Mohammed Atta Dermatology

27/08/2026

اسوداد الرقبة مع زوائد لحمية

Acanthosis nigricans

هذه العلامة تكون فى العادة مؤشر على مقاومة الانسولين

26/08/2026

Patient 20-year-old with several months of asymptomatic, variably hypopigmented macules and patches involving the upper back, shoulders, and chest, with gradual coalescence. Lesions demonstrate subtle fine scale and become more conspicuous under Wood lamp examination. The distribution and morphology favor a superficial yeast-associated process rather than an inflammatory depigmenting disorder. A classic diagnostic clue is the presence of fine branny scale over multiple hypopigmented macules on the upper trunk.

🩺 Can you guess the diagnosis?

25/08/2026

31/07/2026

بنت صغيرة جاها طفح جلدي على جسمها بعد ارتفاع الحرارة

الحالة هذه اسمها Guttate psoriasis

هى نوع من الصدفية يجى للأطفال بعد التهابات الحلق فى العادة .

الطفح يظهر فجاءة ويختفى بعد حوالى شهر او شهرين

العلاج تحفظى .. يعنى نعالج الاعراض ونطمن الأهل ان الحالة حميدة وراح تختفى تماما.

31/07/2026

قبل وبعد

25/07/2026

🍂🤎 Lichen Planus Amyloidosis (LPA) :
🍂 Definition
- Lichen Planus Amyloidosis (LPA) is a localized form of primary cutaneous amyloidosis characterized by the deposition of amyloid derived from degenerated keratinocytes (AK type amyloid) within the papillary dermis.

- It represents an overlap between Lichen Amyloidosis and Lichen Planus, sharing clinical and histopathological features of both diseases. Chronic scratching and inflammation are believed to trigger keratinocyte degeneration, leading to amyloid deposition.

- Frequently associated with chronic pruritus.

⚠️ Etiology
The exact cause remains unknown.
Proposed mechanisms include:
✅ Chronic friction
✅ Persistent scratching
✅ Genetic susceptibility
✅ Keratinocyte apoptosis
✅ Immune-mediated inflammation

🔬 Pathogenesis
- Chronic itching develops.
- Repeated scratching damages basal keratinocytes.
- Degenerated keratinocytes undergo apoptosis.
- Keratin filaments are transformed into amyloid (AK amyloid).
- Amyloid accumulates within the papillary dermis.
- More amyloid deposition causes further itching, creating a vicious cycle.

🧬 Risk Factors
Chronic eczema
Atopic dermatitis
Lichen planus
Friction from towels or clothing
Xerosis
Genetic predisposition

👩‍⚕️ Clinical Presentation
Patients usually complain of:
✔ Intense chronic itching
✔ Hyperpigmented lesions
✔ Thickened rough skin
Lesions appear as
Brown
Gray-brown
Hyperkeratotic papules
that gradually coalesce into plaques.

📍 Common Sites
Most commonly:
Pretibial area
Shins
Ankles
Less commonly:
Forearms
Thighs
Upper back
Usually bilateral and symmetrical.

🔍 Clinical Features Suggesting LPA
✅ Severe pruritus
✅ Violaceous or brown lichenoid papules
✅ Background hyperpigmentation
✅ Chronic course
✅ Resistant to conventional treatment

🧪 Dermoscopy
Typical findings include:
🟤 Central brown hub
🟤 Gray-brown dots
🟤 Fine white scar-like areas
🟤 Peripheral pigmentation
🟤 Rippled pigmentation

🔬 Histopathology
The gold standard diagnosis.
● Epidermis
Hyperkeratosis
Acanthosis
Hypergranulosis
Irregular rete ridges
Lichenoid interface dermatitis
● Dermis
Amyloid deposits within papillary dermis
Melanophages
Pigment incontinence
Superficial lymphocytic infiltrate

🧫 Special Stains
Amyloid is positive with:
✅ Congo Red
Salmon-pink under light microscopy
Apple-green birefringence under polarized light
● Also positive with:
Crystal violet
Thioflavin T

🩺 Diagnosis
Diagnosis is based on:
✔ History
✔ Clinical examination
✔ Dermoscopy
✔ Skin biopsy
✔ Congo Red staining
⚖️ Differential Diagnosis

💊 Treatment
- There is no definitive cure, and management focuses on relieving pruritus and reducing inflammation.
● First-line therapy
✅ High-potency topical corticosteroids
Clobetasol propionate 0.05%
Often combined with occlusion.
● Calcineurin inhibitors
Tacrolimus 0.1%
Pimecrolimus 1%
Useful for long-term maintenance.
● Antihistamines
For symptomatic relief of itching.
Intralesional Corticosteroids
Triamcinolone acetonide for thick localized plaques.
● Systemic Therapy (Selected Cases)
Acitretin
Cyclosporine
Methotrexate
Dupilumab (in selected patients with severe chronic pruritus or concomitant atopic disease)
● Phototherapy
Excellent option for extensive disease.
Narrowband UVB
PUVA
Laser Therapy
May improve pigmentation and texture.
Examples:
Fractional CO₂ laser
Er:YAG laser
Q-switched Nd:YAG laser (for pigmentation)
General Measures
✔ Avoid scratching
✔ Moisturize daily
✔ Treat xerosis
✔ Wear soft cotton clothing
✔ Avoid excessive friction

📈 Prognosis
Benign condition
Chronic and relapsing
No risk of systemic amyloidosis
Pigmentation may persist even after inflammation subsides
Long-term control of pruritus is the key to preventing recurrence.