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Intermittent use of topical dimethyl sulfoxide in macular and papular amyloidosis
E Ozkaya-Bayazit1, A Kavak, H Güngör
1Department of Dermatology, Istanbul Medical Faculty, Istanbul University, Turkey.
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.
Insights
Topical dimethyl sulfoxide (DMSO) therapy effectively manages pruritus in cutaneous amyloidosis. Intermittent DMSO application helps maintain symptom relief and improves patient tolerance to side effects.
Area of Science:
- Dermatology
- Cutaneous Medicine
Background:
- Severe pruritus is a hallmark of macular (MA) and lichen (LA) amyloidosis, often leading to further skin damage.
- Topical dimethyl sulfoxide (DMSO) has shown promise in managing this condition, but relapses occur after daily treatment.
Purpose of the Study:
- To evaluate the efficacy of intermittent topical DMSO therapy for maintaining symptom relief in MA and LA.
- To determine the optimal application interval for sustained therapeutic benefit.
Main Methods:
- Thirteen patients with cutaneous amyloidosis received daily 50% or 100% DMSO until pruritus resolved.
- DMSO application intervals were gradually increased to find the widest effective maintenance interval.
- Patients were monitored for pruritus, papules, pigmentation, and side effects.
Main Results:
- Pruritus resolved in an average of 4.1 weeks; papule flattening and pigmentation reduction were observed.
- The widest effective DMSO interval for symptom maintenance was 8.6 days.
- Side effects were generally milder and better tolerated with interval therapy compared to daily use.
Conclusions:
- Topical DMSO can disrupt the pruritus-amyloidosis cycle in MA and LA.
- Intermittent DMSO therapy is effective for maintaining symptom relief and improving tolerability.