1
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
2
|
Abstract
Necrobiosis lipoidica (NL) is a rare granulomatous disease of hitherto unclear etiology frequently seen in patients with diabetes. Characterized by its potential for ulcerations, it often presents a serious burden for those affected. There are currently neither German nor European guidelines for the treatment of NL. At the same time, standard treatment with topical or intralesional corticosteroids does not always show satisfactory results. We therefore set out to evaluate whether the various treatment regimens published since 2000 have actually expanded the therapeutic armamentarium in a relevant manner. Included were all publications that described more than one patient being treated with any given therapeutic modality. Overall, we analyzed data for 16 different treatment regimens reported in 49 publications. The largest amount of data exists for topical PUVA therapy, photodynamic therapy (PDT), and systemic treatment with fumaric acid esters. Remarkably, our analysis showed that with an increase in the number of documented patients treated with a given therapeutic modality, the proportion of those achieving a complete or partial response actually decreased. This was interpreted as publication bias. Thus, no clear recommendation can be given for second-line therapy in case topical or intralesional corticosteroids fail.
Collapse
Affiliation(s)
| | - Jörg Tittelbach
- Department of Dermatology, University Hospital, Jena, Germany
| | - Peter Elsner
- Department of Dermatology, University Hospital, Jena, Germany
| |
Collapse
|
3
|
Abstract
Die Necrobiosis lipoidica ist eine seltene granulomatöse Erkrankung von bisher unzureichend geklärter Ätiologie. Häufig stellt die bei Diabetikern gehäuft zu beobachtende und zur Ulzeration neigende Dermatose eine starke Belastung für die Patienten dar. Bezüglich der Therapie existieren aktuell keine deutschen oder europäischen Leitlinien. Gleichzeitig lässt sich unter der aktuellen Standardtherapie, der lokalen oder intraläsionalen Anwendung von Glukokortikoiden, nicht immer ein zufriedenstellendes Ansprechen beobachten. Daher wurde untersucht, ob seit dem Jahr 2000 publizierte Therapiemodalitäten das Therapiespektrum relevant und erfolgversprechend erweitern. Es erfolgte eine Betrachtung aller Arbeiten im oben genannten Zeitraum, bei denen mehr als ein Einzelfallbericht je Therapiemodalität publiziert wurde. Insgesamt wurden in einem systematischen Review die Daten von 16 verschiedenen, seit 2000 publizierten Therapieverfahren in 49 Publikationen analysiert. Im Ergebnis zeigte sich, dass die meisten Erfahrungen bezüglich der topischen PUVA-Therapie, der photodynamischen Therapie (PDT) und der systemischen Therapie mit Fumarsäureestern vorliegen. Allerdings ist auffällig, dass mit steigender Zahl der pro Behandlungsmodalität behandelten Patienten der Anteil der Patienten, bei denen eine Abheilung bzw. eine teilweise Abheilung berichtet wurde, sinkt. Wir interpretieren diese Beobachtung als Publikationsbias. Daher kann für keines der besprochenen Verfahren eine klare Empfehlung als Therapie der zweiten Wahl nach Versagen der lokalen bzw. intraläsionalen Steroidtherapie gegeben werden.
Collapse
Affiliation(s)
| | | | - Peter Elsner
- Klinik für Hautkrankheiten, Universitätsklinikum Jena
| |
Collapse
|
4
|
Abstract
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.
Collapse
Affiliation(s)
- Michael J Tidman
- Department of Dermatology, Lauriston Building, The Royal Infirmary, Lauriston Place, Edinburgh, EH3 9HA, Scotland, UK,
| | - Catriona Duncan
- Department of Dermatology, Lauriston Building, The Royal Infirmary, Lauriston Place, Edinburgh, EH3 9HA, Scotland, UK
| |
Collapse
|
5
|
Abstract
Ulcerated necrobiosis lipoidica is one of the differential diagnoses in leg ulcers. The diagnosis is confirmed by histopathology. The authors report on a 68-year-old female patient with a history of chronic venous insufficiency who developed a chronic leg ulcer that did not respond to good ulcer care and compression bandaging. Skin biopsies revealed necrobiosis lipoidica. The patient was recently discovered to have diabetes mellitus that was treated orally by ascarose. Phlebosurgery and mesh grafting were performed, and the patient was given pentoxyfiline, dapsone, and clofazimine, but none of these treatments was successful. Therefore, topical PUVA therapy was introduced that resulted in partial remission and stabilizing of the residual pathology. Based on these experiences, the use of surgical methods alone is questionable.
Collapse
Affiliation(s)
- Erich Köstler
- Department of Dermatology, Hospital Dresden-Friedrichstadt, Dresden, Germany.
| | | |
Collapse
|
6
|
Reid SD, Ladizinski B, Lee K, Baibergenova A, Alavi A. Update on necrobiosis lipoidica: A review of etiology, diagnosis, and treatment options. J Am Acad Dermatol 2013; 69:783-791. [DOI: 10.1016/j.jaad.2013.05.034] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 05/23/2013] [Accepted: 05/30/2013] [Indexed: 11/16/2022]
|
7
|
Abstract
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.
Collapse
Affiliation(s)
- Sunil Kumar Kota
- Department of Endocrinology, Medwin Hospitals, Hyderabad, Andhra Pradesh, India
| | - Sruti Jammula
- Department of Pharmaceutics, Roland Institute of Pharmaceutical Sciences, Berhampur, Orissa, India
| | - Siva Krishna Kota
- Department of Anesthesia, Central Security Hospital, Riyadh, Saudi Arabia
| | - Lalit Kumar Meher
- Department of Medicine, MKCG Medical College, berhampur, Orissa, India
| | - Kirtikumar D. Modi
- Department of Endocrinology, Medwin Hospitals, Hyderabad, Andhra Pradesh, India
| |
Collapse
|
8
|
Mahé E, Zimmermann U. [Significant improvement in ulcerative necrobiosis lipoidica with doxycycline]. Ann Dermatol Venereol 2011; 138:686-8. [PMID: 21978507 DOI: 10.1016/j.annder.2011.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 09/01/2010] [Accepted: 02/21/2011] [Indexed: 11/29/2022]
|
9
|
Kordonouri O, Maguire AM, Knip M, Schober E, Lorini R, Holl RW, Donaghue KC. Other complications and associated conditions with diabetes in children and adolescents. Pediatr Diabetes 2009; 10 Suppl 12:204-10. [PMID: 19754631 DOI: 10.1111/j.1399-5448.2009.00573.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Olga Kordonouri
- Diabetes Center for Children and Adolescents, Children's Hospital auf der Bult, Hannover, Germany.
| | | | | | | | | | | | | |
Collapse
|
10
|
Kordonouri O, Maguire AM, Knip M, Schober E, Lorini R, Holl RW, Donaghue KC. ISPAD Clinical Practice Consensus Guidelines 2006-2007. Other complications and associated conditions. Pediatr Diabetes 2007; 8:171-6. [PMID: 17550428 DOI: 10.1111/j.1399-5448.2007.00249.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
11
|
Abstract
The aim of our study was to evaluate the long-term results of topical psoralen ultraviolet A (PUVA) in patients with necrobiosis lipoidica (NL), in whom conventional methods (pentoxifylline, vitamin E, tretinoin, and topical or intralesional corticosteroids) had failed. The study comprised 10 women (age range 17-44 years), six of whom were insulin-dependent diabetics and four were diabetes-free. Duration of NL ranged from 3 to 10 years. The patients were treated with a 0.005% aqueous solution of 8-methoxypsoralen, applied topically for 30 min, and subsequently irradiated with UVA three times weekly. All the patients experienced almost complete remission (softening of skin lesions, no hyperpigmentation, lack of lesion progression) after a mean of 47 sessions (mean UVA cumulative dose 69.5 J/cm2). They were followed up for 12-24 months, during which time two recurrences, both in diabetic patients, were observed after 8 and 12 months of treatment cessation, which further resolved after another course of topical PUVA. We conclude that topical PUVA is well tolerated by NL patients and may serve as an alternative therapeutic regimen.
Collapse
Affiliation(s)
- J Narbutt
- Department of Dermatology, Medical University of Lodz, Poland
| | | | | | | |
Collapse
|
12
|
Affiliation(s)
- E Stewart
- Department of Dermatology, Ninewells Hospital, Dundee, UK.
| |
Collapse
|
13
|
Abstract
A 55-year-old woman with severe, chronic, treatment-resistant ulcerating necrobiosis lipoidica of the shins was commenced on oral cyclosporin at a dose of 2.5 mg/kg/day. Improvement started within 1 week of commencing treatment, and the lesions healed completely over 8 months. Further ulceration occurred 3 months after discontinuing cyclosporin, with improvement on reintroduction of cyclosporin. There have been four previous case reports of healing of treatment-resistant ulcerating necrobiosis lipoidica with cyclosporin.
Collapse
Affiliation(s)
- Amy Stanway
- Department of Dermatology, Waikato Hospital, Pembroke Street, Private Bag 2500, Hamilton, New Zealand.
| | | | | |
Collapse
|
14
|
Affiliation(s)
| | - Annie M Jones
- Department of Health Sciences, University of York, York
| |
Collapse
|
15
|
Cather JC, Menter MA. Leg Lesions and Velvety Hyperpigmentation on the Neck. Proc (Bayl Univ Med Cent) 2002; 15:327-8. [PMID: 16333458 PMCID: PMC1276631 DOI: 10.1080/08998280.2002.11927859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Jennifer Clay Cather
- Division of Dermatology, Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas, USA
| | | |
Collapse
|