Lichen amyloidosis is a type of amyloidosis that affects only the skin. It’s the most common form of a group of skin conditions known as primary localized cutaneous amyloidosis (PLCA). Lichen amyloidosis is considered a benign (noncancerous) condition and does not affect the internal organs the way systemic (whole-body) amyloidosis can. However, lichen amyloidosis can cause ongoing symptoms, including pruritus (intense itching), that affect a person’s comfort and quality of life.

Continue reading to learn more about what lichen amyloidosis looks like and how it’s treated.

What Is Lichen Amyloidosis?

Lichen amyloidosis is the most common subtype of PLCA, a skin-specific form of amyloidosis that does not affect internal organs. Other types of PLCA include:

• Macular amyloidosis
• Nodular amyloidosis

• Biphasic amyloidosis (having lichen and macular amyloidosis at the same time)

Who Gets Lichen Amyloidosis?

There haven’t been many studies that specifically measure how common lichen amyloidosis is. However, it is a subtype of amyloidosis — a rare disease diagnosed in fewer than 1 in every 100,000 people in Western countries each year, according to StatPearls.

Lichen amyloidosis can affect people of any sex. Some research suggests it may be more common in men than in women, according to the Canadian Medical Association Journal. Other studies report no significant differences based on gender.

People of all racial and ethnic backgrounds can develop lichen amyloidosis. It’s considered rare in people with European origins but appears to be more common in people with darker skin tones and in people from Southeast Asia, China, and South America, according to Pigment International.

Symptoms typically begin between the ages of 50 and 70.

What Causes Lichen Amyloidosis?

Amyloidosis occurs when the body produces abnormal proteins that clump together and build up in tissues or organs. These clumps are known as amyloid deposits.

The exact cause of lichen amyloidosis isn’t fully understood. Researchers believe that chronic scratching and rubbing, along with possible immune system dysfunction, may damage skin cells. This damage could cause the cells to release abnormal proteins — likely related to keratin, a protein that helps form skin, hair, and nails. These proteins may then form amyloid deposits in the skin.

In some cases, lichen amyloidosis may be inherited. A small percentage of people — about 10 percent — may have a genetic mutation (a change in a gene passed from a parent to a child) that leads to the condition. Lichen amyloidosis is one of the most common inherited forms of PLCA.

What Areas on the Body Does Lichen Amyloidosis Affect?

Lichen amyloidosis is a type of localized amyloidosis that affects only the skin. Because it’s thought to develop from repeated rubbing, scratching, or friction, it often appears on areas of the body that are easy to reach or rub.

The most common location is the shins (the front of the lower legs). For instance, some people develop lichen amyloidosis on the shins from habits like rubbing the area with the heel of their foot.

Other areas that may be affected include the upper arms, back, and scalp. In rare cases, lichen amyloidosis may appear on the eyelids, nasal passages, tongue, or buttocks.

What Does Lichen Amyloidosis Look Like?

Lichen amyloidosis usually appears as clusters of papules (small bumps) that may be:

• Between one-eighth and one-quarter of an inch across
• Slightly raised and dome shaped
• Hyperpigmented (darker than the surrounding skin)
• Firm to the touch
• Very itchy

The appearance of lichen amyloidosis can vary depending on your skin tone. The papules may look red, brown, gray, or purple and often appear in clusters. These bumps are typically darker than the surrounding skin, but the exact color may differ for people with lighter or darker skin tones.

At first, the bumps may show up on just one side of the body. However, over time, they often appear on both sides. As the condition progresses, the small bumps can merge into a larger patch (called a plaque) with a rippled pattern that may look like cobblestones.

How Is Lichen Amyloidosis Diagnosed?

Lichen amyloidosis is diagnosed based on a combination of symptoms, medical history, and laboratory test results. In some cases, a healthcare provider may recognize lichen amyloidosis based on its appearance and pattern of symptoms alone — especially if it presents in a classic or well-known way.

Your provider may also ask about any other health conditions that can cause itching in the affected area. Some people with lichen amyloidosis have a history of other itchy skin conditions, such as atopic dermatitis (the most common form of eczema). Blood and urine tests may be ordered to check for other health issues, including signs of systemic amyloidosis.

Your healthcare provider may recommend a skin biopsy to confirm the diagnosis and rule out other skin conditions. A skin biopsy involves removing a small sample of affected skin to examine under a microscope. A pathologist — a doctor who specializes in studying body tissues — will look for signs of amyloid deposits in the sample.

How Is Lichen Amyloidosis Treated?

There’s no single standard treatment for lichen amyloidosis. Because research is limited, treatment usually focuses on relieving itching and improving the skin’s appearance.

It’s important to know that no treatment has been shown to work consistently for everyone. Your healthcare provider can help you explore different options to see what works best for you.

Treatments for Itching

Lichen amyloidosis often causes intense itching that can affect your sleep, mood, and quality of life. Managing the itch can also help stop the itch-scratch cycle — a loop where scratching leads to more inflammation and irritation, which causes more itching. In some cases, your healthcare provider may suggest covering the affected area to discourage scratching.

Common treatments for itch relief include:

• Topical corticosteroid (steroids) — These are applied directly to the affected skin to reduce inflammation and itching. They should only be used short term to avoid side effects like thinning skin.
• Steroid injections — These are injected directly into itchy areas, especially if topical creams don’t help.
• Tacrolimus ointment — This steroid-free option may reduce inflammation and help relieve itching.

Other treatments for itching related to lichen amyloidosis may include:

• Skin moisturizers
• Topical capsaicin
• Antihistamines
• Doxepin — A low-dose antidepressant sometimes used to relieve itching and help with sleep

Systemic Treatments

If topical treatments don’t help, your healthcare provider may recommend systemic treatments. These are typically considered for more severe cases. However, no systemic treatments are specifically approved for lichen amyloidosis, and the available research mostly comes from individual case reports or small studies.

Examples of systemic treatments that have been used include:

• Immunosuppressants
• Oral retinoids
• Chemotherapy medications
• Biologics (drugs that target the immune system)

Medical Procedures

Several medical procedures may improve the appearance of affected skin or reduce symptoms — but symptoms often return over time, even after treatment.

Procedures that may be used include:

• Surgical removal of affected skin
• Phototherapy (light therapy)
• Laser therapy
• Dermabrasion (a form of skin resurfacing)

What’s the Outlook With Lichen Amyloidosis?

There’s currently no cure for lichen amyloidosis. If it’s not treated, the affected areas of skin may become thicker, more discolored, and more resistant to treatment. However, unlike systemic forms of amyloidosis, lichen amyloidosis does not affect internal organs.

Chronic (long-term) itching is the most disruptive symptom for many people. Research shows that ongoing itch can significantly lower quality of life and is linked to symptoms of anxiety, depression, and poor sleep.

Everyone’s experience with lichen amyloidosis is different. Working with a healthcare provider can help you find the right strategies to manage symptoms and improve your quality of life. Don’t hesitate to ask your provider about ways to get relief — or when to consider other options if your current treatment isn’t helping.

Find Your Team

MyAmyloidosisTeam is the social media network for people with amyloidosis and their loved ones. Members come together to ask questions, give advice, and share their experiences with others who understand life with amyloidosis.

Are you living with lichen amyloidosis? Share your experiences below, or start a conversation by posting on your Activities page.