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Abstract
Background: Macular amyloidosis (MA) represents a common variant of primary localized cutaneous amyloidosis. Various modalities were used in the treatment of Macular amyloidosis including topical steroids, Dimethyl sulfoxide (DMSO), oral retinoids, various types of lasers and others with variable results. Objective: To compare the efficacy of fractional CO2 laser versus glycolic acid peeling with topical tretinoin application on treating macular amyloidosis. Methods: Twenty five female patients with macular amyloidosis aged between 19-59 years, were treated by 4 sessions of fractional CO2 laser on the right side and Glycolic acid (20%) peeling and topical tretinoin 0.025% cream in between the sessions on the left side at 3-week intervals. Clinical improvement (in terms of global improvement score, degree of pigmentation and presence of rippling) was evaluated using a grading scale at baseline, every visit, 4 and 8 weeks after the last treatment. Itch score and subjective satisfaction rates were also assessed. Results: Both areas showed significant increase in the global improvement scale, significant decrease in the pigmentation and itching scores after treatment on both sides. But there was no significant difference between both areas. Unfortunately, there was non-significant decrease in the frequency of rippling on both sides. Subject satisfaction was relatively high, 42.9% had moderate satisfaction, 14.3% had very good satisfaction, 9.5% had excellent satisfaction and 33.3% had mild satisfaction on the right area. While on the left area, 38.1% had moderate satisfaction, 28.6% had very good satisfaction, 14.3% had excellent satisfaction while 19% had mild satisfaction. There was no significant difference in satisfaction between both areas. Higher Patient satisfaction was positively associated with higher global improvement scale and lower scores of pigmentation and itching. Six patients suffered transient post-inflammatory hyperpigmentation (PIH) after fractional CO2 laser was applied. None of the patients suffered severe pain, ulceration, pixilation or infection. No complications occurred from glycolic acid peeling or topical tretinoin except for minimal tingling sensation during application on the left side