br J Dermatol. 2017;176(5):1308–1315. https://doi.zorg/10.1111/ bjd.15060
2. Schreml S, Szeimies RM, Vogt T, Landthaler M, Schroeder J, Babilas P. Cutaneous amyloidoses and systemic amyloidoses with cutaneous involvement. Eur J Dermatol. 2010;20(2):152-160. doi:10.1684/ejd.2010.0842
3. Kang S. The mechanism of action of topical retinoids. Cutis. 2005;75(2 Suppl):10-13.
4. Weidner T, Illing T, Elsner P. Primary localized cutaneous amyloidosis: a systematic treatment review. Am J Clin Dermatol. 2017;18(5):629–642. https://doi.org/10.1007/s40257-017-0278-9
2. Schreml S, Szeimies RM, Vogt T, Landthaler M, Schroeder J, Babilas P. Cutaneous amyloidoses and systemic amyloidoses with cutaneous involvement. Eur J Dermatol. 2010;20(2):152-160. doi:10.1684/ejd.2010.0842
3. Kang S. The mechanism of action of topical retinoids. Cutis. 2005;75(2 Suppl):10-13.
4. Weidner T, Illing T, Elsner P. Primary localized cutaneous amyloidosis: a systematic treatment review. Am J Clin Dermatol. 2017;18(5):629–642. https://doi.org/10.1007/s40257-017-0278-9
AUTHOR CORRESPONDENCE
Adam Friedman MD ajfriedman@mfa.gwu.edu
