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Hwang AS, Kechter JA, Li X, Hughes A, Severson KJ, Boudreaux B, Bhullar P, Nassir S, Yousif M, Zhang N, Butterfield RJ, Nelson S, Xing X, Tsoi LC, Zunich S, Sekulic A, Pittelkow M, Gudjonsson JE, Mangold A. Topical Ruxolitinib in the Treatment of Necrobiosis Lipoidica: A Prospective, Open-Label Study. J Invest Dermatol 2024; 144:1994-2001.e4. [PMID: 38417541 DOI: 10.1016/j.jid.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 03/01/2024]
Abstract
Necrobiosis lipoidica (NL) is a rare granulomatous disease. There are few effective treatments for NL. We sought to investigate the efficacy and safety of the Jak1/2 inhibitor, ruxolitnib, in the treatment of NL and identify the biomarkers associated with the disease and treatment response. We conducted an open-label, phase 2 study of ruxolitinib in 12 patients with NL. We performed transcriptomic analysis of tissue samples before and after treatment. At week 12, the mean NL lesion score decreased by 58.2% (SD = 28.7%, P = .003). Transcriptomic analysis demonstrated enrichment of type I and type II IFN pathways in baseline disease. Weighted gene coexpression network analysis demonstrated post-treatment changes in IFN pathways with key hub genes IFNG and signal transducer and activator of transcription 1 gene STAT1. Limitations include small sample size and a study group limited to patients with <10% body surface area. In conclusion, ruxolitinib is an effective treatment for NL and targets the key pathogenic mediators of the disease.
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Affiliation(s)
- Angelina S Hwang
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Jacob A Kechter
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Xing Li
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Alysia Hughes
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Kevin J Severson
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Blake Boudreaux
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Puneet Bhullar
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Shams Nassir
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Miranda Yousif
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Nan Zhang
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - Steven Nelson
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Xianying Xing
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Lam C Tsoi
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Samantha Zunich
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - Mark Pittelkow
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - Aaron Mangold
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA.
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Becker SL, Kody S, Fett NM, Hines A, Alavi A, Ortega-Loayza AG. Approach to the Atypical Wound. Am J Clin Dermatol 2024; 25:559-584. [PMID: 38744780 DOI: 10.1007/s40257-024-00865-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 05/16/2024]
Abstract
The heterogeneity of atypical wounds can present diagnostic and therapeutic challenges; however, as the prevalence of atypical wounds grows worldwide, prompt and accurate management is increasingly an essential skill for dermatologists. Addressing the underlying cause of an atypical wound is critical for successful outcomes. An integrated approach with a focus on pain management and patient engagement is recommended to facilitate enduring wound closure. Advances in treatment, in addition to further research and clinical training, are necessary to address the expanding burden of atypical wounds.
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Affiliation(s)
- Sarah L Becker
- Department of Dermatology, Oregon Health & Science University, 3303 S Bond Ave Building 1, 16th Floor, Portland, OR, 97239, USA
| | - Shannon Kody
- Department of Dermatology, Oregon Health & Science University, 3303 S Bond Ave Building 1, 16th Floor, Portland, OR, 97239, USA
| | - Nicole M Fett
- Department of Dermatology, Oregon Health & Science University, 3303 S Bond Ave Building 1, 16th Floor, Portland, OR, 97239, USA
| | | | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health & Science University, 3303 S Bond Ave Building 1, 16th Floor, Portland, OR, 97239, USA.
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3
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Mohammed H, Vilenchik V, Banner A, Keith D. Necrobiosis lipoidica treated using 308nm excimer pulsed light. Lasers Med Sci 2024; 39:105. [PMID: 38630151 DOI: 10.1007/s10103-024-04045-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/25/2024] [Indexed: 04/19/2024]
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Li Pomi F, Motolese A, Paganelli A, Vaccaro M, Motolese A, Borgia F. Shedding Light on Photodynamic Therapy in the Treatment of Necrobiosis Lipoidica: A Multicenter Real-Life Experience. Int J Mol Sci 2024; 25:3608. [PMID: 38612420 PMCID: PMC11011432 DOI: 10.3390/ijms25073608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
Necrobiosis Lipoidica (NL) is a dermatological condition characterized by the development of granulomatous inflammation leading to the degeneration of collagen and subsequent formation of yellowish-brown telangiectatic plaques usually localized on the pretibial skin of middle-aged females. Due to its rarity and unclear etiopathogenesis, therapeutic options for NL are not well-standardized. Among them, photodynamic therapy (PDT) is an emerging tool, although its efficacy has primarily been evaluated in single case reports or small case series. This study reports the real-life experience of a cohort of NL patients treated with PDT at the Section of Dermatology of the University Hospital of Messina and Reggio-Emilia. From 2013 to 2023, 17 patients were enrolled -5 males (29%) and 12 females (71%) aged between 16 and 56 years (mean age: 42 ± 13 years), with a median duration of NL of 8 years. The overall complete clearance (>75% lesion reduction) was 29%, while the partial clearance (25-75% lesion reduction) was 59%, with 12% being non-responders. This study adds to the little amount of evidence present in the literature regarding the effectiveness of PDT in the treatment of NL. Variability in treatment responses among patients underscores the need for personalized protocols, optimizing photosensitizers, light sources, and dosimetry. The standardization of treatment protocols and consensus guidelines are essential to ensure reproducibility and comparability across studies.
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Affiliation(s)
- Federica Li Pomi
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, 90127 Palermo, Italy;
| | - Alfonso Motolese
- Dermatology Unit, Department of Surgery, Infermi Hospital, AUSL Romagna, 47923 Rimini, Italy;
| | - Alessia Paganelli
- Dermatology Unit, Santa Maria Nuova Hospital IRCCS, 42123 Reggio Emilia, Italy; (A.P.); (A.M.)
| | - Mario Vaccaro
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, 98125 Messina, Italy;
| | - Alberico Motolese
- Dermatology Unit, Santa Maria Nuova Hospital IRCCS, 42123 Reggio Emilia, Italy; (A.P.); (A.M.)
| | - Francesco Borgia
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, 98125 Messina, Italy;
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5
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Hrin ML, Oscherwitz M, Jorizzo JL, Feldman SR, Huang WW. Evaluation of pentoxifylline in the treatment of necrobiosis lipoidica: outcomes in 10 patients. Int J Dermatol 2024; 63:390-392. [PMID: 38238633 DOI: 10.1111/ijd.17037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 01/05/2024] [Accepted: 01/06/2024] [Indexed: 02/17/2024]
Affiliation(s)
- Matthew L Hrin
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Max Oscherwitz
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Joseph L Jorizzo
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Dermatology, University of Southern Denmark, Odense, Denmark
| | - William W Huang
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Ionescu C, Petca A, Dumitrașcu MC, Petca RC, Ionescu (Miron) AI, Șandru F. The Intersection of Dermatological Dilemmas and Endocrinological Complexities: Understanding Necrobiosis Lipoidica-A Comprehensive Review. Biomedicines 2024; 12:337. [PMID: 38397939 PMCID: PMC10887100 DOI: 10.3390/biomedicines12020337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Necrobiosis lipoidica (NL) is a rare granulomatous skin disorder with a predilection for females, often associated with diabetes mellitus (DM). This paper aims to comprehensively review the literature on NL, focusing on its association with DM, thyroid disorders, and the metabolic syndrome. METHODS A systematic search was conducted in English-language literature from inception to October 2023, utilizing PubMed. We identified 530 studies and selected 19 based on clinical significance, statistical support, and relevance to the paper's goals. RESULTS The coexistence of NL and DM is prevalent, with rates ranging from 11% to 65.71%. NL may precede DM diagnosis and a correlation between NL and increased daily insulin requirements has been observed in such patients. NL is suggested as a potential prognostic marker for DM complications; however, recent studies question this association, highlighting the need for further research. Studies in the context of NL and Thyroid Disease indicate a correlation, especially with autoimmune thyroiditis. Regarding NL and Metabolic Syndrome, the prevalence of metabolic syndrome among NL patients is notably higher than in the general population. Additionally, DM patients with ulcerated NL commonly exhibit hypertension or obesity, raising questions about the potential influence of hypertension and obesity on NL ulcerations. CONCLUSION Additional research is required to untangle the complex connections between NL and various comorbidities.
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Affiliation(s)
- Corina Ionescu
- Department of Dermatovenerology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.I.); (F.Ș.)
- Dermatology Department, “Elias” University Emergency Hospital, 011461 Bucharest, Romania
| | - Aida Petca
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.P.); (M.C.D.)
- Department of Obstetrics and Gynecology, Elias Emergency University Hospital, 011461 Bucharest, Romania
| | - Mihai Cristian Dumitrașcu
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.P.); (M.C.D.)
- Department of Obstetrics and Gynecology, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania
| | - Răzvan-Cosmin Petca
- Department of Urology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Urology, “Prof. Dr. Th. Burghele” Clinical Hospital, 050659 Bucharest, Romania
| | - Andreea Iuliana Ionescu (Miron)
- Department of Oncological Radiotherapy and Medical Imaging, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Medical Oncology, Colțea Clinical Hospital, 030167 Bucharest, Romania
| | - Florica Șandru
- Department of Dermatovenerology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.I.); (F.Ș.)
- Dermatology Department, “Elias” University Emergency Hospital, 011461 Bucharest, Romania
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Mauricio D, Gratacòs M, Franch-Nadal J. Diabetic microvascular disease in non-classical beds: the hidden impact beyond the retina, the kidney, and the peripheral nerves. Cardiovasc Diabetol 2023; 22:314. [PMID: 37968679 PMCID: PMC10652502 DOI: 10.1186/s12933-023-02056-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 11/07/2023] [Indexed: 11/17/2023] Open
Abstract
Diabetes microangiopathy, a hallmark complication of diabetes, is characterised by structural and functional abnormalities within the intricate network of microvessels beyond well-known and documented target organs, i.e., the retina, kidney, and peripheral nerves. Indeed, an intact microvascular bed is crucial for preserving each organ's specific functions and achieving physiological balance to meet their respective metabolic demands. Therefore, diabetes-related microvascular dysfunction leads to widespread multiorgan consequences in still-overlooked non-traditional target organs such as the brain, the lung, the bone tissue, the skin, the arterial wall, the heart, or the musculoskeletal system. All these organs are vulnerable to the physiopathological mechanisms that cause microvascular damage in diabetes (i.e., hyperglycaemia-induced oxidative stress, inflammation, and endothelial dysfunction) and collectively contribute to abnormalities in the microvessels' structure and function, compromising blood flow and tissue perfusion. However, the microcirculatory networks differ between organs due to variations in haemodynamic, vascular architecture, and affected cells, resulting in a spectrum of clinical presentations. The aim of this review is to focus on the multifaceted nature of microvascular impairment in diabetes through available evidence of specific consequences in often overlooked organs. A better understanding of diabetes microangiopathy in non-target organs provides a broader perspective on the systemic nature of the disease, underscoring the importance of recognising the comprehensive range of complications beyond the classic target sites.
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Affiliation(s)
- Dídac Mauricio
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain.
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, IR Sant Pau, Barcelona, Spain.
- Department of Medicine, University of Vic - Central University of Catalonia, Vic, Spain.
| | - Mònica Gratacòs
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Josep Franch-Nadal
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
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Schiefer-Niederkorn A, Sadoghi B, Binder B. Literaturrecherche zur Therapie der Necrobiosis lipoidica in der Kindheit. J Dtsch Dermatol Ges 2023; 21:1120-1130. [PMID: 37845061 DOI: 10.1111/ddg.15137_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 04/25/2023] [Indexed: 10/18/2023]
Abstract
ZusammenfassungDie Necrobiosis lipoidica (NL) ist eine seltene granulomatöse Erkrankung mit scharf begrenzten, teleangiektatischen, braun‐roten Plaques mit atroph‐gelblichen Zentren, die zu Ulzerationen neigen und hauptsächlich an den Schienbeinen auftreten. Bei Kindern ist NL sehr selten, jedoch sind die Therapieresistenz, das problematische kosmetische Erscheinungsbild, die schmerzhaften Ulzerationen und die mögliche Entwicklung von Plattenepithelkarzinomen besonders herausfordernd für diese Altersgruppe. Unsere Literaturrecherche inkludiert 29 Berichte über NL bei Patienten unter 18 Jahren, die seit 1990 auf PubMed, EMBASE und Medline publiziert wurden. Das mittlere Alter war 14,3 Jahre mit weiblicher Prädominanz von 2 : 1 und hoher Prävalenz von Diabetes mellitus (80%). Aus den Daten geht hervor, dass hochpotente topische Steroide bis zu zweimal täglich Behandlung erster Wahl sind. Therapierefraktäre Fälle können auf Tacrolimus umgestellt werden. Ulzerationen profitieren von phasenadaptierter Wundversorgung und antientzündlichen medizinischen Verbänden wie mit medizinischem Honig. Das Hinzufügen einer hyperbaren Sauerstoffbehandlung zur lokalen oder systemischen Therapie kann bei schwer behandelbaren ulzerierten Läsionen in Betracht gezogen werden. Therapieresistente Fälle können umgestellt werden auf topische Photochemotherapie oder systemische Behandlung mit TNF‐alpha‐Inhibitoren, systemischen Steroiden (bevorzugt bei Patienten ohne Diabetes), Pentoxifyllin oder Hydroxychloroquin. Necrobiosis lipoidica in der Kindheit ist mit über 40% fehlgeschlagenen Therapieversuchen schwer zu behandeln, weshalb weitere Forschung über Patientenregister empfohlen wird.
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Affiliation(s)
- Anna Schiefer-Niederkorn
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz, Graz, Österreich
| | - Birgit Sadoghi
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz, Graz, Österreich
| | - Barbara Binder
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz, Graz, Österreich
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Schiefer-Niederkorn A, Sadoghi B, Binder B. Necrobiosis lipoidica in childhood: a review of literature with emphasis on therapy. J Dtsch Dermatol Ges 2023; 21:1120-1129. [PMID: 37401158 DOI: 10.1111/ddg.15137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 04/25/2023] [Indexed: 07/05/2023]
Abstract
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.
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Affiliation(s)
| | - Birgit Sadoghi
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - Barbara Binder
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
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10
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Hwang E, Abdelghaffar M, Shields BE, Damsky W. Molecularly Targeted Therapies for Inflammatory Cutaneous Granulomatous Disorders: A Review of the Evidence and Implications for Understanding Disease Pathogenesis. JID INNOVATIONS 2023; 3:100220. [PMID: 37719661 PMCID: PMC10500476 DOI: 10.1016/j.xjidi.2023.100220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/21/2023] [Accepted: 07/28/2023] [Indexed: 09/19/2023] Open
Abstract
Inflammatory cutaneous granulomatous diseases, including granuloma annulare, cutaneous sarcoidosis, and necrobiosis lipoidica, are distinct diseases unified by the hallmark of macrophage accumulation and activation in the skin. There are currently no Food and Drug Administration-approved therapies for these conditions except prednisone and repository corticotropin injection for pulmonary sarcoidosis. Treatment of these diseases has generally been guided by low-quality evidence and may involve broadly immunomodulatory medications. Development of new treatments has in part been limited by an incomplete understanding of disease pathogenesis. Recently, there has been substantial progress in better understanding the molecular pathogenesis of these disorders, opening the door for therapeutic innovation. Likewise, reported outcomes of treatment with immunologically targeted therapies may offer insights into disease pathogenesis. In this systematic review, we summarize progress in deciphering the pathomechanisms of these disorders and discuss this in the context of emerging evidence on the use of molecularly targeted therapies in treatment of these diseases.
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Affiliation(s)
- Erica Hwang
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mariam Abdelghaffar
- School of Medicine, Royal College of Surgeons in Ireland, Busaiteen, Bahrain
| | - Bridget E. Shields
- Department of Dermatology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - William Damsky
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
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Elzaouk E, Bourlond F, Scrivener Y, Cribier B. Post-traumatic ulcerated and chronic necrobiosis lipoidica of the elbow: A new entity? Ann Dermatol Venereol 2023; 150:185-188. [PMID: 37208216 DOI: 10.1016/j.annder.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/15/2022] [Accepted: 03/07/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Necrobiosis lipoidica (NL) is a chronic granulomatous dermatosis usually affecting the lower limbs, although less common sites have been described. Herein we report a series of cases of NL located on the elbow, with an unusual presentation and occurring after trauma or surgery. OBSERVATIONS Our series includes three men and one woman, with a mean age of 64 years. Three had undergone surgery for elbow bursitis and one had had trauma after a fall from a horse, with exposure of subcutaneous tissue prior to healing. Within 5 years, they had all developed an atrophic erythematous annular plaque with papular and telangiectatic edges, with recurrent episodes of ulceration and scarring. Repeated tests for infectious agents were negative. Histological examinations showed granulomas and necrobiosis with palisading or early-stage palisading. Partial healing was achieved in two patients after 6 months of doxycycline. Treatment with adalimumab resulted in disappearance of the ulcers at 6 months in one patient. DISCUSSION Unusual sites of NL impose consideration of other types of palisading granuloma or mycobacterial infections, which we were able to rule out. Two other cases of NL of the elbow similar to ours are reported in the literature. These cases, involving multiple ulcerations over a very long period of time, probably constitute a distinct entity because of the very distinct character of these 6 cases. Tetracyclines are partially active and tumour necrosis factor alpha (TNF)-alpha inhibitors may offer an option.
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Affiliation(s)
- E Elzaouk
- Dermatology Clinic, Hôpitaux Universitaires et Université de Strasbourg, 1 Place de l'Hôpital, 67091 Strasbourg Cedex, France.
| | - F Bourlond
- Dermatology Clinic, Hôpitaux Universitaires et Université de Strasbourg, 1 Place de l'Hôpital, 67091 Strasbourg Cedex, France
| | - Y Scrivener
- Dermatology Clinic, Hôpitaux Universitaires et Université de Strasbourg, 1 Place de l'Hôpital, 67091 Strasbourg Cedex, France
| | - B Cribier
- Dermatology Clinic, Hôpitaux Universitaires et Université de Strasbourg, 1 Place de l'Hôpital, 67091 Strasbourg Cedex, France
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12
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Palomares SJ, Farberg AS. Nonulcerated Necrobiosis Lipoidica Successfully Treated with Tapinarof: A Case Report. Clin Cosmet Investig Dermatol 2023; 16:1373-1376. [PMID: 37275215 PMCID: PMC10237186 DOI: 10.2147/ccid.s408070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/25/2023] [Indexed: 06/07/2023]
Abstract
Necrobiosis lipoidica (NL) is a chronic granulomatous disorder of the skin which usually presents with red papules and plaques on the lower extremities. Diabetes mellitus has been found to be associated with NL, but the pathophysiology of the disease is unknown. Based on a Doppler flowmetry study showing increased blood flow at NL lesions and the macrophage upregulation of granulomatous disorders, it is reasonable to conclude that there is an inflammatory component to it. NL is extremely challenging to manage. The initial treatment of choice is usually topical or intralesional corticosteroids, and if this fails to work, many dermatologists depend on the small number of case reports for more treatment options. We present a pre-diabetic patient with nonulcerative NL who was successfully treated with the first-in-class therapeutic aryl hydrocarbon receptor (AHR)-modulating agent tapinarof cream (VTAMA, Dermavant). Following the case presentation is a discussion of this topical novel agent and its unique anti-inflammatory mechanism of action. Tapinarof specifically binds to and activates AHR leading to downregulation of TNF-α/IL-23/IL-17 and inhibition of IL-4/IL-13 mediated STAT6 activation. Anti-TNF-α agents and JAK-inhibitors have also been found to be beneficial in treating NL; tapinarof seems to target both these pathways without the risk of their serious adverse reactions.
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Blevins M. Atypical Ulcerative Necrobiosis Lipoidica Diabeticorum: A Case Study. THE INTERNATIONAL JOURNAL OF LOWER EXTREMITY WOUNDS 2023; 22:185-189. [PMID: 33745343 DOI: 10.1177/1534734621999269] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Necrobiosis lipoidica is a granulomatous skin condition commonly associated with diabetes. When associated with diabetes mellitus, the name expands to necrobiosis lipoidica diabeticorum (NLD). In these patients, this rare condition has an incidence rate of 0.3% to 1.6%. The cause of NLD remains unknown even though many speculations exist in the medical literature. The treatment of this condition has most researchers agreeing on the use of topical steroids for the anti-inflammatory effect on NLD; however, the role of glucose control in the treatment of this disorder has been debatable. The following case presents a patient who, despite better glucose control, did not improve until the introduction of doxycycline.
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14
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Hines A, Butterfield R, Boudreaux B, Bhullar P, Severson KJ, McBane RD, Davis MDP, Pittelkow MR, Mangold AR, Alavi A. Characteristics of ulcerated and non‐ulcerated necrobiosis lipoidica. Int J Dermatol 2022; 62:790-796. [PMID: 36479693 DOI: 10.1111/ijd.16529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/30/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Necrobiosis lipoidica (NL) is complicated by ulceration in up to 35% of cases. METHODS Retrospective study of patients with NL seen at our institution between January 1, 1992, and May 25, 2021, was conducted. Ulcerated NL (UNL, n = 83) and non-ulcerated NL (NUNL, n = 233) groups were compared. RESULTS Twenty-six percent (83/316) of patients with NL experienced ulceration. UNL was significantly more likely to be painful (52% vs. 36%, P = 0.01), was more likely to have a lesion-associated cutaneous malignancy (7% vs. 0%, P < 0.001), and had a larger median size (7 vs. 5 cm, P = 0.004) compared to NUNL. Vascular studies were performed on a subset of patients and revealed transcutaneous oxygen pressure (TcPO2) < 40 mm Hg in 53% and venous insufficiency in 62% with no significant differences between UNL and NUNL groups. In patients with unilateral ulceration, mean TcPO2 values (39.7 vs. 46.6 mm Hg), regional perfusion index <0.6 (29% vs. 14%), and TcPO2 < 40 mm Hg (43% vs. 14%) were worse in the ulcerated leg compared to the non-ulcerated leg, but these differences were not statistically significant. CONCLUSIONS UNL was more likely to be painful, develop lesion-associated malignancy, and be larger in size compared to NUNL. There were no statistically significant differences in venous insufficiency, arterial Doppler/ankle brachial index, or TcPO2 values between UNL and NUNL patients, however, a significant portion of the cohort demonstrated abnormal vascular studies, particularly on TcPO2 and venous insufficiency testing.
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Affiliation(s)
| | | | | | | | | | - Robert D. McBane
- Division of Vascular Medicine of Cardiovascular Diseases Mayo Clinic Rochester MN USA
| | | | | | | | - Afsaneh Alavi
- Department of Dermatology Mayo Clinic Rochester MN USA
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15
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Verheyden MJ, Rodrigo N, Gill AJ, Glastras SJ. A case series and literature review of necrobiosis lipoidica. Endocrinol Diabetes Metab Case Rep 2022; 2022:21-0185. [PMID: 36001014 PMCID: PMC9422228 DOI: 10.1530/edm-21-0185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/26/2022] [Indexed: 12/05/2022] Open
Abstract
Summary Necrobiosis lipoidica (NL) is a rare and chronic disease characterised by yellow-brown, atrophic, telangiectatic plaques usually located on the lower extremities, with pathological features of collagen necrobiosis and dermal inflammation. Most cases are seen in those with diabetes mellitus, particularly type 1 diabetes (T1DM), and many without diabetes have evidence of abnormal glucose tolerance or family history of autoimmune disease. In this study, we describe four patients with NL and T1DM. A common theme is late identification and delay in diagnosis. Hence, we discuss the clinical features, need for clinicopathological correlation, and the management and prognostic implications for this distinctive entity. While most remain relatively asymptomatic, others progress to debilitating disease with pruritus, dysesthesia, and pain. Pain is often intense in the presence of ulcerated plaques, a morbid complication of NL. Diagnosis requires the integration of both clinical and histopathological findings. NL has proven a challenging condition to treat, and despite the numerous therapeutic modalities available, there is no standard of care. Hence, in this study, we provide an overview of current management strategies available for NL. Learning points Necrobiosis lipoidica (NL) is classically seen in patients with type 1 diabetes. Koebner phenomenon, defined as the appearance of new skin lesions on previously unaffected skin secondary to trauma, is a well-recognised feature in NL. Background skin phototype contributes to variable yellow appearance of lesions in NL. Diagnosis of NL requires careful clinicopathological correlation. NL is a chronic disease often refractory to treatment leading to significant morbidity for the patient and a management conundrum for the multidisciplinary healthcare team. No standard therapeutic regimen has been established for the management of NL.
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Affiliation(s)
- Matthew J Verheyden
- Department of Diabetes, Metabolism and Endocrinology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Natassia Rodrigo
- Department of Diabetes, Metabolism and Endocrinology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Department of Diabetes and Endocrinology, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Anthony J Gill
- Cancer Diagnosis and Pathology Group, Kolling Institute, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Sarah J Glastras
- Department of Diabetes, Metabolism and Endocrinology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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16
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Perlamutrov YN, Svishchenko SI, Pugner AS. Scleroderma-like form of lipoid necrobiosis in a patient with idiopathic thrombocytopenic purpura. VESTNIK DERMATOLOGII I VENEROLOGII 2022. [DOI: 10.25208/vdv1302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
A 33-year-old female patient with idiopathic thrombocytopenic purpura complained of rashes on the skin of the lower extremities, accompanied by moderate itching and a feeling of skin tightness, as well as a histologically verified diagnosis of lipoid necrobiosis. A combined treatment was carried out with the glucocorticosteroid Methylprednisolone at a dose of 32 mg per day in combination with PUVA therapy with 0.3% solution of ammi majus fructuum furocumarines, with a positive effect in the form of a decrease in the color intensity and induction of rashes, under the control of platelet levels. When using the method of PUVA-therapy with 0.3% solution of ammi majus fructuum furocumarines, there was an improvement in the 8th phototherapy procedure, however, due to a decrease in the level of platelets in the blood, the course of phototherapy was suspended.
The method of PUVA therapy with 0.3% solution of ammi majus fructuum furocumarines turned out to be clinically effective in the treatment of lipoid necrobiosis, however, the presence of concomitant pathology in the patient requires an interdisciplinary approach to the choice of treatment tactics.
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17
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Brandes GIG, Peixoto-Barbosa R, Meski APG, Giuffrida FMA, Reis AF. Granuloma annulare and necrobiosis lipoidica in a patient with HNF1A-MODY. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:2359-3997000000477. [PMID: 35551682 PMCID: PMC9832856 DOI: 10.20945/2359-3997000000477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 12/22/2021] [Indexed: 11/23/2022]
Abstract
Maturity-onset diabetes of the young (MODY) is a heterogeneous group of monogenic forms of diabetes mellitus with distinct clinical features. Clinical dermatological phenotypes in MODY patients are very rare in literature. This report describes a patient with HNF1A-MODY presenting with necrobiosis lipoidica (NL) and granuloma annulare (GA). A 39-year-old asymptomatic woman, with atypical diabetes diagnosed at age 17, has a confirmed HNF1A mutation on exon 2 (c.392G>A, p.R131Q), classified as Pathogenic by the ACMG guidelines. She has reasonable metabolic control using oral anti-diabetic medications and has no chronic diabetic complications. Clinical and histologic diagnoses of both NL and GA were made. We discuss these conditions and their association with MODY.
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Affiliation(s)
| | - Renata Peixoto-Barbosa
- Disciplina de Endocrinologia, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador, BA, Brasil
| | - Ana Paula Gomes Meski
- Departamento de Dermatologia, Hospital das Clínicas, Universidade de São Paulo (USP), São Paulo, SP, Brasil
| | - Fernando M A Giuffrida
- Disciplina de Endocrinologia, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil,
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador, BA, Brasil
- Fernando M. A. Giuffrida is joint senior author
| | - André F Reis
- Disciplina de Endocrinologia, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
- André F. Reis is joint senior author
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18
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Means A, Marvin EK, Anderson KR, Lehman JS, Hertel D. Necrobiotic xanthogranuloma with type 1 cryoglobulinemia mimicking necrobiosis lipoidica in a young woman with myeloma. JAAD Case Rep 2022; 21:195-197. [PMID: 35252521 PMCID: PMC8894138 DOI: 10.1016/j.jdcr.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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19
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Kök GF, Türsen Ü. The Immunogenetics of Granulomatous Diseases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1367:349-368. [DOI: 10.1007/978-3-030-92616-8_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Aróstegui Aguilar J, Diago A, Carrillo Gijón R, Fernández Figueras M, Fraga J, García Herrera A, Garrido M, Idoate Gastearena M, Christian Laga A, Llamas-Velasco M, Martínez Campayo N, Monteagudo C, Onrubia J, Pérez Muñoz N, Ríos-Martín J, Ríos-Viñuela E, Rodríguez Peralto J, Rozas Muñoz E, Sanmartín O, Santonja C, Santos-Briz A, Saus C, Suárez Peñaranda J, Velasco Benito V, Beato Merino M, Fernandez-Flores A. Granulomas in Dermatopathology: Principal Diagnoses - Part 1. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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21
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Absil G, Collins P, El Hayderi L, Nikkels AF. Necrobiosis Lipoidica following Breast Reduction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3788. [PMID: 34522566 PMCID: PMC8432637 DOI: 10.1097/gox.0000000000003788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/06/2021] [Indexed: 11/26/2022]
Abstract
Necrobiosis lipoidica (NL) is a rare granulomatous skin disorder of unknown physiopathology that is frequently associated with diabetes mellitus. The typical skin lesions of NL present as chronic, bilateral, well-defined red to yellow-brown plaques with telangectasias, a violaceous border and a waxy atrophic center. The lower legs are the most often involved areas, but NL may exceptionally develop on scar tissue following surgery. The treatment is very challenging and notoriously difficult. We report a 60-year-old diabetic woman who developed NL all along the surgical scars following breast reduction, without presenting NL on the lower legs. NL should be considered among the rare but possible skin healing complications of surgery.
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Affiliation(s)
- Gilles Absil
- From the Department of Dermatology, CHU du Sart Tilman, University of Liège, Liège, Belgium
| | - Patrick Collins
- Department of Dermatopathology, CHU du Sart Tilman, University of Liège, Liège, Belgium
| | - Lara El Hayderi
- From the Department of Dermatology, CHU du Sart Tilman, University of Liège, Liège, Belgium
| | - Arjen F. Nikkels
- From the Department of Dermatology, CHU du Sart Tilman, University of Liège, Liège, Belgium
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22
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McPhie ML, Swales WC, Gooderham MJ. Improvement of granulomatous skin conditions with tofacitinib in three patients: A case report. SAGE Open Med Case Rep 2021; 9:2050313X211039477. [PMID: 34422275 PMCID: PMC8375329 DOI: 10.1177/2050313x211039477] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Granulomatous skin conditions are poorly understood inflammatory skin diseases consisting predominantly of macrophages. Granuloma annulare (GA) is the most common granulomatous skin disease and the generalized variant is particularly difficult to treat due to the prolonged course and lack of efficacious treatment options. Necrobiosis lipoidica (NL) is another granulomatous disorder of uncertain etiology. There is a growing body of evidence for the use of Janus kinase (JAK) inhibitors in the management of inflammatory skin diseases. In our report, we describe three patients with recalcitrant granulomatous disease including NL and generalized GA who responded favourably to treatment with the JAK inhibitor tofacitinib. JAK inhibitors may be a beneficial therapeutic option for patients with granulomatous skin diseases that are unresponsive to conventional therapies. Further research is required to determine the long-term efficacy and safety of JAK inhibitors in treating granulomatous skin conditions.
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Affiliation(s)
| | - William C Swales
- SKiN Centre for Dermatology, Peterborough, ON, Canada
- Probity Medical Research, Waterloo, ON, Canada
| | - Melinda J Gooderham
- Queen’s University, Kingston, ON, Canada
- SKiN Centre for Dermatology, Peterborough, ON, Canada
- Probity Medical Research, Waterloo, ON, Canada
- Melinda J Gooderham, SKiN Centre for Dermatology, 775 Monaghan Road, Peterborough, ON K9J 5K2, Canada.
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23
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Abba S, Messager D, Mihoubi A, Adegas Vila Nova O, Vignes S. [Pigmented lesions of the lower legs]. Rev Med Interne 2021; 43:59-61. [PMID: 34217569 DOI: 10.1016/j.revmed.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 06/13/2021] [Accepted: 06/15/2021] [Indexed: 11/30/2022]
Affiliation(s)
- S Abba
- Unité de lymphologie, Centre national de référence des maladies vasculaires rares (lymphœdème primaire, malformations lymphatiques), Hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France
| | - D Messager
- Service de nutrition, Hôpital Cognacq-Jay, 15 rue Eugène-Millon, 75015 Paris, France
| | - A Mihoubi
- Unité de lymphologie, Centre national de référence des maladies vasculaires rares (lymphœdème primaire, malformations lymphatiques), Hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France
| | - O Adegas Vila Nova
- Unité de lymphologie, Centre national de référence des maladies vasculaires rares (lymphœdème primaire, malformations lymphatiques), Hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France
| | - S Vignes
- Unité de lymphologie, Centre national de référence des maladies vasculaires rares (lymphœdème primaire, malformations lymphatiques), Hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France.
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24
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Beatty P, Killion L, Blake C, Kelly G, Tobin A. Ulcerating necrobiosis lipoidica successfully treated with ustekinumab. Australas J Dermatol 2021; 62:e473-e474. [PMID: 34115373 DOI: 10.1111/ajd.13643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/15/2021] [Indexed: 11/29/2022]
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25
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Aróstegui Aguilar J, Diago A, Carrillo Gijón R, Fernández Figueras M, Fraga J, García Herrera A, Garrido M, Idoate Gastearena MÁ, Christian Laga Á, Llamas-Velasco M, Martínez Campayo N, Monteagudo C, Onrubia J, Pérez Muñoz N, Ríos-Martín JJ, Ríos-Viñuela E, Rodríguez Peralto JL, Rozas Muñoz E, Sanmartín O, Santonja C, Santos-Briz Á, Saus C, Suárez Peñaranda JM, Velasco Benito V, Beato Merino MJ, Fernandez-Flores A. Granulomas in Dermatopathology: Principal Diagnoses - Part 1. ACTAS DERMO-SIFILIOGRAFICAS 2021; 112:S0001-7310(21)00139-3. [PMID: 33887235 DOI: 10.1016/j.ad.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 04/05/2021] [Indexed: 11/23/2022] Open
Abstract
This series of 2 articles on dermatopathologic diagnoses reviews conditions in which granulomas form. Part 1 clarifies concepts, discusses the presentation of different types of granulomas and giant cells, and considers a large variety of noninfectious diseases. Some granulomatous diseases have a metabolic origin, as in necrobiosis lipoidica. Others, such as granulomatous mycosis fungoides, are related to lymphomas. Still others, such as rosacea, are so common that dermatologists see them nearly daily in clinical practice.
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Affiliation(s)
- J Aróstegui Aguilar
- Servicio de Dermatología, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - A Diago
- Servicio de Dermatología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - R Carrillo Gijón
- Servicio de Anatomía Patológica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - M Fernández Figueras
- Servicio de Anatomía Patológica, Hospital Universitari General de Catalunya, Barcelona, España
| | - J Fraga
- Servicio de Anatomía Patológica, Hospital Universitario de La Princesa, Madrid, España
| | - A García Herrera
- Servicio de Anatomía Patológica, Hospital Clinic, Barcelona, España
| | - M Garrido
- Departamento de Anatomía Patológica, Hospital Universitario 12 de Octubre, Universidad Complutense, Instituto de Investigación I+12, Madrid, España
| | - M Á Idoate Gastearena
- Servicio de Anatomía Patológica, Hospital Universitario Virgen Macarena, Departamento de Citología, Histología y Anatomía Patológica, Facultad de Medicina, Universidad de Sevilla, Sevilla, España
| | - Á Christian Laga
- Departamento de Patología, Brigham and Women's Hospital, Boston, EE. UU
| | - M Llamas-Velasco
- Servicio de Dermatología, Hospital Universitario de La Princesa, Madrid, España
| | - N Martínez Campayo
- Servicio de Dermatología, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - C Monteagudo
- Servicio de Anatomía Patológica, Hospital Clínico Universitario de Valencia, Facultad de Medicina, Universidad de Valencia, Valencia, España
| | - J Onrubia
- Servicio de Anatomía Patológica, Hospital Universitario San Juan de Alicante, Alicante, España
| | - N Pérez Muñoz
- Servicio de Anatomía Patológica, Hospital Universitari General de Catalunya, Quirón salud, Barcelona, España
| | - J J Ríos-Martín
- Servicio de Anatomía Patológica, Hospital Universitario Virgen Macarena, Sevilla, España
| | - E Ríos-Viñuela
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - J L Rodríguez Peralto
- Departamento de Anatomía Patológica, Hospital Universitario 12 de Octubre, Universidad Complutense, Instituto de Investigación I+12, Madrid, España
| | - E Rozas Muñoz
- Departamento de Dermatología, Hospital de San Pablo, Coquimbo, Chile
| | - O Sanmartín
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - C Santonja
- Servicio de Anatomía Patológica, Fundación Jiménez Díaz, Madrid, España
| | - Á Santos-Briz
- Servicio de Anatomía Patológica, Hospital Universitario de Salamanca, Salamanca, España
| | - C Saus
- Servicio de Anatomía Patológica, Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, España
| | - J M Suárez Peñaranda
- Servicio de Anatomía Patológica, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, España
| | - V Velasco Benito
- Servicio de Anatomía Patológica, Hospital Universitario de Cruces, Barakaldo, Vizcaya, España
| | - M J Beato Merino
- Servicio de Anatomía Patológica, Hospital Universitario La Paz, Madrid, España
| | - A Fernandez-Flores
- Servicio de Anatomía Patológica, Hospital Universitario El Bierzo, Ponferrada, León, España; Servicio de Anatomía Patológica, Hospital de La Reina, Ponferrada, León, España; Unidad de Investigación, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidad de A Coruña, A Coruña, España.
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26
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Severson KJ, Costello CM, Brumfiel CM, Patel MH, Butterfield RJ, Nelson SA, Pittelkow MR, Mangold AR. Clinical and morphological features of necrobiosis lipoidica. J Am Acad Dermatol 2021; 86:1133-1135. [PMID: 33878403 DOI: 10.1016/j.jaad.2021.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 03/13/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Kevin J Severson
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, Arizona
| | | | | | - Meera H Patel
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, Arizona
| | | | - Steven A Nelson
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Mark R Pittelkow
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Aaron R Mangold
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, Arizona.
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27
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Erfurt-Berge C, Heusinger V, Reinboldt-Jockenhöfer F, Dissemond J, Renner R. Comorbidity and Therapeutic Approaches in Patients with Necrobiosis Lipoidica. Dermatology 2021; 238:148-155. [PMID: 33827092 DOI: 10.1159/000514687] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/23/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Necrobiosis lipoidica (NL) is a rare granulomatous disorder of unknown aetiology. Randomized controlled studies are not available due to it being an orphan disease. OBJECTIVES We evaluated patients in 2 dermatological centres to cluster data about epidemiology, the therapeutic approaches for NL, and their efficacy. MATERIALS AND METHODS Comorbidity and the efficacy of the applied treatment was assessed for 98 patients. RESULTS We identified 54% of patients with concomitant diabetes and 19% with thyroidal disorders. Topical steroids (85.7%) were predominantly used followed by calcineurin inhibitors (31%) and phototherapy (41.8%). Systemically, fumaric acid esters were more frequently applied (26.8%) than steroids (24.4%) and dapsone (24.4%). Steroids, compression therapy, calcineurin inhibitors, phototherapy, fumaric acid esters, and dapsone showed remarkable efficacy. CONCLUSION Therapeutic options were chosen individually in accordance with the severity of NL and presence of ulceration. Topical calcineurin inhibitors, systemic application of fumaric acid esters, and dapsone represent effective alternatives to the use of steroids.
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Affiliation(s)
- Cornelia Erfurt-Berge
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Veronika Heusinger
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | | | - Joachim Dissemond
- Department of Dermatology, Venerology and Allergology, University Hospital Essen, Essen, Germany
| | - Regina Renner
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
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28
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Severson KJ, Patel MH, Brumfiel CM, Breen I, Butterfield RJ, Nelson SA, Sekulic A, Pittelkow MR, Mangold AR. Comorbidities and diabetic complications in patients with necrobiosis lipoidica. J Am Acad Dermatol 2021; 86:891-894. [PMID: 33722550 DOI: 10.1016/j.jaad.2021.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/02/2021] [Accepted: 03/06/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Kevin J Severson
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Meera H Patel
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, Arizona
| | | | - Ilana Breen
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona
| | | | - Steven A Nelson
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, Arizona
| | | | - Mark R Pittelkow
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Aaron R Mangold
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, Arizona.
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Shrestha S, Spierings N, Marahatta S. Necrobiosis lipoidica: A case report with dermoscopic review. Clin Case Rep 2021; 9:1171-1174. [PMID: 33768804 PMCID: PMC7981773 DOI: 10.1002/ccr3.3713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/08/2020] [Accepted: 12/12/2020] [Indexed: 11/06/2022] Open
Abstract
The diagnosis of NL is made traditionally by Histopathological Examination (HPE). This case report will aid for alternative noninvasive modality for confirmation of the condition via dermoscopy and differentiating it from other granulomatous skin condition.
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Ogundipe V. Layer Cake Granulomas: A Case of Calciphylaxis Coexisting With Necrobiosis Lipoidica. Can J Diabetes 2021; 45:692-693. [PMID: 33622630 DOI: 10.1016/j.jcjd.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/30/2020] [Accepted: 12/16/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Vanessa Ogundipe
- St Joseph Mercy Oakland Hospital, Pontiac, Michigan, United States.
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31
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Abdat R, Cohen SR, Deverapalli S, Hoot J, Yang FC. Use of fractionated microneedle radiofrequency for necrobiosis lipoidica. Lasers Med Sci 2021; 36:1337-1339. [PMID: 33389307 DOI: 10.1007/s10103-020-03237-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Rana Abdat
- Department of Dermatology, Tufts Medical Center, Box #114, 800 Washington Street, Boston, MA, 02111, USA
| | - Stephanie R Cohen
- Department of Dermatology, Tufts Medical Center, Box #114, 800 Washington Street, Boston, MA, 02111, USA.
| | - Sandhya Deverapalli
- Department of Dermatology, Tufts Medical Center, Box #114, 800 Washington Street, Boston, MA, 02111, USA
| | - Joyce Hoot
- Department of Dermatology, Tufts Medical Center, Box #114, 800 Washington Street, Boston, MA, 02111, USA
| | - F Clarissa Yang
- Department of Dermatology, Tufts Medical Center, Box #114, 800 Washington Street, Boston, MA, 02111, USA
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Alkhatieb M, Mortada H. Truncal necrobiosis lipoidica diabeticorum: A first case report. Int J Surg Case Rep 2020; 77:311-313. [PMID: 33197774 PMCID: PMC7677668 DOI: 10.1016/j.ijscr.2020.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/01/2020] [Accepted: 11/02/2020] [Indexed: 12/03/2022] Open
Abstract
Necrobiosis lipoidica is a rare chronic dermatitis found in diabetic patients. These skin lesions affect 0.3–1.2% of patients with diabetes mellitus. Our patient developed necrobiosis lipoidica on the trunk, an unusual location. Treatment of necrobiosis lipoidica is difficult, related to good glycemic control.
Introduction Necrobiosis lipoidica (NL) is a known chronic rare granulomatous dermatitis. NL typically occurs in the lower extremity, there have only been previously reported cases of NL on the face, scalp, forearms, and dorsum of the hands. However, truncal NL is not a typical location. Presentation of case A 67-year-old man known to have diabetes type 2, presented with a 3-year history of painful and itchy skin lesions on the right lateral chest wall. On clinical examination, he had a red discolored patch with superficial capillaries and yellow discoloration at the center. Based on the histological examination, necrobiosis lipoidica was confirmed. Initial treatment with clobetasol propionate, tacrolimus, and topical corticosteroid cream was unsuccessful, and further NL lesions developed on the lower limb. Discussion NL rash is characterized by its location in the lower limbs and rarely involves fingers, hands, scalp, or face. It is noteworthy that the patient presented with NL skin lesions bon the trunk, which is outside the usual presentation. The prevalence of NL ranges from 0.3% to 1.2% among patients with diabetes mellitus. The treatment of NL is usually difficult. Initial management includes smoking cessation and proper diabetes control. In addition, intralesional and topical corticosteroids might be effective. In this case report, there was no improvement in NL despite the use of topical corticosteroids. Conclusion Immediate diagnosis and treatment of NL may prevent disease progression; therefore, the diagnosis of NL should be considered, even in an unusual location.
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Affiliation(s)
- Maram Alkhatieb
- Division of General Surgery, Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Hatan Mortada
- Division of Plastic Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
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Rajabi-Estarabadi A, Aickara DJ, Hirsch M, Williams NM, Maranda EL, Van Badiavas E. Laser and light therapies for the treatment of necrobiosis lipoidica. Lasers Med Sci 2020; 36:497-506. [PMID: 32970197 DOI: 10.1007/s10103-020-03147-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
Abstract
Necrobiosis lipoidica (NL) is a rare, inflammatory granulomatous skin disorder involving collagen degeneration. In recent years, several light and laser therapies have been proposed and used in the treatment of NL with variable outcomes. The aim of the study was to investigate the efficacy and safety of lasers and light therapies for the treatment of NL. A review of PubMed was conducted to search for studies using laser and light therapies for the treatment of NL. Articles that employed a combination of treatment modalities were excluded. Twenty-four studies were reviewed. Light and laser therapies used in these studies included CO2 laser, pulsed dye laser, methyl aminolevulinate (MAL)-photodynamic therapy (PDT), aminolevulinic acid (ALA)-PDT, ultraviolet A1 (UVA1) phototherapy, and psoralen plus ultraviolet-A (PUVA). PUVA was identified as the modality with the most available evidence (7 studies), followed by MAL-PDT and ALA-PDT (5 studies each), pulsed dye laser and UVA1 (3 studies each), and lastly CO2 laser (2 studies). Most modalities demonstrated variable efficacies and side effects with the exception of PDL, which consistently showed successful outcomes. Multiple dermatologic light and laser therapies have been investigated for the treatment of NL, including PUVA, ALA-PDT, MAL-PDT, pulsed dye laser, UVA1, and CO2 laser. However, a clear consensus on the preferred treatment is yet to be addressed. Each treatment option demonstrates both advantages and disadvantages that should be discussed with patients when selecting the treatment modality.
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Affiliation(s)
- Ali Rajabi-Estarabadi
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1150 NW 14th St., Miami, FL, 33136, USA.
| | - Divya J Aickara
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1150 NW 14th St., Miami, FL, 33136, USA
| | - Melanie Hirsch
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1150 NW 14th St., Miami, FL, 33136, USA
| | - Natalie M Williams
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1150 NW 14th St., Miami, FL, 33136, USA
| | - Eric L Maranda
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1150 NW 14th St., Miami, FL, 33136, USA
| | - Evangelos Van Badiavas
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1150 NW 14th St., Miami, FL, 33136, USA
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Necrobiosis lipoídica: una manifestación más de la diabetes mellitus. Semergen 2020; 46:e51-e52. [DOI: 10.1016/j.semerg.2020.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 03/17/2020] [Accepted: 03/20/2020] [Indexed: 11/20/2022]
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Abstract
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.
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Affiliation(s)
- Emily Burns
- Baylor College of Medicine, Houston, TX, USA
| | - Uzoamaka Ukoha
- Department of Dermatology, Baylor College of Medicine, Houston, TX, USA
| | - Audrey Chan
- Department of Dermatology, Baylor College of Medicine, Houston, TX, USA.,Department of Dermatology, Texas Children's Hospital, Houston, TX, USA
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36
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Bernia E, Llombart B, Bancalari B, Diago A, Serra-Guillén C. Photodynamic Therapy for Necrobiosis Lipoidica: Successful Treatment in a Series of 4 cases. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2020.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Bernia E, Llombart B, Bancalari B, Diago A, Serra-Guillén C. Tratamiento de la necrobiosis lipoídica con terapia fotodinámica convencional: serie de 4 casos tratados con éxito. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:605-608. [DOI: 10.1016/j.ad.2019.01.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/02/2019] [Accepted: 01/08/2019] [Indexed: 11/26/2022] Open
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Necrobiosis Lipoidica Affecting the Leg: What Is the Best Treatment in a Patient with Very High Aesthetic Demand? PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3000. [PMID: 32802684 PMCID: PMC7413758 DOI: 10.1097/gox.0000000000003000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/26/2020] [Indexed: 12/01/2022]
Abstract
Necrobiosis Lipoidica (NL) is a rare necrotising disorder of the skin characterized by collagen degeneration, thickening of blood vessels, and granulomatous inflammatory process. Its main clinical features are brownish-red papules and yellowish plaques with atrophic central areas. NL affects 0.3% -1.2% of the diabetic population, mostly women (female/male ratio is 3:1). Management of NL is challenging, especially for large lesions refractory to medical therapy, thus requiring surgical excision as an alternative option. Due to the rare occurrence of this condition no treatment guidelines exist and individualized treatment mostly depends on the severity of the lesion, location and patient's expectations. A case of a 30-year-old diabetic woman with very high aesthetic expectations was succesfully treated with staged resections of a giant NL to the leg and reconstruction with dermal template and full thickness skin grafts. Grafts were taken from the groin region bilaterally and from the lower abdomen after a cosmetic mini-abdominoplasty procedure. This approach allowed for a stable and very satisfactory aesthetic result with no donor site exposed scars.
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39
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Crizón-Díaz DP, Morales-Cardona CA. Manifestaciones dermatológicas de la diabetes: clasificación y diagnóstico. IATREIA 2020. [DOI: 10.17533/udea.iatreia.58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Se estima que en Colombia hay 2.836.500 adultos con diabetes, una enfermedad con una prevalencia del 8,4 %. La exposición a niveles elevados de glucosa afecta los procesos de proliferación y diferenciación en las células de todos los órganos y tejidos, así mismo en los queratinocitos, fibroblastos y demás células presentes en la piel, alteraciones que ocurren en más de un tercio de los diabéticos y que pueden ser la manifestación inicial de la enfermedad. La frecuencia y presentación de estas dermatosis varía según la población estudiada. La dermopatía diabética, la acantosis nigricans, los fibromas laxos, el prurito y la xerosis son las formas más comunes y se consideran marcadores cutáneos de la diabetes. La presente revisión se enfoca en las manifestaciones dermatológicas específicas y no específicas de la diabetes, así como en las relacionadas con su tratamiento. Estas pueden ser un reflejo del estado metabólico actual o previo del paciente diabético y su oportuna identificación permite orientar el diagnóstico primario, sospechar un estado rediabético u optimizar el tratamiento de la enfermedad en los individuos ya diagnosticados.
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40
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Konschake W, Westphal T, Jünger M, Arnold A, Lutze S. A rare case of a patient with PPP syndrome presenting pancreatic pseudocysts, panniculitis, and symptoms of polyarthritis. A radicular cyst of the upper jaw could be another manifestation of the syndrome. Clin Case Rep 2020; 8:625-629. [PMID: 32274023 PMCID: PMC7141739 DOI: 10.1002/ccr3.2651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 12/03/2019] [Accepted: 12/12/2019] [Indexed: 11/26/2022] Open
Abstract
In rare cases, pancreatic enzymes can enter the bloodstream and cause fat necrosis in the bone and tissue leading to a disorder called pancreatitis, panniculitis, and polyarthritis syndrome. Clinicians should have this syndrome in mind when treating patients with pancreatitis.
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Affiliation(s)
| | - Thea Westphal
- Department of Dermatology University of Greifswald Greifswald Germany
| | - Michael Jünger
- Department of Dermatology University of Greifswald Greifswald Germany
| | - Andreas Arnold
- Department of Dermatology University of Greifswald Greifswald Germany
| | - Stine Lutze
- Department of Dermatology University of Greifswald Greifswald Germany
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41
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Marchand L, Villar-Fimbel S. Necrobiosis Lipoidica. Am J Med 2020; 133:e112. [PMID: 31520619 DOI: 10.1016/j.amjmed.2019.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 08/05/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Lucien Marchand
- Department of Endocrinology and Diabetes, St. Joseph-St. Luc Hospital, Quai Claude Bernard, 69007 Lyon, France.
| | - Sylvie Villar-Fimbel
- Department of Endocrinology and Diabetes, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France
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42
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Hashemi DA, Brown-Joel ZO, Tkachenko E, Nelson CA, Noe MH, Imadojemu S, Vleugels RA, Mostaghimi A, Wanat KA, Rosenbach M. Clinical Features and Comorbidities of Patients With Necrobiosis Lipoidica With or Without Diabetes. JAMA Dermatol 2020; 155:455-459. [PMID: 30785603 DOI: 10.1001/jamadermatol.2018.5635] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Necrobiosis lipoidica (NL) is a rare granulomatous condition. Current knowledge of its key features is based on a limited number of studies and case reports, leading to wide variability in the characterization of its defining features, with limited comparison of patients with or without diabetes. Objective To evaluate the epidemiologic characteristics, clinical features, and disease associations of NL in patients with or without type 1 or 2 diabetes. Design, Setting, and Participants This multicenter retrospective review included 236 patients aged 15 to 84 years who were evaluated and received a diagnosis of NL at the University of Pennsylvania Health System between January 1, 2008, and July 15, 2018; University of Iowa Hospitals and Clinics between January 1, 2000, and June 15, 2018; and Brigham and Women's Hospital and Massachusetts General Hospital between January 1, 2000, and February 15, 2018. Main Outcomes and Measures Patient demographics, clinical features, medical comorbidities, and biopsy status. Results Of the 236 patients with NL, 200 were women and 36 were men, and 182 were white, with a median age at presentation of 50.0 years (interquartile range, 33.0-59.0 years). The diagnosis was biopsy proven in 156 patients (66.1%). Of the 230 patients with location specified, 225 (97.8%) had NL on the lower legs. A total of 138 patients with NL (58.5%; 95% CI, 52.7%-65.3%) had diabetes. The median hemoglobin A1c for patients with diabetes was 8.00% (interquartile range, 6.68%-9.50%) (to convert hemoglobin A1c to proportion of total hemoglobin, multiply by 0.01). Patients with diabetes were significantly younger than patients without diabetes (median age, 45.0 vs 52.0 years; P = .005), and slightly less likely to be female (112 of 138 [81.2%] vs 87 of 96 [90.6%]; P = .046), but lesion characteristics were otherwise comparable. Other notable comorbidities included obesity in 95 of 184 patients (51.6%; 95% CI, 44.4%-58.9%), hypertension in 104 of 230 patients (45.2%), dyslipidemia in 98 of 225 patients (43.6%), and thyroid disease in 56 of 229 patients (24.5%). Conclusions and Relevance This study of NL supports its associations with diabetes as well as obesity, hypertension, dyslipidemia, and thyroid disease. Younger age and female sex were observed more frequently in patients with diabetes. Otherwise, NL lesions in patients with or without diabetes shared many clinical features, suggesting that risk factors outside of elevated blood glucose may play an important role in the disease. Future studies should evaluate these associations with the goal of further elucidating NL's underlying pathophysiologic characteristics.
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Affiliation(s)
- David A Hashemi
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | | | - Caroline A Nelson
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Megan H Noe
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Sotonye Imadojemu
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ruth Ann Vleugels
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Karolyn A Wanat
- Department of Dermatology, University of Iowa Carver College of Medicine, Iowa City
| | - Misha Rosenbach
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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Barbet-Massin MA, Rigalleau V, Blanco P, Mohammedi K, Poupon P, Belin E, Poursac N, Cadart O, Blanco L. Remission of necrobiosis lipoidica diabeticorum with a JAK1/2 inhibitor: A case report. DIABETES & METABOLISM 2020; 47:101143. [PMID: 31981714 DOI: 10.1016/j.diabet.2020.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 12/31/2019] [Accepted: 01/01/2020] [Indexed: 11/29/2022]
Affiliation(s)
- M-A Barbet-Massin
- Hôpital Haut-Levêque, USN, avenue Magellan, 33604 Pessac/Bordeaux, Aquitaine, France.
| | - V Rigalleau
- Hôpital Haut-Levêque, USN, avenue Magellan, 33604 Pessac/Bordeaux, Aquitaine, France
| | - P Blanco
- Hôpital Haut-Levêque, USN, avenue Magellan, 33604 Pessac/Bordeaux, Aquitaine, France
| | - K Mohammedi
- Hôpital Haut-Levêque, USN, avenue Magellan, 33604 Pessac/Bordeaux, Aquitaine, France
| | - P Poupon
- Hôpital Haut-Levêque, USN, avenue Magellan, 33604 Pessac/Bordeaux, Aquitaine, France
| | | | - N Poursac
- Hôpital Haut-Levêque, USN, avenue Magellan, 33604 Pessac/Bordeaux, Aquitaine, France
| | - O Cadart
- Hôpital Haut-Levêque, USN, avenue Magellan, 33604 Pessac/Bordeaux, Aquitaine, France
| | - L Blanco
- Hôpital Haut-Levêque, USN, avenue Magellan, 33604 Pessac/Bordeaux, Aquitaine, France
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Hybiak J, Broniarek I, Kiryczyński G, Los LD, Rosik J, Machaj F, Sławiński H, Jankowska K, Urasińska E. Aspirin and its pleiotropic application. Eur J Pharmacol 2019; 866:172762. [PMID: 31669590 DOI: 10.1016/j.ejphar.2019.172762] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 10/21/2019] [Accepted: 10/25/2019] [Indexed: 12/31/2022]
Abstract
Aspirin (acetylsalicylic acid), the oldest synthetic drug, was originally used as an anti-inflammatory medication. Being an irreversible inhibitor of COX (prostaglandin-endoperoxide synthase) enzymes that produce precursors for prostaglandins and thromboxanes, it has gradually found several other applications. Sometimes these applications are unrelated to its original purpose for example its use as an anticoagulant. Applications such as these have opened opportunities for new treatments. In this case, it has been tested in patients with cardiovascular disease to reduce the risk of myocardial infarct. Its function as an anticoagulant has also been explored in the prophylaxis and treatment of pre-eclampsia, where due to its anti-inflammatory properties, aspirin intake may be used to reduce the risk of colorectal cancer. It is important to always consider both the risks and benefits of aspirin's application. This is especially important for proposed use in the prevention and treatment of neurologic ailments like Alzheimer's disease, or in the prophylaxis of myocardial infarct. In such cases, the decision if aspirin should be applied, and at what dose may be guided by specific molecular markers. In this revived paper, the pleiotropic application of aspirin is summarized.
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Affiliation(s)
- Jolanta Hybiak
- Department of Pathology, Pomeranian Medical University, Szczecin, Poland.
| | - Izabela Broniarek
- Department of Gene Expression, Institute of Molecular Biology and Biotechnology, Adam Mickiewicz University Poznan, Poland
| | - Gerard Kiryczyński
- Department of Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Laura D Los
- Faculty of Science, University of Manitoba, Winnipeg, Canada
| | - Jakub Rosik
- Department of Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Filip Machaj
- Department of Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Hubert Sławiński
- Wellcome Centre for Human Genetics, University of Oxford, United Kingdom
| | - Kornelia Jankowska
- Department of Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Elżbieta Urasińska
- Department of Pathology, Pomeranian Medical University, Szczecin, Poland
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Sandhu VK, Alavi A. The role of anti-tumour necrosis factor in wound healing: A case report of refractory ulcerated necrobiosis lipoidica treated with adalimumab and review of the literature. SAGE Open Med Case Rep 2019; 7:2050313X19881594. [PMID: 31666953 PMCID: PMC6801891 DOI: 10.1177/2050313x19881594] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Necrobiosis lipoidica is a chronic granulomatous disease historically associated
with diabetes. Necrobiosis lipoidica commonly presents with erythematous papules
or plaques on the anterior lower extremities, which can be ulcerated in up to
30% of patients. The pathophysiology of necrobiosis lipoidica is unknown but
proposed to be predominantly linked to microangiopathy. No treatment option for
necrobiosis lipoidica has shown consistent efficacy. Previous case reports have
shown immune-modulating agents to be reasonable treatment options for ulcerative
necrobiosis lipoidica. However, evidence for the tumour necrosis factor-alpha
inhibitor, adalimumab, is limited and contradictory. We report a case of a
74-year-old type 2 diabetic female with a 2-year history of multiple ulcerated
necrobiosis lipoidica plaques resistant to topical and systemic therapy.
Treatment with adalimumab showed complete re-epithelization of all ulcers by
week 28. Adalimumab may be an effective treatment option for ulcerated
necrobiosis lipoidica that has failed traditional therapies. Further reports of
adalimumab treatment of necrobiosis lipoidica and other chronic inflammatory
wounds are needed.
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Affiliation(s)
| | - Afsaneh Alavi
- Department of Dermatology, University of Toronto, Toronto, ON, Canada.,York Dermatology Center, Richmond Hill, ON, Canada
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46
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Lopes S, Gomes N, César A, Barros AM, Pinheiro J, Azevedo F. An Exuberant Case of Necrobiotic Xanthogranuloma. Indian Dermatol Online J 2019; 11:83-86. [PMID: 32055516 PMCID: PMC7001415 DOI: 10.4103/idoj.idoj_74_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Necrobiotic xanthogranuloma (NXG) is a rare form of inflammatory granulomatous disease of the skin characterized by the presence of pruritic to painful lesions, generally located in the periorbital area, although trunk and proximal extremities may also be involved. We report a case of a 69-year-old male patient with extensive involvement of the trunk, upper and lower extremities, and an associated gamma monoclonal gammopathy. The skin biopsy was consistent with the diagnosis of NXG. Necrobiosis lipoidica and granuloma annulare were the major differential diagnosis in this case. We highlight the importance of searching for clinical and histological features that may differentiate these entities, which is crucial to select an adequate therapeutic and surveillance strategy.
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Affiliation(s)
- Sofia Lopes
- Department of Dermatology and Venereology, Centro Hospitalar e Universitário de São João EPE, Porto, Portugal
| | - Nuno Gomes
- Department of Dermatology and Venereology, Centro Hospitalar e Universitário de São João EPE, Porto, Portugal
| | - Artur César
- Department of Dermatology and Venereology, Centro Hospitalar e Universitário de São João EPE, Porto, Portugal
| | - Ana Margarida Barros
- Department of Dermatology and Venereology, Centro Hospitalar e Universitário de São João EPE, Porto, Portugal
| | - Jorge Pinheiro
- Department of Pathology, Centro Hospitalar e Universitário de São João EPE, Porto, Portugal
| | - Filomena Azevedo
- Department of Dermatology and Venereology, Centro Hospitalar e Universitário de São João EPE, Porto, Portugal
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Schoenberg E, McGuinn KP, Connolly D, Yang S. An atypical presentation of a rare disease. JAAD Case Rep 2019; 5:255-257. [PMID: 30891473 PMCID: PMC6403114 DOI: 10.1016/j.jdcr.2019.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Özkur E, Hasçiçek SÖ, Altunay İK. Atypical presentation of necrobiosis lipoidica in a pediatric patient. Pediatr Dermatol 2019; 36:e31-e33. [PMID: 30506892 DOI: 10.1111/pde.13716] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Necrobiosis lipoidica (NL) is a rare chronic granulomatous inflammatory skin disease characterized by brownish-red papules and yellowish plaques with atrophic centers, which usually affect the legs, bilaterally. The average age of onset is 30-40 years, and there are very few reported cases of necrobiosis lipoidica in children. A nondiabetic girl aged 14 years presented to our clinic with a history of an asymptomatic, 7 × 5-cm single red plaque over her back in the interscapular area, which had started 5 years ago. Her laboratory tests were normal. A histopathologic evaluation confirmed the diagnosis of NL, and local treatment with clobetasol propionate twice daily was administrated. The patient will be followed up to monitor plasma glucose levels and evaluation of the lesion. Herein, we report a pediatric patient without diabetes mellitus who had NL in an atypical location and review the literature in view of the clinical features, complications, and treatment regimens for NL in children.
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Affiliation(s)
- Ezgi Özkur
- Dermatology Department, University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Seyhan Ö Hasçiçek
- Pathology Department, University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - İlknur Kıvanç Altunay
- Dermatology Department, University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
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