Treatment with benzoyl peroxide of ulcers on legs within lesions of necrobiosis lipoidica diabeticorum

The treatment of necrobiosis lipoidica

Necrobiosis lipoidica is an inflammatory disorder, associated with diabetes mellitus, for which the underlying pathological mechanism is unknown and for which there is no rational therapy. However, benefit has been reported from such different treatment regimens as drugs acting on the haemostatic mechanisms, corticosteroid therapy (topical, intralesional and systemic), enhancers of wound healing, surgery and immunomodulating therapies (including photochemotherapy). This is a review of these treatment options.

Treatment Modalities of Necrobiosis Lipoidica: A Concise Systematic Review

Necrobiosis lipoidica (NL) is a rare inflammatory granulomatous skin disorder closely associated with diabetes mellitus. The aim of this paper is to review and discuss all the treatment modalities proposed and tested for this disease. A systematic review of the existing literature was conducted to investigate all the available data and summarize all the clinical trials, case reports and original articles on NL. Two major databases (PubMed and Google Scholar) were used. We have examined about 70 articles. Numerous treatment modalities have been currently investigated to compare recalcitrant NL. Being rare, most of the studies regarding this disease are case reports or small-scale clinical trials. We have found that, in spite of plentiful investigations carried out during the years, there is no treatment modality that has proved to be utterly satisfactory in treating NL.

Necrobiosis lipoidica diabeticorum: A case-based review of literature

Necrobiosis lipoidica diabeticorum (NLD) is a rare chronic and granulomatous skin disorder that affects 0.3% of diabetic patients. Although the etiology and pathogenesis of NLD is still controversial, it is thought that microangiopathy has an important role. The legs are the most common site for NLD, but involvement of other areas such as the abdomen, upper extremities and scalp has been reported. There is no rational therapy. However, benefit has been reported from different treatment regimens such as drugs acting on the hemostatic mechanisms, corticosteroid therapy (topical, intralesional and systemic), enhancers of wound healing, surgery and immunomodulating therapies (including photochemotherapy). We report a 59-year-old female, who was a diabetic patient with multiple, disseminated lesions on the legs, which tended to disappear as the glycemic control was achieved. Hereby, we also review the existing literature for the evolving aspects of etiopathogenesis and treatment.

Necrobiosis lipoidica

Necrobiosis lipoidica has distinctive clinical and histopathologic features. Although theories abound, its cause and pathogenesis remain unknown. Despite many reports of effective treatments, a critical review of the literature suggests that none is uniformly effective.

Necrobiosis lipoidica: treatment with porcine dressings, split-thickness skin grafts and pressure garments. A case report and review of treatment modalities

A 39-year old nondiabetic female had severely ulcerated necrobiosis lipoidica of the legs which was refractory to medical management for 2 1/2 years. Surgical management with porcine grafting followed by autologous split-thickness skin grafts successfully healed these ulcerations. With the use of custom-fitted contoured pads and pressure gradient stockings, the grafts have remained intact for 2 1/2 years, and there has been significant improvement of the nonulcerated plaques.

Cutaneous manifestations of diabetes mellitus in children

This article reviews skin changes occurring in diabetic children. Skin changes may be related to metabolic alterations associated with diabetes. Others may be manifestations of macro or microvascular disease. Insulin injections, required for management of most diabetes in the pediatric age group, may also cause cutaneous changes. There remain several cutaneous abnormalities which are observed with increased frequency among diabetics, the significance of which is unknown. The skin is a potentially invaluable tool for understanding certain diabetic complications; however, the value of observations and experimental data relating to cutaneous changes in diabetics depends upon documentation of the type of diabetes mellitus employing the currently accepted classification system.

Contact sensitization to benzoyl peroxide

The incidence of contact allergy to a 5% benzoyl peroxide (BP) gel has been studied by patch testing in 222 patients. Positive allergic reactions to BP were found in 3.1% of cases in a general clinical population (94 patients), whereas 5.8% of 69 patients with eczematous dermatoses were found to be BP-sensitized. In a group of acne vulgaris patients having used a commercial 5% or 10% BP gel for a period of 12 days to 3 1/2 years (mean: 10.7 months), positive allergic reactions were found in three cases (5.1%).

Contact sensitization to benzoyl peroxide following topical treatment of chronic leg ulcers

Sixteen patients with chronic leg ulcers were treated with 10% benzoyl peroxide gel for 6 weeks. At the end of the treatment, patch tests with 2% benzoyl peroxide in petrolatum and 10% in a gel showed that nine patients (56%) had become sensitized. This high sensitization rate is in good accord with the results obtained by experimental investigations using human maximization tests and repeated insult patch tests. A strong sensitizer such as benzoyl peroxide should not be used in the routine treatment of chronic leg ulcers, despite its good healing effect.