[Truss-induced macular amyloidosis].
A 80-year-old male presented with a long time history of a localized red-brown macule with superficial lichenification and slight scaling in the right groin. An earlier skin biopsy revealed the presence of amyloid deposits. The patient therefore had a complete internal checkup including a rectal biopsy for exclusion of systemic amyloidosis. However, the laboratory data did not reveal any specific abnormalities including immunoglobulins and Bence-Jones protein. The rectal biopsy was also nonspecific. After skin examination, a rebiopsy was performed at our department showing acanthosis and spongiosis of the epidermis with parakeratosis. A homogenous eosinophilic deposit was present in the upper dermis and stained positive with thioflavine. At the second visit the patient wore a truss for a right inguinal hernia, perfectly matching the area of the skin lesion. Thus, the diagnosis of a localized macular amyloidosis was confirmed very likely due to permanent local friction. The classification of localized cutaneous amyloidoses should include local trauma as a cause to avoid unnecessary and exhausting internal checkups to exclude systemic involvement.
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Klinik und Poliklinik für Dermatologie, Klinikum der Universität Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg. christoph.abels@klinik.uni-regensburg.de
Karrer
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Landthaler
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Szeimies
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RM
D000368:Aged; D000369:Aged, 80 and over; D000686:Amyloidosis / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D001706:Biopsy; D003937:Diagnosis, Differential; D017276:Friction; D006552:Hernia, Inguinal / Q000534:rehabilitation; D006801:Humans; D008297:Male; D012867:Skin / Q000473:pathology; D012871:Skin Diseases / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D014340:Trusses / Q000009:adverse effects*