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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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Asfour L, Ismail D, Madan V. The Role of Lasers in Connective Tissue and Inflammatory Dermatoses: A 10-Year Retrospective Review of 60 Patients in a UK Tertiary Laser Clinic. Indian Dermatol Online J 2023; 14:616-623. [PMID: 37727556 PMCID: PMC10506828 DOI: 10.4103/idoj.idoj_439_22] [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: 08/11/2022] [Revised: 09/30/2022] [Accepted: 11/29/2022] [Indexed: 09/21/2023] Open
Abstract
Introduction The role of lasers in the treatment of standard therapy-resistant inflammatory dermatoses and connective tissue disorders has been controversial and evidence supporting the role of lasers in this setting is scarce. Objective To assess the efficacy of lasers in the management of inflammatory dermatoses and connective tissue disorders (CTD). Materials and Methods A retrospective case review of all inflammatory dermatoses/connective tissue diseases treated in a tertiary laser clinic between March 2010 and 2020 was undertaken. Results A total of 60 cases (48 = female) were included and the average age was 51 years (range 21 to 74). The following conditions were treated: scleroderma n = 22 (37%), granuloma faciale n = 10 (17%), sarcoidosis n = 8 (13%), discoid lupus erythematosus n = 7 (12%), and systemic lupus erythematosus n = 2 (3%). Other diagnoses included necrobiosis lipoidica, pyoderma vegetans, hypertrophic lichen planus, and dermatomyositis. The most common type of laser used was pulsed dye laser (PDL) in n = 41 (68%) cases. Eight (13%) patients received treatment with the carbon dioxide (CO2) laser. The most common site treated was the face. A good response with a marked reduction of signs was seen in 62% of patients while 10% of the patients did not respond to laser treatment. Self-limiting complications included purpura and hyperpigmentation. Limitations Lack of objective assessment and outcome measures. Conclusions This is the largest cohort of patients to have undergone laser treatment for inflammatory dermatoses/connective tissue disease. Based on this retrospective review, we conclude that lasers can be a useful adjunct in the management of otherwise difficult-to-treat selected inflammatory and connective tissue diseases.
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Affiliation(s)
- Leila Asfour
- Department of Dermatology, Laser Division, Salford Royal NHS Foundation Trust Hospital, Stott Lane, Salford, Manchester, United Kingdom
| | - Dina Ismail
- Department of Dermatology, Laser Division, Salford Royal NHS Foundation Trust Hospital, Stott Lane, Salford, Manchester, United Kingdom
| | - Vishal Madan
- Department of Dermatology, Laser Division, Salford Royal NHS Foundation Trust Hospital, Stott Lane, Salford, Manchester, United Kingdom
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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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Cheboxarov DI, Molodykh KJ, Monakhov KN, Sokolovskiy EV. A new atypical form of lipoid necrobiosis not associated with diabetes mellitus. VESTNIK DERMATOLOGII I VENEROLOGII 2023. [DOI: 10.25208/vdv1369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
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.
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Crockett E, Bain SC. An elderly woman with scars on her shins. Diabet Med 2022; 39:e14818. [PMID: 35191081 DOI: 10.1111/dme.14818] [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: 01/26/2022] [Accepted: 02/17/2022] [Indexed: 11/29/2022]
Affiliation(s)
- E Crockett
- Singleton Hospital, Swansea Bay University Health Board, Swansea, UK
| | - S C Bain
- Singleton Hospital, Swansea Bay University Health Board, Swansea, UK
- Swansea University Medical School, Swansea, UK
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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: 4] [Impact Index Per Article: 1.3] [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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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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Abstract
The colors reflected from the skin are important indicators of dermatologic and systemic disorders. Incident light is subject to absorption by chromophores in the skin and scattering. Chromophores associated with yellow light reflection include the carotenoids and bilirubin. Various pathophysiologic mechanisms associated with these and other chromophores manifest with a yellow hue on examination. This review describes these mechanisms and the clinical features of yellow skin disorders by morphology. A brief summary of the differential diagnosis, laboratory investigations, and treatments are presented. Yellow skin disorders are a heterogenous group composed of abnormalities in keratin, elastic and connective tissue, lipid metabolism, and other states of metabolic, inflammatory, or organ dysfunction. Patients will present through different routes, and skin disease may precede or follow systemic disease. Dermatologists have an essential role in identifying those with malignant or systemic associations to ensure early diagnosis and treatment.
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Affiliation(s)
- Ian T Logan
- Department of Dermatology, Addenbrooke's Hospital, Cambridge, England, United Kingdom.
| | - Richard A Logan
- Department of Dermatology, Princess of Wales Hospital, Bridgend, Wales, United Kingdom
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Isoherranen K, O'Brien JJ, Barker J, Dissemond J, Hafner J, Jemec GBE, Kamarachev J, Läuchli S, Montero EC, Nobbe S, Sunderkötter C, Velasco ML. Atypical wounds. Best clinical practice and challenges. J Wound Care 2019; 28:S1-S92. [DOI: 10.12968/jowc.2019.28.sup6.s1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Kirsi Isoherranen
- Helsinki University Central Hospital and Helsinki University, Wound Healing Centre and Dermatology Clinic, Helsinki, Finland
| | | | - Judith Barker
- Nurse Practitioner - Wound Management, Rehabilitation, Aged and Community Care., Adjunct Associate Professor, University of Canberra, Canberra, Australia
| | - Joachim Dissemond
- University Hospital of Essen, Department of Dermatology, Venerology and Allergology, Hufelandstraße 55, Essen, Germany
| | - Jürg Hafner
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland
| | - Gregor B. E. Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Jivko Kamarachev
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland
| | - Severin Läuchli
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland
| | | | - Stephan Nobbe
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland Department of Dermatology, Cantonal Hospital of Frauenfeld, Switzerland
| | - Cord Sunderkötter
- Chair, Department of Dermatology and Venerology, University and University Hospital of Halle, Ernst-Grube-Strasse 40, Halle, Germany
| | - Mar Llamas Velasco
- Department of Dermatology, Hospital Universitario De La Princesa, Madrid, Spain
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Fekaj EH. Concomitant necrobiosis lipoidica and splenic abscess. J Surg Case Rep 2019; 2019:rjz088. [PMID: 30949338 PMCID: PMC6439504 DOI: 10.1093/jscr/rjz088] [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: 01/28/2019] [Revised: 03/01/2019] [Accepted: 03/12/2019] [Indexed: 11/20/2022] Open
Abstract
Necrobiosis lipoidica is an idiopathic dermatosis of unknown origin, occurring mainly in patients with diabetes. Splenic abscesses are rare entities. We report a case with concomitant necrobiosis lipoidica and splenic abscess. A 58-year-old man presented to emergency center with a two day history of left upper abdominal pain, general malaise, and pyrexia. On both lower legs the patient had skin lesions. The contrast-enhanced computed tomography of the abdomen revealed splenomegaly and splenic abscess in the upper pole of the spleen. On the fourth day after admission, patient underwent open splenectomy. For the lesions on lower legs, by clinical examination, necrobiosis lipoidica was confirmed. The patient was treated by topical administration of steroid cream. After a 2 months follow-up, this treatment was not effective. Left upper abdominal pain and pyrexia in patient with necrobiosis lipoidica may suggest splenic abscess.
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Affiliation(s)
- Enver H Fekaj
- Department of Abdominal Surgery, University Clinical Center of Kosovo, Str. 'Bulevardi i Deshmoreve', Prishtina, Republic of Kosovo
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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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Abstract
The skin of the lower extremity can be a helpful diagnostic tool for systemic disease. Diabetes, renal disease, genetic disorders, and even cancer can have cutaneous manifestations in the legs and feet; moreover, proper diagnosis can facilitate earlier treatment of these diseases and not only clear up the skin symptoms but also bring about resolution of the systemic disease causing them. Although not comprehensive, this article discusses many of these disorders presenting with integumentary manifestations in the lower extremities. Where appropriate, it also enumerates the treatments involved, both systemic and localized.
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Affiliation(s)
- Joseph Vella
- Private Practice, Impression Foot & Ankle, 5656 South Power Road, Suite 124, Gilbert, AZ 85295, USA.
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