Methotrexate for the Treatment of Recalcitrant Primary Localized Cutaneous Amyloidosis: A Case Series

Primary localized cutaneous amyloidosis (PLCA) is characterized by deposition of keratinocyte-derived amyloid within the papillary dermis. PLCA often presents with intensely pruritic, waxy papules that coalesce into plaques on the extensor surfaces of the extremities. PLCA is most common in Asians and South Americans, and has been associated with atopic dermatitis.

PLCA poses a therapeutic challenge. Various treatment methods have been employed, but evidence in the form of randomized controlled trials is lacking. Topical therapies for PLCA include high potency steroids, calcipotriene, and menthol. Systemic therapies include acitretin, cyclophosphamide and cyclosporine. Additionally, the use of phototherapy and laser therapy has been reported. Despite the array of available treatments, PLCA often exhibits limited response, with frequent recurrence. Herein, we describe two cases of PLCA successfully treated with methotrexate (MTX).