Cases Of Necrobiosis Lipoidica Research Articles

Sarcoidosis with necrobiosis-lipoidica-like skin lesions: A challenge for the dermatologist.

Necrobiosis lipoidica (NL) and cutaneous sarcoidosis are granulomatous skin disorders of unknown etiology. 1 Although these two diseases are distinct, they share histopathological and clinical features and, occasionally, one may mimic the other. 2 Only a few cases of concomitant NL and sarcoidosis have been reported. 3 Sarcoidosis is characterized by the formation of epithelioid and giant cell granulomas without caseous necrosis, and it may affect not only the skin but also many organs, most frequently (90%‐95% of cases) affecting the lungs. 4 , 5 Classic cutaneous lesions are erythematous papules, which become confluent forming a painless infiltrated plaque. 6 These lesions may be seen in any part of the body, especially on the face, superior chest and extensor face of the limbs. 7 In this report, a female patient, non‐diabetic, who was followed up along 20 years, presented different features of cutaneous sarcoidosis with no evidence of systemic invovement.

An atrophic plaque on the breast six years after breast reconstruction surgery

Necrobiosis lipoidica (NL) is a cutaneous disease entity that typically manifests as atrophic yellow plaques with telangiectasias on the anterior tibial region. Although NL is commonly associated with diabetes mellitus, the role of trauma in disease development is less commonly emphasized. The relationship between NL and the Köbner phenomenon has been established, as a few cases of NL occurring in surgical scars have been reported in the literature. We report the first case of NL occurring in a mastectomy scar on the breast in a non-diabetic female, and explore the relationship between NL, diabetes mellitus, and trauma.

Adipophilin expression in necrobiosis lipoidica, granuloma annulare, and sarcoidosis.

Necrobiosis lipoidica (NL), granuloma annulare (GA), and sarcoidosis usually are distinguished by clinical presentation and routine microscopy, but their distinction can sometimes be challenging. Historically, a clue to diagnosing NL or GA has been the identification of lipid droplets in the areas of altered collagen, but such studies have required fresh frozen tissue, making them impractical. Here, we present the first report of immunohistochemical staining to detect adipophilin, a membrane protein in lipid droplets, in NL (n = 12), GA (n = 19), sarcoidosis (n = 12), and, as a control for nonspecific tissue damage, nongranulomatous cutaneous necrosis (n = 13). Four patterns of labeling were identified: (1) extracellular, within zones of altered collagen; (2) both intracellular and extracellular, after the distribution of palisaded or scattered histiocytes; (3) intracellular, within clustered histiocytes; and (4) periadnexal. All cases of NL demonstrated pattern 1; nearly all cases of GA (18/19) demonstrated pattern 2; most sarcoidosis (10/12) demonstrated pattern 3; and nongranulomatous necrosis demonstrated either pattern 4 (6/13) or did not stain (6/13), confirming that the antibody to adipophilin did not adhere nonspecifically to the damaged tissue. An additional set of 3 biopsies with overlapping or partially sampled features of NL, GA, and/or sarcoidosis subsequently confirmed the potential utility of adipophilin staining in diagnostically challenging cases. We conclude that the pattern of adipophilin expression is a useful adjunct in the evaluation of granulomatous dermatitis.

Czy proces zapalny odgrywa rolę w patogenezie obumierania tłuszczowatego?

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Słowik-Kwiatkowska I, Lesiak A, Woźniacka A, Sysa-Jędrzejowska A, Narbutt J. Does inflammation play a role in development of necrobiosis lipoidica?. Dermatology Review/Przegląd Dermatologiczny. 2014;101(3):187-191. doi:10.5114/dr.2014.43808. APA Słowik-Kwiatkowska, I., Lesiak, A., Woźniacka, A., Sysa-Jędrzejowska, A., & Narbutt, J. (2014). Does inflammation play a role in development of necrobiosis lipoidica?. Dermatology Review/Przegląd Dermatologiczny, 101(3), 187-191. https://doi.org/10.5114/dr.2014.43808 Chicago Słowik-Kwiatkowska, Iwona, Aleksandra Lesiak, Anna Woźniacka, Anna Sysa-Jędrzejowska, and Joanna Narbutt. 2014. "Does inflammation play a role in development of necrobiosis lipoidica?". Dermatology Review/Przegląd Dermatologiczny 101 (3): 187-191. doi:10.5114/dr.2014.43808. Harvard Słowik-Kwiatkowska, I., Lesiak, A., Woźniacka, A., Sysa-Jędrzejowska, A., and Narbutt, J. (2014). Does inflammation play a role in development of necrobiosis lipoidica?. Dermatology Review/Przegląd Dermatologiczny, 101(3), pp.187-191. https://doi.org/10.5114/dr.2014.43808 MLA Słowik-Kwiatkowska, Iwona et al. "Does inflammation play a role in development of necrobiosis lipoidica?." Dermatology Review/Przegląd Dermatologiczny, vol. 101, no. 3, 2014, pp. 187-191. doi:10.5114/dr.2014.43808. Vancouver Słowik-Kwiatkowska I, Lesiak A, Woźniacka A, Sysa-Jędrzejowska A, Narbutt J. Does inflammation play a role in development of necrobiosis lipoidica?. Dermatology Review/Przegląd Dermatologiczny. 2014;101(3):187-191. doi:10.5114/dr.2014.43808.

Necrobiosis Lipoidica in the Absence of Diabetes Mellitus: A Case Report and an Analysis of 116 Japanese Cases

A 60-year-old Japanese woman was referred to our hospital for yellow-brown plaques accompanied by ulceration on her left lower leg. Her medical history included neither diabetes mellitus nor minor trauma. A histopathological examination of the plaques showed necrobiotic changes within the dermal collagen surrounded by granulomas that comprised lymphocytes, histiocytes, and giant cells. The lower dermis revealed fibrotic changes that extended into the subcutaneous tissue. The patient’s blood glucose and glycated hemoglobin levels were within the normal ranges. We considered a diagnosis of necrobiosis lipoidica (NL) in the absence of diabetes mellitus. We reviewed 116 cases of NL that were reported in the Japanese medical literature between 1986 and 2014 and found that NL onset was most common in individuals of both sexes ≥ 60 years of age. Previous reports that reviewed NL cases in the Japanese medical literature that were published during the1900s indicated that NL occurs in people ≥ 40 years of age. We suggest that the aging population and increasingly longer life spans have increased the average age of NL onset in Japan. With regard to treatments, there were no effective treatments, but skin grafts were curative. NL treatment is very difficult, especially when ulcers are present; hence, we suggest that further research is needed to determine effective NL treatments.

Necrobiosis lipoidica: A clinicopathological study in the Indian scenario

Context:Necrobiosis lipoidica (NL) is a chronic granulomatous dermatitis that is commonly associated with diabetes mellitus. Most of the current knowledge about this entity is from western literature.Aims:This study evaluates the clinicohistological features of NL in an Indian scenario.Materials and Methods:We retrospectively reviewed clinical features, associated comorbidities, and biopsies of all patients with NL over a period of one year.Results:Five cases of NL were seen during the duration of the study. The preliminary clinical diagnosis ranged from sarcoidosis to tinea incognito. The commonest clinical presentation in the Indian scenario was of asymptomatic erythematous to skin-colored plaques and nodules on the shins with or without central atrophy. The most common site of involvement was the shin (3 of 5 patients). NL was associated with Diabetes mellitus in only two cases, both of whom were male patients. On histology, various patterns of inflammation were seen including the palisading, interstitial, and mixed granulomatous infiltrates. One patient had sarcoidal granulomas in association with an interstitial pattern. Features seen consistently in all cases include perivascular lymphoplasmacytic infiltrates, interstitial lymphocytic infiltrates, and fibroplasia. Interstitial mucin deposition was not observed in any of the biopsies.Conclusion:The diagnosis of NL was missed in most cases due to the rarity of the disease, absence of concomitant diabetes, and atypical presentations. Histology was a useful tool in clinching the diagnosis.

Necrobiosis Lipoidica Diabeticorum

Necrobiosis lipoidica is a rare disorder that usually appears in the lower extremities and it is often related to diabetes mellitus. There are few reported cases of necrobiosis lipoidica in children. We present an interesting case in that the patient developed lesions on the abdomen, which is an unusual location.

Three cases of necrobiosis lipoidica treated with photodynamic therapy.

Three cases of necrobiosis lipoidica treated with photodynamic therapy.

Detection of spirochaetal microorganisms by focus floating microscopy in necrobiosis lipoidica in patients from central Europe

Necrobiosis lipoidica (NL) is a chronic inflammatory skin disease with unknown aetiology. The aim was to determine the presence of spirochaetal microorganisms in NL. Focus-floating microscopy (FFM) is a modified immunohistochemical technique that was developed to detect borrelial spirochaetes within tissue sections. It has proven to be more sensitive for the detection of spirochaetes than polymerase chain reaction (PCR). Fifty-six cases of NL as well as 44 negative and 33 positive controls were investigated for the presence of Borrelia within tissue specimens. Using FFM, Borrelia could be detected in 42 cases (75.0%) and were seen significantly more often in histologically active inflammatory-rich (38/41, 92.7%) than in inflammatory-poor (4/15, 26.7%) cases of NL (P < 0.001). Seven cases investigated with a Borrelia-specific PCR (23s-RNA) remained negative. In contrast, FFM was positive in 30 of 33 (90.9%) positive controls of acrodermatitis chronica atrophicans and 15 of the positive controls (45.5%) were also positive with PCR, whereas no negative controls revealed any microorganisms. Detection of spirochaetes in NL points to a specific involvement of B. burgdorferi or other similar strains in the development of or trigger for this disease.

Light‐chain‐restricted plasmacellular infiltrates in necrobiosis lipoidica – a clue to an underlying monoclonal gammopathy

Necrobiosis lipoidica (NL) is a member of the palisading granulomatous dermatitides that is associated, in most cases, with diabetes mellitus. However, there are an increasing number of cases of NL associated with other forms of systemic disease. We describe a novel case of NL associated with a light-chain-restricted plasmacellular infiltrate; subsequent investigations established an underlying monoclonal gammopathy. Skin biopsy material was obtained and was processed in the usual fashion for hematoxylin and eosin (H and E) examination. Immunohistochemical staining was performed by utilizing kappa and lambda monoclonal antibodies (Dako Corporation, Carpentiera, CA, USA). Kappa and lambda in situ hybridization was also performed (Ventana Medical Systems, Tucson, AZ, USA). A 55-year-old woman with a 5-year history of bilateral thigh subcutaneous nodules underwent a skin biopsy, showing typical changes of NL; there was a concomitant prominent perivascular plasmacellular infiltrate. Kappa light chain restriction was observed amid the plasmacellular infiltrate. Bone marrow biopsy and immunophenotyping studies revealed a clonal plasmacytosis with kappa light chain restriction. Granulomatous inflammation, including NL, may be a cutaneous paraneoplastic expression of low-grade B-cell lymphoproliferative disease in the context of an underlying plasma cell dyscrasia.

Subcutaneous pseudomembranous fat necrosis: new observations.

Pseudomembranous fat necrosis is a peculiar manifestation of necrosis of adipose tissue characterized by formation of pseudocystic cavities lined by crenulated membranes. The underlying mechanism for the formation of pseudomembranes is unknown and numerous hypotheses have been proposed. Despite divergent interpretations, most authors consider necrotic fat cells to be the anatomic substrate for the formation of pseudomembranes. A total of 341 panniculitides were reviewed for the presence of pseudomembranous fat necrosis. The specific diagnoses were established after correlation of all available clinical and laboratory data with the histopathology. Special attention was given to the time in the evolution of the disease when the biopsy was taken. Additional immunohistochemical studies were performed in 12 cases. Thirty of 341 cases of different types of panniculitides were found to show pseudomembranous fat necrosis, namely: 10 of 15 cases of sclerosing panniculitis (lipodermatosclerosis), 6 of 95 cases of erythema nodosum, 7 of 34 cases of traumatic panniculitis, 1 of 7 cases of lupus panniculitis, 1 of 20 cases of erythema induratum Bazin (nodular vasculitis), 1 of 9 cases of necrobiosis lipoidica, 1 of 4 cases of sclerotic lipogranuloma, 1 of 9 cases of infectious panniculitis (erysipelas), 1 of 2 cases of pancreatic panniculitis, and 1 of 4 cases of subcutaneous sarcoidosis. Pseudomembranous fat necrosis labelled strongly for the histiocytic markers CD68 and lysozyme. Our series provides data suggesting that pseudomembranous fat necrosis represents a dynamic process that varies according to the evolution of the lesion at the time of the biopsy. In biopsies taken from early foci of panniculitides pseudomembranes show vescicular or picnotic nuclei. Later, pseudomembranes retain their crenulated appearance but lack nuclear elements. Furthermore, we present histopathologic, histochemical, and immunohistochemical evidence that pseudomembranous fat necrosis results from the interaction of residual products of disintegrated fat cells and macrophages. Histiocytic markers such as CD68 and lysozyme may be used as reliable tools in order to detect pseudomembranes in panniculitides.

Concomitant Granuloma annulare and Necrobiosis lipoidica

A case of concomitant granuloma annulare (GA) and necrobiosis lipoidica (NL) is presented. The etiology of these two disorders remains obscure. The similarity of the histopathology in GA and NL might suggest a common origin. However, a review of the 5 previous cases of concomitant GA and NL and recent biochemical, immunological and immunohistochemical studies comparing GA to NL indicates an independent etiology for these two histologically related disorders. Some evidence points toward a closer relationship of NL with diabetes than GA, while GA may be related to delayed-type hypersensitivity reactions.

Necrobiosis lipoidica: clinical and immunofluorescent study.

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.