A systematic review of procedural treatment for primary localized cutaneous amyloidosis: focus on efficacy, safety, treatment durability in comparison and combination.

BACKGROUND AND AIMS: Primary localized cutaneous amyloidosis (PLCA) is a persistent dermatological disorder characterized by the accumulation of amyloid deposits within the dermal papillae, resulting in pigmentation alterations, pruritus, and textural modifications of the skin. Given the lack of a standardized treatment for this condition, this review aims to evaluate the efficacy and safety of various procedural modalities for PLCA management.

METHODS

PubMed/Medline, Scopus, and Web of Science were systematically searched until August 25th, 2024. The study selection was restricted to English-language clinical studies, excluding case reports and case series. Our study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews and meta-analyses.

RESULTS

Based on our inclusion criteria, 16 studies with 432 patients were included, assessing fractional CO₂ laser, Nd: YAG laser, Er: YAG laser, microneedling, and phototherapy for PLCA treatment. Fractional CO₂ laser effectively improved pigmentation and pruritus, especially when combined with corticosteroids or vitamin C. Nd: YAG and Er: YAG lasers demonstrated favorable outcomes, with combination therapies enhancing efficacy. Microneedling and phototherapy (PUVA/UVB) also showed benefits, with PUVA being superior for pruritus.

CONCLUSION

Fractional CO₂ laser, especially with corticosteroids or vitamin C, showed the most effective results for pigmentation, pruritus, and amyloid reduction in PLCA. Nd: YAG and Erbium lasers, microneedling, and phototherapy also demonstrated benefits. However, further comparative clinical trials are needed to determine the most effective approach and establish standardized treatment protocols.