Persistently itchy papules

A man aged 47 years presented with a three-year history of intensely itchy legs following failed treatment with mild to mid-strength topical steroids elsewhere. The patient reported no other medical problems, and there was no family history of any skin disorder. Red-brown and red-grey papules were present on the anterior, antero-medial and antero-lateral skin of both legs (Figure 1). With time, some lesions became small firm nodules with adherent scale. His body mass index (BMI) was 29 kg/m2, and the systems examination was normal. A shave biopsy revealed lichen amyloidosis, (Figure 2). Full blood examination, urea, electolytes, creatinine, liver function test and urinalysis (protein) were normal.