Necrobiosis lipoidica with rapid response to doxycycline

Shedding Light on Photodynamic Therapy in the Treatment of Necrobiosis Lipoidica: A Multicenter Real-Life Experience

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.

Atypical Ulcerative Necrobiosis Lipoidica Diabeticorum: A Case Study

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.

A new atypical form of lipoid necrobiosis not associated with diabetes mellitus

A 55-year-old woman has lipoid necrobiosis of both legs, complicated by ulceration. The first manifestations of the disease appeared after an injury in the region of the left shin, an abrasion appeared, which later transformed into a glossy spot that slowly increased in size. She first sought medical help in 2017 and was clinically diagnosed with necrobiosis lipoidica. The prescribed treatment did not lead to an improvement in the patients condition. In 2021, after vaccination against COVID-19, the patient notes a sharp deterioration in the process. No convincing data for diabetes mellitus received. She has a history of multinodular non-toxic goiter, for which in 1995 a complete resection of the left lobe of the thyroid gland was performed and in 2003 a partial resection of the right lobe of the thyroid gland. The patient has been receiving L-thyroxine replacement therapy since 2003. A biopsy of the affected skin was taken. The final diagnosis was established according to the pathological and anatomical study of the biopsy. As a result of the treatment, the patient was discharged from the clinic with improvement.

Tetracyclines-An Important Therapeutic Tool for Dermatologists

Tetracyclines are a group of antibiotics whose first representative was discovered over 70 years ago. Since then, they have been of great interest in dermatology. In addition to their antibacterial activity, they are able to inhibit metalloproteinases and exhibit anti-inflammatory, anti-apoptotic and antioxidant effects. The side effects have been thoroughly studied over the years, the most characteristic and important ones in daily dermatological practice being: phototoxicity, hyperpigmentation, onycholysis, photoonycholysis, induced lupus erythematosus, and idiopathic intracranial hypertension. In this article, we summarize the use of tetracyclines in infectious diseases and inflammatory dermatoses, and further discuss the instances where the efficacy and safety of tetracyclines have been highlighted over the past few years.