Bullous amyloidosis is a rare form of cutaneous involvement in systemic amyloidosis. It should be considered in a patient with an unexplained bullous eruption, especially if the patient is older or has other signs of amyloidosis.


Clinical features:

(1) The patient develops a bullous skin eruption which may be pruritic and/or hemorrhagic.

(2) Other types of skin lesions may also be present.

(3) The patient may have a history of amyloidosis but in some patients the skin lesions may be the first manifestation.

(4) The patient will have evidence of monoclonal proteins in serum and/or urine as well as elevation in free serum light chains.


A skin biopsy will show subepidermal bullae. Amyloid deposits are often seen in the papillary dermis on special histochemical stains or with immunofluorescence. A few patients have negative amyloid stains but the deposits can be seen on electron microscopy.


Differential diagnosis:

(1) cutaneous porphyria

(2) bullous pemphigoid

(3) drug eruption


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