Abstract

We present a case of a 45-year-old man with numerous, pruritic, hyperpigmented, smooth papules in a grouped isomorphic reaction pattern, to the bilateral conchal bowls and antihelices, clinically suggestive of comedones. There was no obstruction of external auditory canals. The remaining skin exam was normal. On histology, the stratum corneum was hyperkeratotic orthokeratosis with admixed parakeratosis, and deposition of amorphous eosinophilic material in the papillary dermis. The material demonstrated apple-green birefringence and Congo red positivity, consistent with auricular amyloidosis. Previously known as “collagenous papules of the ears”, this condition may represent a variant of lichen amyloidosis, as the hyperkeratosis and pruritus are shared in both conditions, versus a distinct rare form of primary cutaneous amyloidosis. It is more common in women and has been previously linked to basal keratinocyte degeneration specifically of keratin 5; however, this represents a primary cutaneous amyloid where systemic disease is never present, and clinical and histological findings are rare.

Financial Disclosure:
No current or relevant financial relationships exist.