Systemic therapy of necrobiotic xanthogranuloma: a systematic review

Xenograft: a suitable treatment of eyelid complications in long-standing necrobiotic xanthogranuloma

A porcine xenograft was successfully used as a temporary biological cover for severe xanthogranulomatous defects of the eyelid. Xenografts were successfully used in both upper and lower eyelid reconstructions. Other surgical techniques or the use of full-thickness skin grafts were not possible.

Therapie des nekrobiotischen Xanthogranuloms - Fallserie und aktuelle Literatur: Therapy of necrobiotic xanthogranuloma - case series and review of the literature

Das nekrobiotische Xanthogranulom ist eine seltene Erkrankung, die zu den Nicht‐Langerhans‐Zell‐Histiozytosen gehört. Charakteristisch sind gelbliche Hautveränderungen, die typischerweise periorbital lokalisiert sind. Extrakutane Manifestationen aller Organe sind möglich und können potenziell lebensbedrohliche Komplikationen verursachen. Die Erkrankung gehört zu den fakultativen Paraneoplasien und zeigt eine hohe Assoziation zu Paraproteinämien. Diese Aspekte sollten in der Umfelddiagnostik berücksichtigt werden. Da die Erkrankung sehr selten ist, gibt es bislang keine standardisierten Richtlinien zur Therapie. Als erfolgreiche Therapieregime haben sich insbesondere die Kombination aus Prednisolon und Chlorambucil sowie die intravenösen Immunglobuline herausgestellt. Wir präsentieren vier Fälle aus unserer Klinik sowie die aktuellen Ergebnisse der Literatur in diesem Mini‐Review und möchten damit die therapeutische Herausforderung sowie die Relevanz der Erarbeitung von Richtlinien unterstreichen.

Therapy of necrobiotic xanthogranuloma - case series and review of the literature

Necrobiotic xanthogranuloma is a rare disease that is part of the non-Langerhans cell histiocytoses. It is characterized by yellowish skin lesions, which are typically periorbitally localized. Extracutaneous manifestations of all organs are possible and can cause potentially life-threatening complications. The disease also belongs to the facultative paraneoplasias and is often associated with paraproteinemia. These aspects should be considered regarding further diagnostics. Due to the rarity of the disease, there are no standardized guidelines for therapy so far. The combination of prednisolone and chlorambucil as well as intravenous immunoglobulins seem to be effective therapeutic options. We present four cases from our clinic as well as the current results of the literature in this mini-review and would like to highlight the therapeutic challenge as well as the need for the development of guidelines.

Non-dermatologic isolated intracranial necrobiotic xanthogranuloma

Necrobiotic xanthogranuloma is a condition that was first identified in 1980 based on its characteristic histological identity, and it has been known since then as a dermatologic manifestation of an underlying systemic dysproteinemia. Intracranial manifestation is a rare presentation of this condition and has been reported only once in its more than 40 years of existence. Herein and to our knowledge, we report the second observation of an intracranial manifestation and, surprisingly, the first case without the expected dermatologic and systemic dysproteinemia associations. This case identifies an existing knowledge gap in our understanding of necrobiotic xanthogranuloma and emphasises the need for further research into understanding the presentation, comorbidities and management of this condition.

Granulomatous annular diseases

Granulomatous skin disorders comprise a large group of diseases that are typically characterized by granuloma formation both in the skin and in many other tissues. Cutaneous lesions are usually seen as erythematous papules and plaques that may occasionally be arranged in an annular, ringlike configuration. The etiopathogenesis is unclear in most cases, and granuloma formation may be associated with various systemic, infectious, and metabolic disorders, foreign bodies, environmental antigens, or malignancies. Treatment options are dependent on the etiology, extent, and severity of the lesions. This review includes the clinical, histopathologic, and dermatoscopy findings, differentials, and treatment options for noninfectious granulomatous annular skin disorders.