Question:

A middle-aged man complains of persistent itchy lesions of both shins for 5 years. He has tried different topical steroids, and there has been a partial response.

Answer: C. Lichen amyloidosis

Lichen amyloidosis is a form of localised cutaneous amyloidosis. It is particularly common in the Chinese. It usually presents as papules and nodules symmetrically distributed at the pretibial region. Biopsy shows an amorphous or hyalinised amyloid mass in the dermis and plasma cells may be present. The clinical picture is often typical and skin biopsy is normally not necessary to make the diagnosis. Topical corticosteroids, intralesional steroids, dermabrasion and carbon dioxide laser ablation have all been used with varying degrees of success in improving the cosmetic appearance and partial relief of itch.