Necrobiosis lipoidica in a patient with bronze diabetes

A case of necrobiosis lipoidica in a patient with idiopathic hemochromatosis and diabetes mellitus is presented. Histologic examination revealed excessive amounts of iron pigment in macrophages in the corium of the necrobiotic skin. There were no iron deposits in the normal skin.     

Necrobiosis lipoidica in a patient with generalized scleroderma: a case report

A 48-year-old woman with generalized scleroderma of the acrosclerosis type developed several lesions clinically, histologically and ultrastructurally, which were characteristic of necrobiosis lipoidica. The lesions were located to scar tissue. An increased collagen synthesis is suggested as a possible explanation.     

Necrobiosis lipoidica diabeticorum in a tattoo site

BACKGROUND: Trauma is an immediate triggering factor in the development of necrobiosis lipoidica diabeticorum (NLD). NLD has previously never been documented in a tattoo site. OBJECTIVE AND CONCLUSION: Here we report an otherwise healthy 35-year-old woman with an area of NLD located in a tattoo site. Initial injection with intralesional triamcinalone acetonide showed no benefit. Subsequent application of betamethasone valerate cream did not lead to improvement of the lesion.     

Necrobiosis lipoidica of the glans penis

We report a 65-year-old diabetic man with necrobiosis lipoidica occurring on the glans of penis. He was initially seen with chronic ulcerative balanitis that eventually healed with strict control of diabetes mellitus, cystostomy, and pentoxifylline, leaving heavily depressed scars. Penile necrobiotic palisading granulomas include necrobiosis lipoidica and granuloma annulare. On the basis of the literature review, these 2 diseases manifest different skin lesions.     

Necrobiosis lipoidica with rapid response to doxycycline

Necrobiosis lipoidica (NL) is a rare granulomatous disease of unknown etiology. Multiple therapies may be used with varying efficacy. We report a pediatric patient with a history of type I diabetes mellitus and NL with minimal response to an ultrapotent topical steroid, topical calcineurin inhibitor, and intralesional triamcinolone, complicated by steroid atrophy, who rapidly responded after addition of doxycycline.     

Necrobiosis lipoidica diabeticorum: a clinicopathologic study

Necrobiosis lipoidica diabeticorum is an unusual dermatologic condition with a characteristic clinical appearance and a clear association with diabetes mellitus. There is currently no treatment that reverses the atrophic changes associated with this lesion. We have carried out a clinicopathologic study on 15 subjects and, in addition, have reviewed 10 further biopsy specimens of necrobiosis lipoidica diabeticorum. We found a frequent association of necrobiosis lipoidica diabeticorum with other chronic complications of diabetes mellitus, including limited joint mobility. It is possible that nonenzymatic glucosylation or other changes in collagen may be important in the etiology of necrobiosis lipoidica diabeticorum and the limited joint mobility. We confirmed that cutaneous anesthesia is usually present in the necrobiosis lipoidica diabeticorum lesions. With the use of an antibody to S100 protein and an immunohistochemical method, there was an apparent decreased number of nerves in the skin lesions. We suggest that sensory loss results from local destruction of cutaneous nerves by the inflammatory process. Finally, in six elliptical biopsies extending into clinically normal skin, we demonstrated that the inflammatory infiltrate of necrobiosis lipoidica diabeticorum extended from the lesion into apparently normal skin surrounding clinically active lesions. Thus, intradermal steroids might be administered to perilesional areas surrounding active lesions in the hope of halting progression.     

糖尿病性类脂质渐进性坏死1例

报告1例糖尿病性类脂质渐进性坏死。患者男，37岁。左足背和右裸关节处褐色斑块4年余，逐渐增大，边缘隆起，中央无萎缩，局部无瘙痒和疼痛。否认有局部外伤和化学物质接触史。无家族性糖尿病病史。尿糖（ ），糖耐量试验异常。皮损组织病理检查典型的类脂质渐进性坏死特征。随着糖尿病的控制，皮疹逐渐消退。     

Necrobiosis lipoidica: treatment with systemic corticosteroids

In an attempt to find an effective therapy for necrobiosis lipoidica, we have treated six patients with this disease with a 5-week course of systemic corticosteroids. This treatment resulted in complete cessation of disease activity in all patients and no recurrence in a mean follow-up period of 7 months; however, restitution of atrophic skin lesions could not be achieved. The therapy was well tolerated and did not pose problems, even in diabetic patients. These results strongly suggest that short-course therapy of necrobiosis lipoidica with corticosteroids is of lasting benefit to these patients and should probably be considered early in the course of their skin disease.     

Necrobiosis lipoidica. Variants on a theme

A 69-year-old patient presented with different skin lesions all of which belonged to group of necrobiosis lipoidica. The initial histologic diagnosis was actinic granuloma O'Brien. A subsequent biopsy was interpreted as granulomatous necrobiosis lipoidica. The history of these necrobiotic variants is reviewed and exemplarily depicted with this case. Necrobiosis lipoidica is part of the spectrum of granulomatous skin disorders. Although its etiology is unclear, an association with diabetes mellitus is often discussed. Multiple therapeutic options exist, but standardized guidelines for treatment are missing.     

Necrobiosis lipoidica diabeticorum treated with the pulsed dye laser

BACKGROUND AND OBJECTIVE : Different treatment modalities have been advocated for necrobiosis lipoidica diabeticorum but clinical response is unpredictable. The purpose of this study was to evaluate the usefulness of pulsed dye laser (Candela SPTLÁ, Irvine, MA, USA) in the treatment of an area of necrobiosis lipoidica of 4 cm in diameter on the anterior aspect of the leg in a non-diabetic patient. MATERIALS AND METHODS : A spot test was made at 6.0, 6.5 and 7.0 J/cm 2 energy fluences and the best energy fluence was selected after a 2-month postoperative evaluation. The patient received three treatment sessions with a fluence of 6.5 J/cm 2 , 585-nm wavelength, 5-mm spot size, and 450 µs pulse duration at 8-week intervals. The patient was given routine skin care advice with emollient cream and sunscreen (SPF 15) until the following session. RESULTS : Overall cosmetic improvement was achieved, with a decrease of erythema and telangiectasis, and stabilization in terms of progression (size) in the left half of the lesion, with no modification of atrophy or pigmentary changes. The right upper quadrant of the lesion showed an erythematous peripheral halo with minimal reduction in the erythema and telangiectasia, and discrete size increase. CONCLUSION : Pulsed dye laser may be a useful treatment for improving the telangiectasia and erythematous component of necrobiosis lipoidica.     

Necrobiosis lipoidica in two diabetic sisters

Two sisters with diabetes mellitus have developed necrobiosis lipoidica within an interval of 14 years. Evidence is presented to suggest that inherited factors are involved in the aetiology of this uncommon skin disorder.     

Necrobiosis lipoidica in childhood: a review of literature with emphasis on therapy

Necrobiosis lipoidica (NL) is a rare chronic granulomatous disease that manifests as sharply demarcated, telangiectatic, brownish-red plaques with atrophic yellowish centers prone to ulceration and occurs predominantly on the shins. In children, NL is extremely rare, but resistance to therapy, troublesome cosmetic appearance, painful ulcerations, and possible development of squamous cell carcinoma in long-persisting lesions are challenges during treatment. Our review includes 29 reports of NL in patients aged <18 years published from 1990 on PubMed, EMBASE, and Medline. The mean age of patients was 14.3 years, with a female predominance of 2 : 1 and a high prevalence of diabetes mellitus (80%). Data showed that potent topical steroids up to twice daily is the first-line treatment. For refractory cases, therapy can be switched to tacrolimus. Ulcerations benefit from phase-adapted wound care and anti-inflammatory medical dressings such as medical honey. Adding hyperbaric oxygenation to local or systemic therapy in difficult-to-treat ulcerated lesions can be considered. Refractory cases may be switched to topical photochemotherapy or systemic treatment with TNF-α inhibitors, systemic steroids (preferably in non-diabetic patients), pentoxifylline, or hydroxychloroquine. Necrobiosis lipoidica in childhood is difficult to treat, with a treatment failure rate of 40%. Therefore, further research through patient registries is recommended.