Intermittent use of topical dimethyl sulfoxide in macular and papular amyloidosis

• Published in: International journal of dermatology 1998-12, Vol.37 (12), p.949-954
• Main Authors: Özkaya-Bayazit, Esen, e Kavak, Ayş, Güngör, Havva, Özarmagan, Güzin
• Format: Article
• Language: English
• Subjects: Administration, Topical; Adult; Amyloidosis - complications; Amyloidosis - drug therapy; Biological and medical sciences; Dimethyl Sulfoxide - administration & dosage; Drug Administration Schedule; Female; Humans; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Pruritus - drug therapy; Pruritus - etiology; Skin Diseases - drug therapy; Skin, nail, hair, dermoskeleton
• ISSN: 0011-9059; 1365-4632
• DOI: 10.1046/j.1365-4362.1998.00600.x

Background Severe and therapy‐resistant pruritus is the most prominent feature of macular (MA) and lichen (LA) amyloidosis that leads to further amyloid deposition by recurrent frictional trauma to the epidermis. Of the various therapeutic modalities with variable success, the most encouraging and beneficial effect has been observed with topical dimethyl sulfoxide (DMSO) therapy. In a previous study, we achieved marked clinical improvement in nine of 10 patients in a daily treatment regimen over 6–20 weeks, but relapses occurred in the post‐treatment follow‐up period. The aims of this study are to investigate whether the patients would benefit from intermittent therapy and to determine the optimal application interval of DMSO to maintain the relief of symptoms. Methods Thirteen patients with histopathologically verified cutaneous amyloidosis (five MA, two LA and six biphasic) were enrolled in the study. They were treated once daily with a 50 or 100% DMSO solution until pruritus disappeared. Then, DMSO was applied at increasing intervals until the widest effective application interval for maintenance of relief was reached. Patients were regularly followed‐up by a scoring system for pruritus, papules, and pigmentation, control biopsies, photographs, blood biochemistry, and side‐effects. Results The mean time required for the disappearance of pruritus was 4.1 weeks. Remarkable flattening of the papules was achieved after an average therapy period of 9 weeks. After a total therapy period of 6.5 months, a nearly 50% remission in pigmentation and >70% flattening of papules were achieved. The widest effective DMSO application interval was 8.6 days. The side‐effects of therapy were contact urticaria, desquamation, burning sensation, and garlic‐like breath odor, which were more prominent with the higher concentration of DMSO. In interval therapy, side‐effects were tolerated more easily than in daily therapy. No reduction of amyloid deposits was revealed in control biopsies. Conclusions Locally applied DMSO can break the vicious “pruritus–amyloid deposition–pruritus” cycle in patients with MA and LA. In addition to its daily use, interval therapy seems to maintain this effect and enables patients to tolerate side‐effects more easily.