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Abstract
Diabetes mellitus is a significant worldwide health concern and cutaneous manifestations are common. This review describes characteristic skin findings of diabetes, general skin findings related to diabetes, and findings related to diabetes treatment with a focus on clinical presentation, diagnosis, pathophysiology, epidemiology, and treatment. As the prevalence of diabetes continues to rise, cutaneous manifestations of diabetes mellitus likely will be encountered more frequently by physicians in all disciplines including dermatologists and primary care physicians. Accordingly, knowledge regarding the prevention, diagnosis, and management of cutaneous manifestations is an important aspect in the care of patients with diabetes.
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Affiliation(s)
- Alex Hines
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Mark D P Davis
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.
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2
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Verhoeven MMR, Weijer O. [Rare skin condition in a child with diabetes mellitus]. Ned Tijdschr Geneeskd 2019; 163:D3537. [PMID: 31386312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Necrobiosis lipoidica is a painless but disfiguring skin condition regularly complicated by ulceration and that is related to diabetes mellitus. CASE DESCRIPTION We present the case of a 17-year-old girl with type 1 diabetes mellitus in whom necrobiosis lipoidica was diagnosed. After falling with a bicycle, a traumatic ulcer developed. The patient underwent several different treatments (local and systemic glucocorticoids, antibiotics, hydroxychloroquine, calcineurin inhibitor, laser therapy and surgery), but these ultimately resulted in no more than minimal improvement of the skin condition. CONCLUSION Necrobiosis lipoidica is difficult to treat. Treatment recommendations are based on patient descriptions and results of small clinical trials.
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Affiliation(s)
- Maartje M R Verhoeven
- Amsterdam UMC, locatie Louwesweg, polikliniek Vrouw en Kind, Amsterdam
- Contact: M.M.R. Verhoeven
| | - Olivier Weijer
- Amsterdam UMC, locatie Louwesweg, polikliniek Vrouw en Kind, Amsterdam
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Sanches MM, Roda Â, Pimenta R, Filipe PL, Freitas JP. Cutaneous Manifestations of Diabetes Mellitus and Prediabetes. ACTA MEDICA PORT 2019; 32:459-465. [PMID: 31292028 DOI: 10.20344/amp.10738] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 12/14/2018] [Indexed: 11/20/2022]
Abstract
Diabetes is a serious, chronic disease with a rising prevalence worldwide. Its complications are a major cause of morbidity and mortality and contribute substantially to health care costs. In this article the authors review the most common and sensitive skin manifestations that can be present on patients with diabetes and prediabetes. The prompt recognition of these frequently underestimated entities is extremely important as it may trigger not only an adequate metabolic evaluation but also a timely referral and appropriate treatment, minimizing the secondary effects of long-term diabetes and improving the prognosis of diabetic patients.
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Affiliation(s)
| | - Ângela Roda
- Clínica Universitária de Dermatologia. Hospital de Santa Maria. Lisbon. Portugal
| | - Rita Pimenta
- Clínica Universitária de Dermatologia. Hospital de Santa Maria. Lisbon. Portugal
| | - Paulo Leal Filipe
- Clínica Universitária de Dermatologia. Hospital de Santa Maria. Lisbon. Portugal
| | - João Pedro Freitas
- Clínica Universitária de Dermatologia. Hospital de Santa Maria. Lisbon. Portugal
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Elouarradi N, Ansari NE. Necrobiosis lipoidica: a rare complication of diabetes. Pan Afr Med J 2018; 29:214. [PMID: 30100968 PMCID: PMC6080969 DOI: 10.11604/pamj.2018.29.214.15550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 03/26/2018] [Indexed: 11/17/2022] Open
Affiliation(s)
- Nassiba Elouarradi
- Service of Endocrinology, Diabetology and Metabolic Diseases, University Hospital of Marrakech, Marrakech, Morocco
| | - Nawal El Ansari
- Service of Endocrinology, Diabetology and Metabolic Diseases, University Hospital of Marrakech, Marrakech, Morocco
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Basoulis D, Fragiadaki K, Tentolouris N, Sfikakis PP, Kokkinos A. Anti-TNFα treatment for recalcitrant ulcerative necrobiosis lipoidica diabeticorum: A case report and review of the literature. Metabolism 2016; 65:569-73. [PMID: 26975548 DOI: 10.1016/j.metabol.2015.12.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 12/29/2015] [Accepted: 12/30/2015] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Necrobiosis lipoidica diabeticorum (NLD) is a rare degenerative connective tissue disorder associated with diabetes mellitus, which usually presents with red papules or plaques with raised edges and occasional ulceration. Ulcerating NLD is notoriously difficult to treat. We present a young patient with ulcerative NLD who was successfully treated with the anti-TNFα agent infliximab. Case presentation is followed by a review of therapeutic TNFα blockade in NLD. CASE PRESENTATION A 17-year old woman with type 1 diabetes since the age of 8, presented with a long-standing and extensively ulcerated and infected NLD lesion on her left shin. After achieving better glycemic control and treating her for infection of the wound, several NLD treatments failed to help, including corticosteroids and hyperbaric oxygen. She was treated successfully with 4 monthly sessions of 5mg/kg body weight intravenous infliximab, achieving complete resolution of ulceration. DISCUSSION A multitude of available treatments have been suggested for NLD over the past decades, based on two axes, one through wound healing and the other through immunosuppression. Anti-TNFα agents are relatively new drugs that brought a revolution in chronic inflammatory diseases and have been on the rise as novel potential treatments for NLD. Three out of the five available anti-TNFα agents have been safely tested so far, both topically and systematically, with mostly favorable results. CONCLUSION Intravenous infliximab was successful in the treatment of recalcitrant ulcerating NLD in our patient. Taken together with an increasing number of similar reports revealing a pathogenetic role of TNFα in NLD, we suggest that anti-TNFα agents are promising drugs in the management of this condition.
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Affiliation(s)
- Dimitrios Basoulis
- First Department of Propaedeutic Medicine, Medical School, National and Kapodistrian University of Athens, 17 Agiou Thoma St, Goudi, Athens, Greece.
| | - Kalliopi Fragiadaki
- First Department of Propaedeutic Medicine, Medical School, National and Kapodistrian University of Athens, 17 Agiou Thoma St, Goudi, Athens, Greece.
| | - Nicholas Tentolouris
- First Department of Propaedeutic Medicine, Medical School, National and Kapodistrian University of Athens, 17 Agiou Thoma St, Goudi, Athens, Greece.
| | - Petros P Sfikakis
- First Department of Propaedeutic Medicine, Medical School, National and Kapodistrian University of Athens, 17 Agiou Thoma St, Goudi, Athens, Greece.
| | - Alexander Kokkinos
- First Department of Propaedeutic Medicine, Medical School, National and Kapodistrian University of Athens, 17 Agiou Thoma St, Goudi, Athens, Greece.
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Affiliation(s)
- Sarah Y Lee
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lisa Shen
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Emily L Keimig
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Penny HL, Faretta M, Rifkah M, Weaver A, Swires A, Spinazzola J. Selective case study describing the use of Apligraf on necrobiosis lipoidica associated with diabetes. J Wound Care 2014; 23:S12-5. [PMID: 24600755 DOI: 10.12968/jowc.2014.23.sup2a.s12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Necrobiosis lipoidica is a rare skin disease characterised by large, well-demarcated, symmetrical plaques with overlying telangiectasias and atrophic, fibrotic features. The disease is associated with diabetes mellitus (1 in 300 cases), but can also be linked to other diseases such as rheumatoid arthritis. Women are three times more likely to develop necrobiosis lipoidica compared to men. Ulcerations are the most serious type of complications in necrobiosis lipoidica, and they occur most frequently on the legs of patients. However, the aetiology of necrobiosis lipoidica still remains unclear. Although many studies have been conducted in order to determine necrobiosis lipoidica's pathophysiology, a clear and definite path to disease has not been recorded. In this case study, a patient with necrobiosis lipoidica that had been refractory to conventional therapy received treatment with Apligraf® bioengineered wound dressings. Apligraf was shown to be effective in managing the patient's multiple hard-to-heal wounds. It was more successful than previous therapies in achieving granulation tissue formation and wound volume reduction, in addition to being a more rapid form of treatment.
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Pătraşcu V, Giurcă C, Ciurea RN, Georgescu CC, Ciurea ME. Ulcerated necrobiosis lipoidica to a teenager with diabetes mellitus and obesity. Rom J Morphol Embryol 2014; 55:171-176. [PMID: 24715184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Many skin lesions are associated with diabetes mellitus (DM) type 1 or 2, due to the use of antidiabetics or to metabolic and endocrine disorders caused by this disease. Necrobiosis lipoidica (NL) occurs more frequently in patients with DM. Painful ulcerations may occur on NL areas in about 20-25% of the cases and usually they are related to trauma. We present the case of a teenager, male, 17-year-old, having NL with multiple plaques, some of them spontaneously ulcerated after about 33 months of onset. He is known with type 1 DM from 2.5 years and the NL preceding the diagnosis of diabetes mellitus with about six months, presented erythematous-infiltrative skin plaques, some ulcerated for about three months, interesting both shins. Based on clinical, histopathological and paraclinical examinations, we established the following diagnoses: ulcerated NL, type 1 DM, moderate mixed dyslipidemia, class I obesity; commissural candidiasis, juvenile acne. Under treatment with Pentoxifyllinum, Sulodexidum, Ketotifenum and topical therapy with 0.2% Hyaluronic acid two months later, we have managed to heal two of the three ulcerated plaques and of the third has become superficial. We applied 0.5% Fluocortolonum on non-ulcerated plaques recording an improvement after two weeks of treatment. NL is a skin disease with a predilection for the shins, more frequent in patients with diabetes and is a part of palisading granulomatous dermatitis, which leads to skin atrophy. NL is found in the 0.3-1.2% of diabetic patients and is rare in children with diabetes (0.006%). It is more common in the patients with type 1 DM. The onset is in the third decade in diabetic patients and in the fourth decade in non-diabetics. There is no consensus concerning the treatment of NL, and the results are often modest. Antiplatelet agents, corticosteroids (local and general), immunomodulatory drugs, cyclins, wide synthetic antipaludics, heparin, Thalidomide are used. NL treatment is very difficult, especially in the ulcerated forms. Many of the drugs listed have proven efficacy only in isolated cases. Studies are necessary on large series of patients to determine the optimal therapy of NL.
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Affiliation(s)
- Virgil Pătraşcu
- Department of Dermatology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania;
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Gualdi G, Monari P, Farisoglio C, Calzavara-Pinton P. Juvenile ulcerated necrobiosis lipoidica successfully treated with oral cyclosporin A. GIORN ITAL DERMAT V 2013; 148:703-704. [PMID: 24442055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- G Gualdi
- Department of Dermatology, University of Brescia, A.O. Spedali Civili, Brescia, Italy -
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Roy S, Shayaan M. Unsightly rash on shin. Necrobiosis lipoidica diabeticorum. J Fam Pract 2012; 61:215-217. [PMID: 22482106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Satyajeet Roy
- Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, Camden, USA.
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O'Reilly K, Chu J, Meehan S, Heller P, Ashinoff R, Gruson L. Necrobiosis lipoidica. Dermatol Online J 2011; 17:18. [PMID: 22031644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
A 58-year-old woman presented with a seven-year history of an eruption on her lower legs that was associated with edema, weeping, pruritus, and a burning sensation. Past medical history included Hashimoto thyroiditis, which was diagnosed eight years prior to presentation. Histopathologic examination was consistent with necrobiosis lipoidica (NL). To our knowledge, NL that is associated with Hashimoto thyroiditis has been described in only one prior report. NL is a chronic, cutaneous, granulomatous condition with degenerative connective-tissue changes of unknown etiology. Our patient responded well to a potent topical glucocorticoid and topical tretinoin. Although our patient did not have diabetes mellitus, 75 percent of patients with NL have diabetes mellitus at the time of diagnosis or will subsequently develop diabetes mellitus. This association with diabetes mellitus mandates screening for glucose intolerance in all patients with NL.
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Affiliation(s)
- Kathryn O'Reilly
- Department of Dermatology, New York University, New York, New York, USA
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13
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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]
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Azoulay B, Bosque T, Burin des Roziers B, Daoud G, Cartier S. [Breast repaired by silicone implant. Case report of necrobiosis lipoidica]. ANN CHIR PLAST ESTH 2010; 57:79-82. [PMID: 21094576 DOI: 10.1016/j.anplas.2010.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Accepted: 10/12/2010] [Indexed: 11/19/2022]
Abstract
The authors report a very rare case of necrobiosis lipoidica, histopathologically confirmed, which happened in the breast a few months following the insertion of a silicone implant (post-mastectomy reconstruction). This case raises two problems: the physiopathology (role of the silicone implant) and the treatment of this accident, resistant to current therapy.
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Affiliation(s)
- B Azoulay
- Service de chirurgie plastique et maxillo-faciale, reconstructrice et esthétique, centre hospitalier de Gonesse, 25, rue Pierre-de-Theilley, 95500 Gonesse cedex, France.
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Abstract
Necrobiosis lipoidica (NL) remains a major therapeutic challenge for the dermatologist and diabetologist. Amongst many treatment modalities attempted, systemic corticosteroids remain controversial, not least because a proportion of NL patients are diabetic, and corticosteroids are likely to destabilize their diabetic control. Close supervision as an inpatient is often required. We report the ambulatory outpatient management of an insulin-dependent diabetic with ulcerated necrobiosis lipoidica complicated by activated protein C resistance.
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Affiliation(s)
- Eunice Tan
- Department of Dermatology, Addenbrooke's Hospital NHS Trust, Cambridge, United Kingdom.
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Hammami H, Youssef S, Jaber K, Dhaoui MR, Doss N. Perforating necrobiosis lipoidica in a girl with type 1 diabetes mellitus: a new case reported. Dermatol Online J 2008; 14:11. [PMID: 18718195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Necrobiosis lipoidica is an idiopathic dermatological condition that is strongly associated with diabetes mellitus. It is more commonly seen in women than men. The average age of onset is 30-40 years. Necrobiosis Lipoidica diabeticorum is an extremely rare finding in childhood diabetes. We describe the case of a 13-year-old girl who has had type 1 diabetes mellitus since she was 8 years old. The patient presented with 2 well-defined, persistent plaques with a depressed central area and elevated purple peripheral ring, one on the right thigh and the other over the lateral left leg. Histopathologic evaluation of the patient's biopsy confirmed the diagnosis of necrobiosis lipoidica with transfollicular elimination. Our patient is the second pediatric case described with perforating necrobiosis lipoidica. We review the literature and discuss clinical features, several complications, and the most recent treatment options for necrobiosis lipoidica in diabetic children.
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Affiliation(s)
- Houda Hammami
- Dermatology Department, Military Hospital of Tunis, Tunis, Tunisia
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Abdulla FR, Sheth PB. A case of perforating necrobiosis lipoidica in an African American female. Dermatol Online J 2008; 14:10. [PMID: 18718194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
An African American female with type II diabetes of 4 years duration presents with a 3-year history of smooth firm, dark brown plaques focally studded with comedone-like papules. Clinically and histologically her lesions were consistent with the rare entity perforating necrobiosis lipoidica.
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Affiliation(s)
- Farah R Abdulla
- Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Levine N. Bumps on the legs. Geriatrics (Basel) 2007; 62:29. [PMID: 18069883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Affiliation(s)
- Norman Levine
- University of Arizona Health Sciences Center, Tucson, Ariz, USA
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Affiliation(s)
- P Lee
- Department of Endocrinology and Metabolism, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
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Affiliation(s)
- Emmanuel S Antonarakis
- Department of Internal Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
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Affiliation(s)
- Nicole Wake
- Brigham and Women's Hospital, Boston, MA 02115, USA.
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22
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Füessl HS. [Look diagnosis. Unusual skin manifestations]. MMW Fortschr Med 2006; 148:69. [PMID: 16826747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
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Abstract
We describe a 12-year-old white girl with granuloma annulare localized to both ankles since she was five, necrobiosis lipoidica in the left pretibial region since she was ten, and a recent history of weakness, migraine, and weight loss. After initial evaluation, high fasting blood glucose levels and high hemoglobin A1c were found. The family history for non-insulin-dependent diabetes was suggestive of maturity-onset diabetes of the young. Coexistence of necrobiosis lipoidica and granuloma annulare, together with a family history of non-insulin-dependent diabetes, the age of onset, and the absence of ketosis, are specific features making possible, a clinical diagnosis. Genetic confirmation may not be so easily accessible or necessary.
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Affiliation(s)
- Federico Marchetti
- Department of Pediatrics, IRCCS Burlo Garofolo, University of Trieste, Trieste, Italy.
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Phillips P, Weightman W. Diabetes and the skin. Part 2--leg ulcer. Aust Fam Physician 2005; 34:961. [PMID: 16299633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- Pat Phillips
- The Queen Elizabeth Hospital, Woodville, South Australia.
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Leal Hernández M, Abellán Alemán J, Vicente Martínez R, Martínez Crespo J. [Lipoid necrobiosis in an asymptomatic patient: marker of cardiovascular risk?]. Aten Primaria 2004; 33:474-5. [PMID: 15151798 PMCID: PMC7681908 DOI: 10.1016/s0212-6567(04)79437-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- M Leal Hernández
- Centro de Salud Beniáján-San Andrés, Cátedra de Riesgo Cardiovascular, Universidad Católica de Murcia (UCAM), Murcia, Spain
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Papaioannides D, Akritidis N. Photo quiz. Skin rash in a patient with diabetes. Am Fam Physician 2003; 67:139-40. [PMID: 12537177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
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Izaki S. [Dermatologic complications due to diabetes mellitus]. Nihon Rinsho 2002; 60 Suppl 10:380-5. [PMID: 12430258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Affiliation(s)
- Seiichi Izaki
- Department of Dermatology, Saitama Medical Center, Saitama Medical School
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Yigit S, Estrada E. Recurrent necrobiosis lipoidica diabeticorum associated with venous insufficiency in an adolescent with poorly controlled type 2 diabetes mellitus. J Pediatr 2002; 141:280-2. [PMID: 12183729 DOI: 10.1067/mpd.2002.126302] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Type 2 diabetes mellitus and associated long-term complications have become a significant health problem in adolescents. We report a 16-year-old girl with poorly controlled type 2 diabetes mellitus who had recurrent necrobiosis lipoidica diabeticorum associated with venous insufficiency.
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Affiliation(s)
- Sevket Yigit
- Pediatric Endocrinology and Diabetes, Connecticut Children's Medical Center, University of Connecticut, Hartford, CT 06106, USA
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Affiliation(s)
- Y M Bello
- Boston University School of Medicine, USA
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Sucker C, Djawari D. [Plaque-like skin changes of the lower leg in diabetes mellitus]. Med Klin (Munich) 2000; 95:168. [PMID: 10771564 DOI: 10.1007/pl00002100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Two young insulin-dependent diabetic patients suffering from chronic nonhealing leg ulcers of necrobiosis lipoidica diabeticorum were treated by applying topically recombinant human granulocyte-macrophage colony-stimulating factor (GM-CSF) on the ulcer repetitively during 10 weeks. Evaluation of ulcer size was assessed with clinical examinations at 1-week or 2-week intervals. Topical GM-CSF healed the ulcers of both patients in 10 weeks. Decrease in the size of the ulcers was already evident after the first topical applications. During follow-up, the ulcers have remained healed for more than 3 years. This excellent treatment result suggests that topically applied GM-CSF may be a valuable drug for chronic, nonhealing ulcers in patients with diabetes.
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Affiliation(s)
- K Remes
- Turku University Central Hospital, Department of Medicine, Finland
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Imakado S, Satomi H, Iskikawa M, Iwata M, Tsubouchi Y, Otsuka F. Diffuse necrobiosis lipoidica diabeticorum associated with non-insulin dependent diabetes mellitus. Clin Exp Dermatol 1998; 23:271-3. [PMID: 10233624 DOI: 10.1046/j.1365-2230.1998.00402.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report a case of diffuse necrobiosis lipoidica (NL) which first appeared on the legs and scrotum, before gradually spreading across the back and arms; the patient also suffered from diabetes mellitus, and the NL lesion began to disappear as the diabetes mellitus was controlled. The possible contribution of various glycation and glycoxidation products of collagen to the pathogenesis of NL is discussed.
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Affiliation(s)
- S Imakado
- Department of Dermatology, Institute of Clinical Medicine, University of Tsukuba, 1-1-1 Ten-nodai, Tsukuba, Ibaraki 305-8575, Japan
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Smith K. Ulcerating necrobiosis lipoidica resolving in response to cyclosporine-A. Dermatol Online J 1997; 3:2. [PMID: 9141363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Necrobiosis lipoidica often fails to respond adequately to therapy with topical and intralesional corticosteroids, or to systemic medications like niacinamide and pentoxifylline (Trental). On the basis of unpublished work which showed a predominance of T helper cells in lesions of necrobiosis lipoidica, and recalling the case of a woman whose necrobiosis lipoidica improved after she was started on cyclosporine for a renal transplant, systemic cyclosporine was successfully used in the cases of two young women who had insulin-dependent diabetes and were disfigured by severe, ulcerating necrobiosis lipoidica on the anterior lower legs. Response to treatment was monitored with photographs. In both cases the ulcers resolved, and remained in remission after cyclosporine was stopped.
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Abstract
Skin manifestations associated with diabetes mellitus are common and, with close scrutiny, can occur in most, if not all, patients. Little information is available on what common pathophysiologic thread is responsible for the skin manifestation and diabetes. Although controlled studies are lacking, a recognition of the skin manifestations, treatment, and prognosis will help patients and their caregivers to understand treatment alternatives more clearly.
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Affiliation(s)
- R G Sibbald
- Department of Medicine, University of Toronto, Ontario, Canada
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Abstract
Necrobiosis lipoidica diabeticorum is a rare skin disorder, usually considered a marker for diabetes mellitus. More than half of the patients with necrobiosis lipoidica diabeticorum have diabetes mellitus, but less than one per cent of diabetes mellitus patients have necrobiosis lipoidica diabeticorum. In the diabetes and dermatology literature, we find the position that there is no effect of glucose control on either the appearance of necrobiosis lipoidica diabeticorum or the clinical course of the lesion. We base our challenge to this position on a critical review of the original data. And conclude on the contrary, that necrobiosis lipoidica diabeticorum is usually associated with poor glucose control and that tighter glucose control, as currently practised, might improve or prevent the disorder.
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Affiliation(s)
- O Cohen
- Institute of Endocrinology, C. Sheba Medical Center, Tel Hashomer and Sackler School of Medicine, Tel-Aviv University, Israel
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38
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Feldmann R, Prins C. [Skin symptoms in diabetic metabolism]. Ther Umsch 1995; 52:264-8. [PMID: 7754470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Diabetes mellitus is a common disease, and the cutaneous manifestations of it are frequently encountered. Some skin diseases have a strong association with diabetes, as necrobiosis lipoidica and diabetic bullae. They can be regarded as a cutaneous marker for diabetes. Other disorders--for example shin spots--also occur in the nondiabetic population. Cutaneous infections may be a sign of poorly controlled diabetes.
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Affiliation(s)
- J E Jelinek
- Department of Dermatology, New York University Medical School, New York
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Abstract
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.
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Affiliation(s)
- M H Lowitt
- Department of Medicine, New England Deaconess Hospital, Boston, MA
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42
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Schumacher F, Schnyder UW. [Necrobiosis lipoidica and Koebner phenomenon]. Hautarzt 1991; 42:587-8. [PMID: 1938413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Our report describes a 52-year-old female patient with bilateral foci of necrobiosis lipoidica in pretibial scars. The skin changes appeared 6 months after internal fixation of a tibial fracture in each case.
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Affiliation(s)
- F Schumacher
- Dermatologische Klinik des Universitätsspitals Zürich
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43
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Llajam MA. Koebner's phenomenon and necrobiosis lipoidica diabeticorum. Br J Clin Pract 1990; 44:765. [PMID: 2102235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In 1877, Dr Heinrich Koebner inflicted an experimental trauma on the uninvolved skin of a psoriatic patient. This resulted in the appearance of a typical psoriatic lesion at the site of trauma. This reaction, known as Koebner's phenomenon (KP), has subsequently been associated with several skin diseases. However, it has not been associated previously with necrobiosis lipoidica diabeticorum (NBL), a rare skin manifestation of diabetes mellitus. This report presents the unusual finding of NBL associated with KP in a patient with diabetes mellitus.
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Affiliation(s)
- M A Llajam
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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44
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Wozniak KD, Bär M. [Significance of skin changes in diabetes mellitus]. Z Gesamte Inn Med 1990; 45:669-73. [PMID: 2099026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
500 patients of a dispensaire of diabetes were inspected dermatologically. 335 patients had a duration of the glucose metabolism intoleration less than 10 years and 165 patients more than 10 years. 215 patients stated a striking family case history according diabetes. 54 per cent (273) of the cases showed an adiposity, 418 patients (83.6 percent) had pathological changes of the skin and mucosal changes. It is clear that dermatomycoses, eczema and pyodermias occur more often with acute metabolic disorder and adiposity. Neurovascular changes of the skin occur with long persistent glucose metabolism intoleration. Bad healing tendencles of wounds, pruritus, intensive dermatomycoses, balanitis, vulvitis, furunculosis and pyodermias are important references to a glucose metabolism intoleration. They should give rise to look for a diabetes irrespective of the age of the patient.
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Affiliation(s)
- K D Wozniak
- Klinik und Poliklinik für Hautkrankheiten Martin-Luther-Universität Halle-Wittenberg
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45
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Rubianes EI, Sánchez JL. Dermatology diagnosis: necrobiosis lipoidica diabeticorum. Bol Asoc Med P R 1989; 81:468-70. [PMID: 2619845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Abstract
One hundred sixteen patients with granuloma annulare and necrobiosis lipoidica were studied. The relationship of these two disorders with diabetes mellitus suggests that atypical granuloma annulare could be linked to necrobiosis lipoidica, toward which it progresses.
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Affiliation(s)
- M Binazzi
- Department of Dermatology and Venereology, University of Perugia School of Medicine, Italy
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47
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Abstract
Necrobiosis lipoidica diabeticorum is an unusual dermatologic condition with a characteristic clinical appearance and a clear association with diabetes mellitus. There is currently no treatment that reverses the atrophic changes associated with this lesion. We have carried out a clinicopathologic study on 15 subjects and, in addition, have reviewed 10 further biopsy specimens of necrobiosis lipoidica diabeticorum. We found a frequent association of necrobiosis lipoidica diabeticorum with other chronic complications of diabetes mellitus, including limited joint mobility. It is possible that nonenzymatic glucosylation or other changes in collagen may be important in the etiology of necrobiosis lipoidica diabeticorum and the limited joint mobility. We confirmed that cutaneous anesthesia is usually present in the necrobiosis lipoidica diabeticorum lesions. With the use of an antibody to S100 protein and an immunohistochemical method, there was an apparent decreased number of nerves in the skin lesions. We suggest that sensory loss results from local destruction of cutaneous nerves by the inflammatory process. Finally, in six elliptical biopsies extending into clinically normal skin, we demonstrated that the inflammatory infiltrate of necrobiosis lipoidica diabeticorum extended from the lesion into apparently normal skin surrounding clinically active lesions. Thus, intradermal steroids might be administered to perilesional areas surrounding active lesions in the hope of halting progression.
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Affiliation(s)
- A J Boulton
- Department of Medicine, University of Miami School of Medicine, FL
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Watanabe S, Iwata M, Maeda H, Ishibashi Y. Immunohistochemical studies of major histocompatibility antigens in a case of the bare lymphocyte syndrome without immunodeficiency. J Am Acad Dermatol 1987; 17:895-902. [PMID: 3680679 DOI: 10.1016/s0190-9622(87)70277-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A case of the bare lymphocyte syndrome without apparent immunodeficiency was observed. The patient had, in addition, ichthyosis vulgaris and sinobronchial disease. A pustular lesion developed at first on the anterior aspect of lower part of the left leg. This lesion gradually increased in size and evolved into giant indurated, irregular adjoining plaques. On biopsy, the histologic findings were similar to necrobiosis lipoidica. No human lymphocyte antigen (HLA) class I antigens were detected on peripheral mononuclear cells; however, HLA-DR antigens were present on B lymphocytes. Immunohistochemical studies disclosed defective expression of class I antigens in the non-lesional skin, but positive expression was demonstrated in the lesional area. HLA-DR antigens were expressed on keratinocytes and on most infiltrating inflammatory cells in the affected skin. It is therefore speculated that class I antigen appearance and mononuclear cell infiltrate each induces the other and that together they play an important role in the formation and enlargement of the skin lesion.
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Affiliation(s)
- S Watanabe
- Department of Dermatology, Faculty of Medicine, University of Tokyo, Japan
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Laukkanen A, Fräki JE, Väätäinen N, Korhonen T, Naukkarinen A. Necrobiosis lipoidica: clinical and immunofluorescent study. Dermatologica 1986; 172:89-92. [PMID: 3512329 DOI: 10.1159/000249304] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Fourteen patients with necrobiosis lipoidica (NL) were carefully evaluated clinically and histologically. Ten of these patients (71%) had diabetes and most of them were treated with insulin (8 of 10 patients). Trauma was found as an immediate triggering factor in 6 patients (43%) and a possible preceding factor in 3 more cases. No immunoglobulins were found in the lesional skin of NL. Intradermal injections of histamine in healthy skin of legs led to deposition of immunoglobulins and complement (C3) in skin blood vessel walls in 4 of 12 patients studied (30%). These results suggest that immune complexes might be involved only in few cases of NL. Preceding trauma combined with metabolic and inflammatory changes could be an important triggering factor in the etiology of NL.
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