• Users Online: 209
  • Print this page
  • Email this page

  Table of Contents  
Year : 2017  |  Volume : 8  |  Issue : 6  |  Page : 499-501  

Immunofluorescence and immunohistochemistry in macular amyloidosis: An observational study

1 Department of Dermatology and STD, Lady Hardinge Medical College and Associated Hospital, New Delhi, India
2 Department of Pathology, VMCC and Safdarjang Hospital, New Delhi, India

Date of Web Publication14-Nov-2017

Correspondence Address:
Anuja Yadav
Department of Dermatology and STD, Lady Hardinge Medical College and Associated Hospital, New Delhi
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/idoj.IDOJ_83_17

Rights and Permissions

How to cite this article:
Yadav A, Garg T, Mandal A K, Chander R, Yadav A. Immunofluorescence and immunohistochemistry in macular amyloidosis: An observational study. Indian Dermatol Online J 2017;8:499-501

How to cite this URL:
Yadav A, Garg T, Mandal A K, Chander R, Yadav A. Immunofluorescence and immunohistochemistry in macular amyloidosis: An observational study. Indian Dermatol Online J [serial online] 2017 [cited 2020 Apr 9];8:499-501. Available from: http://www.idoj.in/text.asp?2017/8/6/499/218351


Macular amyloidosis (MA) is believed to be multifactorial in origin. It usually presents as small 2–3-mm gray-brown or brown, pruritic (82%) or nonpruritic (18%) macules, which gradually join to form symmetric patches with a characteristic rippled/reticulate pattern involving most frequently the inter-scapular area and less frequently the upper arms, chest, and thighs.[1] Its diagnosis is based on its characteristic clinical appearance or on skin biopsy findings. Direct immunofluorescence (DIF) and immunohistochemistry (IHC) using anti-cytokeratin (CK) antibodies have been used in cases of cutaneous amyloidosis.[2],[3] We studied the role of DIF and IHC using anti CK5 antibodies in cases of MA.

Fifteen females with clinical and histopathological diagnosis (amyloid deposits in papillary dermis) of MA attending our outpatient dermatology department were included in the study [Figure 1]. Detailed history regarding various factors implicated in the etiology such as friction, sunlight, or any other factors such as cosmetic use, atopy, drugs, and systemic illness was obtained. Examination findings including sites involved and pigmentation pattern were recorded. DIF and IHC using anti-CK5 antibodies were carried out from the skin biopsy sample. Other investigations including hemogram, liver and renal function tests, blood sugar, and thyroid profile were performed. Mean age of the patients was 39.40 ± 8.73 years. Duration of symptoms varied from 6 months to 15 years with a mean duration of 52.80 ± 49 months. Pruritus and cosmetic concern were the main symptoms in 13 patients (86.7%) and cosmetic only in 2 patients (13.3%). Majority of MA patients (46.7%) had upper limb involvement as the first site of onset of pigmentation followed by the back (20%). The histopathology showed presence of amyloid deposits in the papillary dermis in all the cases on routine hematoxylin andeosin (H and E) stain and methylviolet stain. On DIF, immunoglobulin (Ig) M and third component of complement (C3) deposition were found in the papillary dermis in 20% of the patients, whereas IgG and IgM deposits in the papillary dermis were seen in 6.7% of the patients [Figure 2]a and [Figure 2]b. The pattern of deposition of IgM, C3, and IgG was in the form of globular deposits. IHC using anti-CK5 antibodies was positive in 13 patients (86.7%) [Figure 3]a and [Figure 3]b. Thyroid function test revealed reduced T3, T4 and increased TSH in 4 (26.6%) patients. Rest of the investigations were normal.
Figure 1: Reticulate and diffuse pigmentation in macular amyloidosis over the upper back

Click here to view
Figure 2: (a) Direct immunofluorescence showing globular depositsof IgM in papillary dermis (DIF, ×40), (b) Direct immunofluorescence showing globular positivityfor C3 in papillary dermis (DIF, ×40)

Click here to view
Figure 3: (a and b) CK-5 positive amyloid in papillary dermis (×40)

Click here to view

DIF findings in MA mainly showed positivity for IgM and C3. In a previous study of lichen amyloidosis, skin biopsies from all patients showed fluorescence with IgM, C3, and IgA throughout the basement membrane zone along with papillary dermal deposits in 20% of the patients. The intensity of fluorescence was strong for IgM in all (100%) these cases.[4] In our study, we noted DIF positivity in less number of patients which could be due to the less quantity of amyloid in the skin biopsy samples. IHC using anti-CK5 antibodies was done in all our cases with positivity in a good number of patients (86.7%). To date, there are only a limited number of reports on CK expression in a small series of primary cutaneous amyloidosis and secondary cutaneous amyloidosis.[5],[6] In a previous study of patients with diffuse pigmentation of the back and arms, IHC of skin biopsies revealed positive immunoreactivity to anti-CK antibody (CK5, 6, 8, 18) in all 9 patients who had amyloid deposits on H and E staining.[7] Positivity to CK5 antibodies signifies the derivation of amyloid from keratin. The detection of CK, using an LP34 clone which detects CK5,6 and 18 has been described as the new gold standard for the diagnosis of cutaneous amyloidosis.[8] In patients presenting with this pattern of pigmentation, histopathology should be done along with special stains for amyloid. DIF and IHC have an adjunctive role in making the diagnosis.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Black MM, Gawkrodger DJ, Seymour CA. Metabolic and nutritional disorders. In: Champion RH, Burton JL, Burns DA, editors. Textbook of Dermatology, 8th ed. Oxford Scientific Publications: Oxford; 1998.p3028-29.  Back to cited text no. 1
MacDonald DM, Black MM, Ramnarain N. Immunofluoresecence studies in primary localized cutaneous amyloidosis. Br J Dermatol 1977;96:635.  Back to cited text no. 2
Yoneda K, Watanabe H, Yanagihara M, Mori S. Immunohistochemical staining properties of amyloids with anti-keratin antibodies using formalin-fixed, paraffin-embedded sections. J CutanPathol 1989;16:133-6.  Back to cited text no. 3
Salim T, Shenoi SD, Balachandran C, Mehta VR. Lichen amyloidosus: A study of clinical, histopathologic and immunofluorescence findings in 30 cases. Indian J Dermatol Venereol Leprol 2005;71:166-9.  Back to cited text no. 4
[PUBMED]  [Full text]  
Eto H, Hashimoto K, Kobayashi H, Fukaya T, Matsumoto M, Sun TT. Differential staining of cytoid bodies and skin-limited amyloids with monoclonal anti-keratin antibodies. Am J Pathol 1984;116:473-81.  Back to cited text no. 5
Kitano Y, Okada N, Kobayashi Y, Tanigaki T, Okano M, Yoshikawa K. A monoclonal anti-keratin antibody reactive with amyloid deposit of primary cutaneous amyloidosis. J Dermatol 1987;14:427-9.  Back to cited text no. 6
Bolognia JL. Disorders of hypopigmentation and hyperpigmentation. In: Harper J, Orange H, Prose N, editors. Textbook of Pediatric Dermatology. 2nd ed. United States: Blackwell Science; 2000.p 868-70.  Back to cited text no. 7
Weedon D. Cutaneous deposits. In: Weedon D, editor. 3rd ed. Weedon's Skin Pathology. China: Elsevier; 2010.p370-96.  Back to cited text no. 8


  [Figure 1], [Figure 2], [Figure 3]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article
    Article Figures

 Article Access Statistics
    PDF Downloaded133    
    Comments [Add]    

Recommend this journal