Pulsed dye laser treatment of necrobiosis lipoidica: report of a case

A 23-year-old woman with long-standing insulin dependent diabetes presented with necrobiosis lipoidica. She was particularly troubled by the telangiectatic element of the lesion and therefore underwent test treatment with the pulsed dye laser. At low fluences minimal therapeutic effect was achieved, and at higher fluences skin breakdown occurred. This resolved with conservative management. It would appear that caution is required when attempting to treat necrobiosis lipoidica with laser.     

沙利度胺联合中波紫外线治疗类脂质渐进性坏死一例

患者女,32岁,因双侧小腿胫前斑块3年余就诊。患者3年前被蚊虫叮咬后左腿局部起丘疹,轻微瘙痒,以后双侧小腿逐渐出现丘疹并逐渐扩大,形成中央轻度凹陷的硬化萎缩性黄色斑块,自行外用多种糖皮质激素药膏无好转,平素身体健康,其母亲有糖尿病史……     

类脂质渐进性坏死一例报告

类脂质渐进性坏死较为少见,现将笔者所见一例报告如下.     

类脂质渐进性坏死1例

报告类脂质渐进性坏死1例。患者女,68岁,因右下肢胫前斑块2年就诊。皮肤专科检查:右下肢胫前可见一大小约10 cm×3 cm黄棕色斑块,边界清楚,表面光滑有光泽,可见毛细血管扩张和褐色斑,上覆鳞屑,上下端皮损中央萎缩凹陷,上见痂,质硬,无压痛。皮损组织病理检查:表皮轻度萎缩,真皮见胶原变性灶,周围组织细胞呈栅栏状排列,真皮浅深层毛细血管增生,管壁增厚,血管周围淋巴细胞、浆细胞、组织细胞及多核巨细胞浸润。实验室检查:血、尿、大便常规、肝肾功能正常,口服葡萄糖耐量试验提示糖耐量异常,糖化血红蛋白正常。诊断:类脂质渐进性坏死。予铒点阵激光(2 940 nm)联合卤米松/三氯生乳膏外用,皮损较前消退,目前仍在随访中。     

Squamous cell carcinoma in an area of necrobiosis lipoidica diabeticorum: a case report

Ulceration in an area of necrobiosis lipoidica diabeticorum is a frequent complication but malignant transformation is rare. One such case is reported in a diabetic patient and the literature is reviewed.     

穿通型类脂质渐进性坏死一例

患者男,24岁。因四肢及腹部起红色斑块,周边隆起3年就诊。3年前无明显诱因右下肢胫前出现1元硬币大小红色斑块,微痒,未曾治疗,皮损逐渐增大、增多,渐发展至腹部,偶有痛痒感。既往有1型糖尿病病史10年,口服降糖药及注射胰岛素治疗（具体不详）,血糖控制不稳。否认高血压、心脏病等内科疾病,否认肝炎、结核等传染性疾病,否认药物过敏史……     

Simultaneous occurrence of ulcerated necrobiosis lipoidica and granuloma annulare in a patient: case report

Simultaneous occurrence of granuloma annulare and necrobiosis lipoidica is quite rare. There are seven reported cases in the literature, but only one presenting ulcerated necrobiosis lipoidica. We report a 39-year-old male with histopathologically confirmed granuloma annulare and ulcerated necrobiosis lipoidica, without diabetes mellitus.     

肢端多发性脂质渐进性坏死一例

患者女,22岁,农民.因双手、小腿、踝部及足背斑块伴瘙痒2年于2011年6月1日在我科就诊.2年前患者被蚊虫叮咬后,左手拇指指背出现一黄豆大小红色丘疹,后逐渐增大变硬,形成一核桃大小硬性暗红色斑块,伴轻度瘙痒,上覆少量鳞屑,无红肿疼痛,无破溃,未进行处理.否认局部外伤和化学物质接触史.其后双手手背及手指、踝部、足背部和小腿先后出现数十块相似皮损,面积0.5 cm×0.5 cm～3.0 cm×3.0 cm,伴轻度瘙痒,无红肿疼痛,无破溃.发病以来,间断自涂外用药(药名不详),皮损仍缓慢扩展.自两年前左手拇指指背出现皮损后,患者出现烦渴、多饮、多食、多尿等症状,在当地医院诊断为2型糖尿病,现口服二甲双胍每日1 g,自诉血糖控制欠佳,空腹血糖8.0 mmol/L左右,餐后血糖不详.否认高血压、甲状腺功能亢进、心脏病等其他系统性及代谢性疾病.其母亲患2型糖尿病,家族中无类似皮肤病史.     

非糖尿病性类脂质渐进性坏死1例

类脂质渐进性坏死是一种代谢障碍性疾病,由于多伴发糖尿病,故又称为糖尿病性类脂质渐进性坏死,而非糖尿病性类脂质渐进性坏死病例十分少见,我们于2007年4月诊治1例,获得显著疗效,报告如下。     

Successful treatment of ulcerated necrobiosis: lipoidica diabeticorum with prostaglandin E1 and skin flap transfer--a case report

A case of a 58-year-old man with ulcerated necrobiosis lipoidica diabeticorum on the lateral aspect of the left foot was described. The ulcer showed no tendency toward healing despite conservative treatment and simple closure. However, a stable covering was achieved by skin flap transfer after radical debridement following intravenous prostaglandin E1 infusion.     

Fractional CO2 laser: a novel therapeutic device for refractory necrobiosis lipoidica

Necrobiosis lipoidica diabeticorum is a granulomatous skin disease of uncertain pathogenesis. Many therapeutic approaches have been reported in the literature, but none of them can be considered the gold standard. Fractional CO₂ laser treatment shows peculiar effects in the skin, mainly due to its ability of modulating cytokine pathways of tissue‐repairing mechanisms. Thus, we propose fractional CO₂ laser in the management of refractory necrobiosis lipoidica in selected recalcitrant patients.     

类脂质渐进性坏死研究进展

类脂质渐进性坏死是一种少见的慢性肉芽肿性疾病,本文综述了其流行病学,发病机制,包括血管、胶原蛋白、免疫球蛋白、中性粒细胞和遗传学,并总结了类脂质渐进性坏死的治疗方法。     

Update: Treatment of necrobiosis lipoidica

Necrobiosis lipoidica (NL) is a rare granulomatous disease of hitherto unclear etiology frequently seen in patients with diabetes. Characterized by its potential for ulcerations, it often presents a serious burden for those affected. There are currently neither German nor European guidelines for the treatment of NL. At the same time, standard treatment with topical or intralesional corticosteroids does not always show satisfactory results. We therefore set out to evaluate whether the various treatment regimens published since 2000 have actually expanded the therapeutic armamentarium in a relevant manner. Included were all publications that described more than one patient being treated with any given therapeutic modality. Overall, we analyzed data for 16 different treatment regimens reported in 49 publications. The largest amount of data exists for topical PUVA therapy, photodynamic therapy (PDT), and systemic treatment with fumaric acid esters. Remarkably, our analysis showed that with an increase in the number of documented patients treated with a given therapeutic modality, the proportion of those achieving a complete or partial response actually decreased. This was interpreted as publication bias. Thus, no clear recommendation can be given for second‐line therapy in case topical or intralesional corticosteroids fail.     

UVA1 phototherapy for treatment of necrobiosis lipoidica

The primary cause of collagen degeneration in necrobiosis lipoidica (NL) is proposed to be immunologically mediated vascular disease. Ultraviolet (UV)A1 has been used successfully to treat scleroderma in which both vascular damage and collagen dysregulation also occur. We treated six patients with NL [(five women; mean age of 32 years (range 22–70) and mean disease duration of 2.9 years (range 6 months to 5 years)] with a high‐output ultraviolet (UV)A1 2‐kW filtered metal halide source (Dr Hönle; Dermalight ultrA 1) having an emission spectrum of 340–440 nm. All patients had NL on the shins, which had been unresponsive to potent topical corticosteroid therapy (n = 6) and had responded minimally or not at all to TL‐01 UVB (n = 2), topical psoralen plus UVA (PUVA) soaking (n = 2) or oral PUVA (n = 1) therapy. Patients received a variable number of total exposures (15–51), given 3–5 times weekly. NL resolved completely in one patient; this patient had minimal improvement after the first course of 16 exposures, but after a further 13 exposures, resolution occurred 6 months later. Two subjects obtained moderate improvement in their overall disease severity after 15 and 24 exposures, while two had only minimal improvement after 15 and 51 exposures. The remaining patient had no improvement after 16 treatments. Patients with the shortest disease duration had the greatest response. UVA1 therapy may be of benefit for the treatment of NL as an adjuvant therapy to topical corticosteroids or as a second‐line alternative to other phototherapies, and may have a superior outcome in a proportion of patients.