Surgery best option for treating nodular primary localized cutaneous amyloidosis, states research

A new study published in the journal of Clinical and Experimental Dermatology showed that for non-nodular primary localized cutaneous amyloidosis (PLCA), laser therapy is recommended, but surgery is the most effective treatment for nodular amyloidosis.

Amyloid buildup in the dermis without systemic involvement is the hallmark of primary localized cutaneous amyloidosis which is an uncommon skin condition. Instead of coming from immunoglobulin or serum protein deposits as in systemic types of amyloidosis, amyloid in PLCA is formed from the keratin peptides of necrotic keratinocytes.

Amyloid development in the skin is thought to be caused by the deposition of filamentous material as a result of severe scratching brought on by pruritogenic processes. Atopic dermatitis is one condition where chronic scratching can lead to keratinocyte destruction and localized amyloid development. This study was set to review the existing treatment approaches and to offer a modern viewpoint on PLCA therapy.

This study examined the Cochrane Library, EMBASE, and PubMed databases for relevant articles. While case reports and case series were assessed using the Mann-Whitney U test, cohort studies were meta-analyzed using a random effects model to assess the results of various therapies.

In all, a total of 535 patients from 117 trials were included. With statistically significant differences for the other treatments, surgery was the preferred treatment for nodular amyloidosis (NA). 20 cohort studies (418 patients) and 62 case-level studies (79 patients) were examined independently for the non-NA group. Biological medicines and JAK inhibitors may be viable treatment for refractory lesions, despite the fact that the case-level studies did not find any statistically significant differences between regimens.

Transcutaneous electrical nerve stimulation, topical therapies, laser therapies, micro-needling, and systemic immunosuppressants had partial response (PR) rates of 100.0%, 100.0%, 97.5%, 96.9%, and 94.4%, respectively, while surgical procedures and laser therapies had complete response (CR) rates of 22.2% and 2.5%.

Overall, the study found surgery to be the best course of action for NA individuals, whereas laser treatment is advised for non-NA patients. For lesions that do not improve with traditional treatments, biologic medicines and JAK inhibitors could be interesting alternatives. JAK inhibitors and biological agents offer potential for refractory lesions. Also, a 100% partial response rate was obtained using transcutaneous electrical nerve stimulation and micro-needling which demonstrated a range of PLCA therapy alternatives.

Source:

Wang, Q.-X., Ye, Q., Zhou, K.-Y., Luo, S.-Y., & Fang, S. (2025). A systematic review and meta-analysis of treatments and outcomes of primary localized cutaneous amyloidosis. Clinical and Experimental Dermatology. https://doi.org/10.1093/ced/llaf081