Granuloma annulare and necrobiosis lipoidica treated by jet injector

A Porto-jet injector was employed to treat forty-five cases of granuloma annulare and five cases of necrobiosis lipoidica with triamcinolone acetonide or sterile normal saline. Complete clearance of granuloma annulare lesions was achieved in nearly 70% of those receiving triamcinolone and in 44% with saline. Inadequate penetration of lesions was responsible for a number of failures. The rate of recurrence after treatment was high but retreatment was usually successful. In three cases of necrobiosis lipoidica complete resolution occurred, while in one, partial improvement was obtained. No serious complications of this type of treatment were observed.     

类脂质渐进性坏死的研究进展

类脂质渐进性坏死是发生在真皮结缔组织的疾病,以小腿胫前的硬皮病样斑块为临床特征.其确切的发病机制不清楚,可能与糖尿病、免疫机制、胶原变性、血小板异常及创伤等多种因素有关.类脂质渐进性坏死同前尚无有效的治疗方法,糖皮质激素、免疫治疗、抗肿瘤坏死因子药物、光疗、延胡索酸酯及外科手术等有一定的疗效.     

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。     

Familial necrobiosis lipoidica not associated with diabetes

A 42-year-old woman presented with a 12-year history of extensive yellow and erythematous plaques, round and oblong with irregular configuration and glossy atrophic central areas on the pretibial aspects of both legs. Her 45-year-old sister presented with a 7-year history of a single plaque with erythematous margins, abundant telangiectases, and an atrophic center in the lower portion of the left leg. There was no family history of type-1 or type-2 diabetes mellitus. Both patients had normal fasting glucose concentration, oral glucose tolerance test, and glucose overload test. Different treatment options including topical corticosteroids were unsuccessful. Treatment with oral fumaric acid esters was attempted but the medication was discontinued because of intolerable side effects (flushing and gastrointestinal discomfort). At present, after a follow-up of 2 years, the plaques remain unchanged. These two cases should be added to the few cases of familial nondiabetic necrobiosis lipoidica previously reported.     

Venous insufficiency in patients with necrobiosis lipoidica

The pretibial area is the most frequently affected site in necrobiosis lipoidica (NL), but proposed mechanisms of NL cannot fully explain this high frequency. Although a few case reports indicate NL patients are complicated with venous insufficiency, no accurate assessment of the relationship between these two conditions has been performed. By using color Doppler ultrasonographic screening of four NL patients for venous insufficiency, we detected venous insufficiency in at least one leg of each patient. NL lesions were observed on all legs with venous insufficiency, and laboratory examination findings revealed that all the patients had hypercholesterolemia. The skin lesions did not respond satisfactorily to 6-month use of anticholesterolemic medication and elastic stockings. However, these results indicate that both hyperlipidemia and venous reflux, in addition to other pathogenic factors, can trigger tissue damage in the lower legs and lead to the onset of NL.     

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.     

Transepithelial elimination in necrobiosis lipoidica

Elimination of necrotic material through the hair follicle as a means of excretion has been observed in three cases of necrobiosis lipoidica. Clinically this process presents as comedo-like plugs localized mainly in the periphery of the lesions.