Venous insufficiency in patients with necrobiosis lipoidica

Nakajima, Takeshi; Tanemura, Atsushi; Inui, Shigeki; Katayama, Ichiro

doi:10.1111/j.1346-8138.2009.00612.x

Cited by 13 publications

(13 citation statements)

References 5 publications

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“…1 Other theories suggest that NL could be caused by collagen fiber abnormalities, 7 defective neutrophil migration, 8 and tissue damage secondary to venous insufficiency. 9 Although the incidence of NL is only 0.3%-1.2% in diabetic patients, 1,10 DM is the most common associated disease. In the longest NL series published in 1956 and 1966, 42% and 65% of patients had DM the before diagnosis of NL.…”

Section: Discussionmentioning

confidence: 99%

Necrobiosis Lipoidica: A Descriptive Study of 35 Cases

Marcoval

Gómez-Armayones

Valentí-Medina

et al. 2015

Actas Dermo-Sifiliográficas (English Edition)

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Section: Discussionmentioning

confidence: 99%

Necrobiosis Lipoidica: A Descriptive Study of 35 Cases

Marcoval

Gómez-Armayones

Valentí-Medina

et al. 2015

Actas Dermo-Sifiliográficas (English Edition)

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“…In the past years, more patients were successfully treated with topical tacrolimus as well (16,32). Compression therapy was performed on all of our patients to support ulcer healing, because previous reports have shown that chronic venous insufficiency, even if there are no clinical signs of stasis, can trigger tissue damage in the lower leg maintaining ulcerations caused by necrobiosis lipoidica (10). The fact that necrobiosis lipoidica almost exclusively appears on the lower legs and not in other body parts leads to the assumption that stasis plays a role in the formation of necrobiosis lipoidica plaques and ulcerations.…”

Section: Treatmentmentioning

confidence: 97%

“…There are reported associations with necrobiosis lipoidica and chronic venous insufficiency as well as hypercholesterolaemia. It has been discussed that both can trigger necrobiosis lipoidica and tissue damage (10,11).…”

Section: Pathophysiologymentioning

confidence: 99%

Ulcerated necrobiosis lipoidica as a rare cause for chronic leg ulcers: case report series of ten patients

Franklin

Stoffels-Weindorf

Hillen

et al. 2013

International Wound Journal

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Necrobiosis lipoidica is a rare granulomatous disorder of the skin. In up to 30% of the affected patients it can lead to ulcerations, which can impair the quality of life and are also very difficult to treat. Its pathogenesis is not fully understood. Only few studies focussing on necrobiosis lipoidica can be found, but none of them focus on ulcerated necrobiosis lipoidica. Therefore, we collected demographic data and comorbidities and assessed treatment options for patients with ulcerated necrobiosis lipoidica. Data of patients who were treated in the wound care centre of the University Hospital of Essen for ulcerated necrobiosis lipoidica over the past 10 years were retrospectively analysed. Hence, data of altogether ten patients (nine women and one man) with ulcerated necrobiosis lipoidica were collected. Of these, 70% of the patients had diabetes mellitus of which 30% had type I diabetes and 40% had type II diabetes; 60% of the patients suffered from arterial hypertension, obesity and hypercholesterolaemia; 40% of the patients suffered from psychiatric disorders such as depression and borderline disorder. Our clinical data demonstrate an association of ulcerated necrobiosis lipoidica and aspects of metabolic syndrome. This leads to a conclusion that ulcerating necrobiosis lipoidica can be seen as part of a generalised inflammatory reaction similar to the inflammatory reaction already known in the pathophysiology of rheumatoid diseases or psoriasis. In patients with clinical atypical painful ulcerations, necrobiosis lipoidica should be considered as a possible differential diagnosis. Therapists should be aware of associated aspects in patients with ulcerated necrobiosis lipoidica who besides diabetes often suffer from other aspects of a metabolic syndrome with increased cardiovascular risk factors. Therefore, these related comorbidities should also be diagnosed and treated.

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“…However, diabetic microangiopathy, immune-complex vasculitis, and collagen abnormalities are some potential underlying causes [1]. Nakajima et al [5] assert that both hyperlipidemia and venous reflux, in addition to other pathogenic factors, can trigger tissue damage in the lower legs and lead to the onset of NL. In constrast, Ngo et al [6] refute the hypothesis that NL is a manifestation of microvascular ischemic disease of the skin and conclude that the increased blood flow seen in NL lesions suggests an ongoing inflammatory process.…”

Section: Discussionmentioning

confidence: 99%

Necrobiosis Lipoidica: Early Diagnosis and Treatment with Tacrolimus

Patsatsi¹,

Kyriakou²,

Sotiriadis³

2011

Case Rep Dermatol

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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.

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Venous insufficiency in patients with necrobiosis lipoidica

Cited by 13 publications

References 5 publications

Necrobiosis Lipoidica: A Descriptive Study of 35 Cases

Necrobiosis Lipoidica: A Descriptive Study of 35 Cases

Ulcerated necrobiosis lipoidica as a rare cause for chronic leg ulcers: case report series of ten patients

Necrobiosis Lipoidica: Early Diagnosis and Treatment with Tacrolimus

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