Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Reviewers 2024
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Reviewers 2024
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Net Letter
ARTICLE IN PRESS
doi:
10.25259/IJDVL_851_2024

Needle radiofrequency ablation (RFA) and topical tacrolimus combination therapy for primary localised cutaneous nodular amyloidosis

Department of Dermatology & Venereology, All India Institute of Medical Sciences, Delhi, India

Corresponding author: Dr. Neetu Bhari, Department of Dermatology & Venereology, All India Institute of Medical Sciences, Delhi, India. drntbhari@gmail.com

Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Danish M, Ahuja R, Gupta S, Bhari N. Needle radiofrequency ablation (RFA) and topical tacrolimus combination therapy for primary localised cutaneous nodular amyloidosis. Indian J Dermatol Venereol Leprol. doi: 10.25259/IJDVL_851_2024

Dear Editor,

Primary localised cutaneous nodular amyloidosis (PLCNA) is a rare skin disorder caused by the deposition of amyloid light chains in the skin and associated with minimal systemic involvement. It typically presents as firm, shiny, waxy nodules on acral sites, face, or trunk, and is often resistant to treatment. Managing PLCNA is challenging, and various therapeutic approaches have been explored. This report highlights a case managed using needle radiofrequency ablation (RFA) in combination with a topical tacrolimus 0.1% ointment. The combination therapy resulted in significant improvement, offering a promising and effective treatment option for this rare and difficult-to-treat dermatological condition.

A 50-year-old man presented with asymptomatic, gradually progressive nodular lesions over the left side of the nose since two years. There were no systemic complaints, and the family history was non-contributory. Cutaneous examination revealed yellowish-orange shiny waxy nodules coalescing to form plaques. There was overlying erythema and telangiectasia involving the dorsum and the left side of the nasal bridge [Figure 1]. No other sites were involved. The differential diagnoses of cutaneous sarcoidosis, cutaneous nodular amyloidosis, and lupus vulgaris were considered. Histopathology showed Congo red positive eosinophilic amorphous material in the dermis, along with mild lympho-histiocytic infiltrates, confirming the diagnosis of primary cutaneous nodular amyloidosis [Figures 2a and 2b]. The serum and urine electrophoresis were normal.

Yellowish-orange, shiny, waxy nodulo-plaque with erythema and telangiectasias on the left nasal dorsum.
Figure 1:
Yellowish-orange, shiny, waxy nodulo-plaque with erythema and telangiectasias on the left nasal dorsum.
Histopathology showing deposition of eosinophilic amorphous material in the dermis (Haematoxylin and eosin, 100x)
Figure 2a:
Histopathology showing deposition of eosinophilic amorphous material in the dermis (Haematoxylin and eosin, 100x)
Congo red stain showing amorphous eosinophillic amyloid deposits in the upper and mid dermis (original magnification ×100)
Figure 2b:
Congo red stain showing amorphous eosinophillic amyloid deposits in the upper and mid dermis (original magnification ×100)

The lesions were treated with needle RFA. 1 Initially, a non-insulated 27- gauge hypodermic needle was inserted approximately 2-4 mm deep into the lesions. The tip of a radiofrequency probe was then placed on the proximal un-inserted portion of the needle. Low-power energy in the coagulation mode (RF Surgical Generators, power supply: 220 V, Monopolar: 1–80 W) with power ranging from 2 to 5 was applied for 1 to 2 seconds and stopped before removing the needle to coagulate only the central portion of the lesions. This induced contraction of the dermal tissue and resulted in flattening of the lesions while preserving the overlying epidermis. Photoprotection and topical mupirocin were advised for 7 days post-procedure. The patient underwent three sessions of needle RFA over 6 months, resulting in about a 50% reduction in the bulk of the nodules with some scarring. In view of persistent erythema, the patient was started on tacrolimus 0.1% ointment twice a day for 3 months, resulting in almost complete resolution of erythema [Figure 3].

Showing response to treatment 9 months post treatment.
Figure 3:
Showing response to treatment 9 months post treatment.

PLCNA is characterised by the deposition of extracellular amyloid light chains in the skin without systemic involvement. 2 The amyloid deposits in PLCNA are composed of λ and/or ĸ immunoglobulins (AL proteins) produced by local plasma cells, in contrast to the more common types: macular and lichen amyloidosis, where amyloid protein is derived from degenerated keratinocytes. PLCNA usually affects middle aged adults both males and females. The most common sites of involvement include the face, 3 genitalia, acral sites, periauricular area, and occasionally the breast. 4 There are few reports of its association with Sjogren syndrome; therefore, some authors recommend screening with anti-SS-A antibodies. 5 It presents as solitary or multiple asymptomatic shiny, waxy erythematous to yellowish-orange nodules, plaques, or occasionally tumours. These may display a purpuric appearance or surface telangiectasias. Histopathology shows large deposits of amorphous, sometimes fissured, pale, eosinophilic amyloid material in the dermis, extending into the subcutaneous tissue. Special stains such as Congo red, periodic acid-Schiff, or crystal violet can aid in amyloid identification. Primary localised cutaneous nodular amyloidosis shares clinical and histological similarities with the cutaneous lesions seen in primary systemic amyloidosis, both being characterised by deposits of light- chain amyloid protein. Studies have reported about a 4-50% rate of progression to systemic amyloidosis. 6 The patient has been asked to undergo regular follow-up for screening for progression to systemic amyloidosis.

Several treatment modalities have been tried in the literature, including cyclophosphamide pulse, curettage, surgical excision, shave excision followed by dermabrasion, cautery, lasers such as fractional CO2 and PDL lasers, and intralesional methotrexate, bortezomib, or dexamethasone. 7 Surgical excision is the most commonly used treatment for PLCNA. This is the first case report of PLCNA showing response with a less invasive combination therapy of needle RFA and topical tacrolimus, with over 50% improvement in the thickness of nodules and almost complete resolution of erythema. Further studies are needed to confirm the efficacy of this treatment.

In conclusion, a combination therapy of needle RFA and topical tacrolimus is a novel, effective, and safe treatment for PLCNA.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Use of artificial intelligence (AI)-assisted technology for manuscript preparation

The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.

References

  1. , , . Intralesional radiofrequency with a thin hypodermic needle in the management of papular acne scars. J Am Acad Dermatol. 2021;84:e259-60.
    [CrossRef] [PubMed] [Google Scholar]
  2. , , . Primary localized cutaneous amyloidosis: A systematic treatment review. Am J Clin Dermatol. 2017;18:629-42.
    [CrossRef] [PubMed] [Google Scholar]
  3. , , , . A rare case of primary cutaneous nodular amyloidosis of the face. J Eur Acad Dermatol Venereol. 2008;22:1011-2.
    [CrossRef] [PubMed] [Google Scholar]
  4. , , , , , , et al. Primary localized cutaneous nodular amyloidosis on areola. Indian J Dermatol Venereol Leprol. 2022;88:653-5.
    [CrossRef] [PubMed] [Google Scholar]
  5. , , , . Localized cutaneous nodular amyloidosis and Sjögren’s syndrome. Intern Med. 2021;60:2513-4.
    [CrossRef] [PubMed] [Google Scholar]
  6. , . Nodular localized primary cutaneous amyloidosis: A long-term follow-up study. Br J Dermatol. 2001;145:105-109.
    [CrossRef] [PubMed] [Google Scholar]
  7. , . Nodular cutaneous amyloidosis effectively treated with intralesional methotrexate. JAAD Case Rep. 2016;2:373-6.
    [CrossRef] [PubMed] [Google Scholar]

Fulltext Views
139

PDF downloads
5
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections