Combined fractional CO2 laser with dimethyl sulfoxide (DMSO) 50% versus fractional CO2 Laser alone in the treatment of macular amyloidosis: clinical and histopathological assessment

Background Macular amyloidosis (MA) could be of cosmetic concern with a significant psychological impact for patients, and its treatment is challenging. Aim of the work: To compare the efficacy and safety of combined fractional CO2 laser with dimethyl sulfoxide (DMSO) 50% versus fractional CO2 laser alone in the treatment of macular amyloidosis. Patients and methods: Twenty patients with macular amyloidosis were treated with monthly session of fractional CO2 laser only in one side of the lesion (area A), and fractional laser followed by application of DMSO 50% solution in the other side of the lesion (area B). All patients were evaluated clinically, by dermoscope and histopathology before and 3 months after the end of 4 treatment sessions. Results: Both treatments showed significant decrease of pigmentation after treatment (p < 0.001). There was non-significant decrease in rippling on both sides (p = 0.06). The median itching score dropped significantly after treatment from 9 to 3.5 in area A (laser only) and to 2 in area B (laser and DMSO), with non-significant difference between both areas (P = 0.244). Dermoscopic features after treatment showed fading and decreasing in multiple features in both areas A and B, with non-significant difference between the 2 areas. Histopathologically, there was significant reduction in the amyloid deposition after treatment in both areas A and B without significant difference between both areas. Conclusion: both fractional CO2 laser combined with topical DMSO 50% and fractional CO2 laser alone are safe and effective treatment options for MA with significant clinical improvement.