Does pancreas transplant in diabetic patients affect the evolution of necrobiosis lipoidica?

Souza, Aieska de; el‐Azhary, Rokea A.; Gibson, Lawrence E.

doi:10.1111/j.1365-4632.2008.04019.x

Cited by 18 publications

(24 citation statements)

References 25 publications

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“…The publications by Mazour et al [ 46 ] and Souza et al [ 47 ] are of interest from a pathophysiological rather than a therapeutic perspective as they reported on the complete resolution of NL lesions following a pancreas transplant. This observation might provide support to the theory that -in diabetes-associated cases of NL -the formation and deposition of glycoproteins possibly constitutes the initial step in endothelial swelling and subsequent granuloma formation [ 51 ] .…”

Section: Findings and Discussionmentioning

confidence: 99%

Update: Treatment of necrobiosis lipoidica

Peckruhn

Tittelbach

Elsner

2017

J Deutsche Derma Gesell

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SummaryNecrobiosis 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.

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Section: Findings and Discussionmentioning

confidence: 99%

Update: Treatment of necrobiosis lipoidica

Peckruhn

Tittelbach

Elsner

2017

J Deutsche Derma Gesell

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“…Diabetic skin has been demonstrated to increase glycation and glycoxidation products . It is postulated that this may be the primary cause of degeneration and granulation process in diabetic skin leading to alterations to blood vessels and collagen fibers . The underlying theory is that the NLD lesions are caused by these microcomplications, leading to poor tissue perfusion and hypoxia .…”

Section: Discussionmentioning

confidence: 99%

“…Immunohistochemical studies have demonstrated increased Glu‐1 receptors, a glucose transport, in the fibroblasts of NL lesions . These receptors that help facilitate transportation of glucose into cells are upregulated when there is an increasing demand, such as when there is poor tissue perfusion . There is conflicting evidence investigating the relationship between NL lesions and tissue oxygenation .…”

Section: Discussionmentioning

confidence: 99%

“…There are many treatment modalities that are used to manage NLD including systemic corticosteroids, PUVA, immunomodulators, pentoxifylline, fibrinolytic agents, nicotinamide, heparin, antiplatelet agents, ticlopidone, clofazimine, excision, temporary porcine grafting, and allografted cultured keratinocytes . Some studies have suggested that improving glycemic control may contribute to NLD resolution …”

Section: Introductionmentioning

confidence: 99%

“…There is great controversy as to whether tighter glycemic control could alleviate NLD. In the past, the assumption was that glycemic control had no effect on the course of NLD, however, more recent literature suggests that improving glycemic control may contribute to NLD resolution . Currently, there are no articles summarizing the change in prognosis of NLD based on glycemic control in patients with diabetes.…”

Section: Introductionmentioning

confidence: 99%

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A systematic review of the relationship between glycemic control and necrobiosis lipoidica diabeticorum in patients with diabetes mellitus

et al. 2017

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The association of specific skin disorders with diabetes mellitus (DM) has been well established. Current literature suggests that approximately 30-91% of patients with diabetes will experience at least one cutaneous manifestation of this systemic disease in their lifetime. To date, there are limited articles summarizing the link between necrobiosis lipoidica diabeticorum (NLD) prognosis and glycemic control in patients with diabetes. The objective of the study is to summarize and appraise the available evidence assessing the relationship between glycemic control and NLD. A literature search was conducted based on MEDLINE (1946-2015), EMBASE (1980-2015), Google Scholar, and PubMed for publications that described the results of diabetes control and NLD. Further studies were identified from bibliographies of all relevant studies, gray literature, and annual scientific assemblies. All studies investigating the relationship between DM (type 1 and type 2) management and NLD were included. Two reviewers independently extracted data including demographics, type of diabetes management measures (glucose, HbA1c, insulin), comorbidities, and outcome. A total of 622 studies were identified, and 10 studies met the inclusion and exclusion criteria: two case series and eight case reports. Of the 24 patients with NLD, 13 patients reported resolution of NLD after implementing various methods of glycemic control (diabetic diet consisting of 1600 kcal/day [1 patient], insulin regimen [3 patients], and pancreatic transplantation [9 patients]). Glycemic control may have a role in influencing the prognosis of necrobiosis lipoidica in patients with diabetes; however, there is currently insufficient evidence to support or refute this claim.

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Pancreas Disease and Diabetes Mellitus

Rongioletti

2010

Clinical and Pathological Aspects of Skin Diseases in Endocrine, Metabolic, Nutritional and Deposition Disease

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Does pancreas transplant in diabetic patients affect the evolution of necrobiosis lipoidica?

Abstract: Patients experienced improvement of NL within 2-8 weeks following pancreas transplantation. Metabolic changes, improvement of the microcirculation and normalization of blood glucose levels may be playing a role in the resolution of NL.

Cited by 18 publications

References 25 publications

Update: Treatment of necrobiosis lipoidica

Update: Treatment of necrobiosis lipoidica

A systematic review of the relationship between glycemic control and necrobiosis lipoidica diabeticorum in patients with diabetes mellitus

Pancreas Disease and Diabetes Mellitus

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