LAUSR

tion is in fact a new subtype of primary cutaneous amyloidosis or a variant of lichen amyloidosis.1,5 The histopathological analysis consists of a nodular deposit of amorphous, eosinophilic, and homogenous material in the papillary dermis. The overlaying epidermis is atrophic and can partially encompass the amyloid material, in thin collarettes, and can present hyperkeratosis. There is some conflicting evidence in the literature regarding the nature of the deposits. The first case reports suggest a collagenous nature of the material, as they were stained with Verhoeff-van Gieson and Periodic acid–Schiff (PAS) and not with Congo red, and presented electronic microscopy consistent with collagen deposit, and the lesions were called collagen papules of the auricular concha.4 However, the majority of the reported cases demonstrated that the material was stained with Crystal Violet and became orange-colored with Congo red, generally presenting positive birefringence when submitted to polarized light, thus suggesting the amyloid origin of such deposits.1,2,3,4 According to the author of the largest case study on this issue, they could represent two distinct entities, though clinically similar, which could have been clarified if immunohistochemistry had been used in the first cases.4 The material deposited in our patient presented a negative birefringence, which does not exclude the diagnosis of primary cutaneous amyloidosis, based on the clinical and histopathological findings. It is suggested that the amyloid material has an epidermal origin, since the immunohistochemical profile is positive for CK 34beta32, which corresponds to cytokeratins of high molecular weight, such as CK 1, 5, 10, and 14, which react with the squamous epithelium, including the epidermis.4 There is no specific treatment capable of removing the amyloid deposits. As the papules of the auricular concha are mostly asymptomatic, localized, and superficial, then electrocoagulation, curettage, and excision seem to be sufficient for a good aesthetic result.2,4q