Necrobiosis Lipoidica: Early Diagnosis and Treatment with Tacrolimus

Abstract

We present a case of necrobiosis lipoidica (NL) with atypical early lesions and good response to topical tacrolimus. NL is a disease with clinical features that are seldom misinterpreted. Often histology just confirms the clinician’s diagnosis. Only in rare cases, the clinical presentation and the involved body sites may be misleading. A 67-year-old diabetic woman was admitted to our department with a well-defined, persistent plaque on her left arm and on her right shin. Histologic examination of both lesions revealed features of NL despite the dissimilar clinical presentation. The patient was treated with 0.1% topical tacrolimus ointment twice daily for 8 weeks and once daily for 8 weeks. A significant improvement and no further lesions were observed after 1 year of follow-up. A high index of suspicion regarding NL lesions with atypical clinical presentation on different body sites is advised in order to avoid misdiagnosis, wrong treatment decisions and ulceration. Additionally, it appears that topical tacrolimus treatment is an effective therapeutic option in patients with recent, non-ulcerated NL lesions.

Pigmented Necrobiosis Lipoidica Accompanied by Insulin-dependent Diabetes Mellitus Induces CD163 Proinflammatory Macrophages and Interleukin-17-producing Cells

“…Recent reports have also described the therapeutic effect of neutralization of proinfiammatory cytokines (e.g. TNF-a) on NL (1, 3). In this report, we describe a case of pigmented NL presenting atypical clinical features, accompanied by IDDM.…”

“…Insulin-dependent type 1 diabetes mellitus (IDDM) is a chronic autoimmune disease caused by the selective destruction of pancreatic insulin-producing B cells (3). Autoimmunity comrnonly occurs when central or peripheral tolerance barriers are broken down, allowing the activation of self-reactive T cells (4).…”

Necrobiosis Lipoidica Diabeticorum: A pediatric case report

“…Some authors have reported a beneficial effect from smoking cessation and blood glucose control. Other therapeutic options are antiplatelet agents, cyclosporine, thalidomide, clofazimine, anti-TNF agents, fumaric acid esters, PUVA, photodynamic therapy, hydroxychloroquine, and tacrolimus 7 - 13 …”

Remission of Ulcerated Necrobiosis Lipoidica Diabeticorum after Bariatric Surgery

“…Microangiopathy, immune complex vasculitis with involvement of T cells, release of proinflammatory cytokines, and abnormal collagen production have all been implicated [11]. Several different therapies have been reported with limited success in the literature, including topical and systemic corticosteroids, nicotinamide, pentoxifylline, tretinoin, anti-TNF- α , mycophenolate mofetil, thalidomide, cyclosporine, tacrolimus, dipyridamole-aspirin, antimalarials, and PUVA [12–14]. …”