Papular amyloidosis (PA) is a form of primary cutaneous amyloidosis characterized by abnormal extracellular deposits of amyloid fibrils [1].

It presents as extremely pruriginous papular lesions, with the color of hyperkeratotic flesh, sitting electively on the anterior surfaces of the lower limbs. Diagnosis is based on histological examination. However, dermoscopy is of great help. Rare observations in the literature have focused on the interest of dermoscopy in the positive diagnosis of papular amyloidosis. The dermoscopic signs are pigmented granulations around a central crossroads histologically related to the amyloid deposit associated with striated pigmentation [2]. Herein, we describe a new case of dermoscopy of papular amyloidosis.

A 57-year-old female presented with pruritic, erythematous and violaceous lesions in the lower limbs evolving for seven years preceded by generalized pruritus and excoriated nodules persistent for fifteen years. A clinical examination revealed brownish, keratotic, and rough papules on confluent palpation in lichened plaques and purplish, erythematous nodules excoriated at the level of the extension faces of the two upper and lower limbs (Figs. 1a and 1b). Dermoscopy at the level of the papules revealed pigmented structures in “black peppercorns” arranged in rays around a central crossroads (Fig. 2). A skin biopsy confirmed the diagnosis of PA. The patient was put on dermocorticoids and the evolution was partially favorable with an improvement in the itching.

	Figure 1: (a) Clinical picture showing a papulonodular rash on the lower limbs. (b) Dermoscopic image showing whitish central junction and grayish-brown granulations.
	Figure 2: Dermoscopic image showing: Pigmented structures in the form of “black peppercorns” arranged in rays around a central crossroads.

REFERENCES

1. Moon AO, Calamia KT, Walsh JS. Nodular amyloidosis:Review and long-term follow-up of 16 cases. Arch Dermatol. 2003;139:1157-9.

2. Gérard E, Ly S, Cogrel O, Pham-Ledard A, Fauconneau A, Penchet I, et al. Primary localized cutaneous nodular amyloidosis:A diagnostic and therapeutic challenge. Ann Dermatol Venereol. 2016;143:134-8.