Lichen Amyloidosus Without Itching Indicates That it is Not Secondary to Chronic Scratching

Sir, The origin of lichen amyloidosus (LA) is controversial. It is a form of primary cutaneous amyloidosus in which fibrillar proteinaceous material is deposited solely in the skin, without associated systemic manifestations. LA is typically highly pruritic, and the deposition of fibrillar material has generally been considered to be secondary to the scratching induced by other subjacent pruritogenic processes. However, our literature search revealed one previous report of LA without pruritus and a small-series study in which pruritus preceded lesions in most but not all patients. Here we present a case of widespread lichen amyloidosus with lesions on the trunk and extremities first noted 7 years previously by a young man, who at no stage reported pruritus. We conclude that, contrary to the actual view, pruritus and scratching are merely possible symptoms of this dermatitis, not requisite causal factors.