PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “NECROBIOSIS LIPOIDICA”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 55 records · Page 3Linked to original sources
PubMed1993

Expression of interstitial collagenase, 92-kDa gelatinase, and tissue inhibitor of metalloproteinases-1 in granuloma annulare and necrobiosis lipoidica diabeticorum.

Granuloma annular (GA) and necrobiosis lipoidica diabeticorum (NLD) are disorders characterized by granulomatous inflammation and degenerative changes in collagen and elastic fibers. Because these disorders have often been described as being associated with altered extracellular matrix deposition, we studied the in situ expression of interstitial collagenase, 92-kDa gelatinase, and tissue inhibitor of metalloproteinases (TIMP)-1. Twelve lesions each of GA and NLD of different histopathologic types and durations were examined. Interstitial collagenase mRNA was seen in histiocyte-like cells in one-third of the cases of both diseases, typically in younger lesions. In GA, collagenase mRNA was only detected in lesions of the palisading type. Signal for 92-kDa gelatinase mRNA was observed in eosinophils, which were present in low numbers in five of 12 GA and three of 12 NLD samples. The signal for this enzyme and the presence of eosinophils did not correlate with the age of lesion. TIMP-1 mRNA was consistently expressed by histiocyte-like cells in both disorders. In GA, TIMP-1 mRNA was detected at the outer edge of the palisading granulomas, but in NLD, inhibitor expression was seen in the perivascular and periadnexal accumulation of inflammatory cells. Our data indicate that collagenase and TIMP are expressed early in these disorders and that these proteins may contribute to stromal remodeling associated with necrobiotic lesions. Our results further indicate that the localization of TIMP-1 production may provide a distinction between the two disorders, whereas metalloproteinase expression is not sufficiently specific to aid in the differential diagnosis of GA and NLD.

Adult↗
PubMed1975

[Ulceration of the skin in necrobiosis lipoidica (author's transl)].

As a supplement to earlier investigations, a case of a 46 year old female patient is reported who has suffered from necrobiosis lipoidica granulomatosa with ulceration for 17 years. A marked remission was obtained by treatment with anti-inflammatory and immunosuppressive therapy. It is pointed out that under the usual treatment when ulcers of the lower leg and other areas of the skin do not heal, after exclusion of malignancies, necrobiosis lipoidica diabeticorum or necrobiosis lipoidica granulomatosa must be considered, especially as prophylactic examinations may arise.

Anti-Inflammatory Agents↗
PubMed1999

Necrobiosis lipoidica: a case with prominent cholesterol clefting and transepithelial elimination.

Transepithelial elimination of degenerated collagen through the hair follicle in necrobiosis lipoidica is rare, clinically manifesting as comedo-like plugs. Also unusual in necrobiosis lipoidica is the finding of cholesterol cleft formation. We report a case of necrobiosis lipoidica with transepithelial elimination of cholesterol crystals through hair follicles. This has been described in necrobiotic xanthogranuloma, demonstrating some overlap in the histopathologic findings in both necrobiotic granulomas. Additional criteria should be used to establish the diagnosis.

Aged↗
PubMed1977

Necrobiosis lipoidica. An immunofluorescence study.

Biopsy specimens from 12 patients with necrobiosis lipoidica (diabeticorum) were studied by direct immunofluorescent microscopy. The immunoglobulin IgM was present in blood vessel walls of involved skin from six patients, and the third component of complement (C3) was present in the blood vessel walls of involved skin from seven patients. The immunoglobulin IgA was similarly observed in two patients. In addition, IgM, C3, or fibrinogen were observed at the dermal-epidermal junction of involved skin from seven patients. Necrobiotic areas invariably contained fibrinogen. These findings suggest that an immunecomplex vasculitis may be involved in the pathogenesis of necrobiosis lipoidica.

Adolescent↗
PubMedDate not supplied

[Ulcerated necrobiosis lipoidica associated with insulin-dependent diabetes mellitus. Beneficial effect of corticosteroid therapy by oral administration].

OBJECTIVES: Necrobiosis lipoidica is a rare degenerative disease of dermal connective tissue usually observed in young diabetic patients. Several drugs have been suggested to be useful, but none have been shown to be effective in all cases. CASE REPORT: A young patient with insulin-dependent diabetes had a severe invalidating ulcerated necrobiosis lipoidica. Oral corticosteroids led to a satisfactory regression then stabilization with 6 mg/d prednisone. DISCUSSION: Oral corticosteroids would appear to be effective treatment and should be validated by controlled studies. Corticosteroids should only be used in exceptionally severe forms of ulcerated necrobiosis lipoidica after failure of conventional treatments. Diabetes would be an indication under strict metabolic control.

Administration, Oral↗
PubMed2001

Necrobiosis lipoidica diabeticorum treated with the pulsed dye laser.

BACKGROUND AND OBJECTIVE: Different treatment modalities have been advocated for necrobiosis lipoidica diabeticorum but clinical response is unpredictable. The purpose of this study was to evaluate the usefulness of pulsed dye laser (Candela SPTL, Irvine, MA, USA) in the treatment of an area of necrobiosis lipoidica of 4 cm in diameter on the anterior aspect of the leg in a non-diabetic patient. MATERIALS AND METHODS: A spot test was made at 6.0, 6.5 and 7.0 J/cm(2) energy fluences and the best energy fluence was selected after a 2-month postoperative evaluation. The patient received three treatment sessions with a fluence of 6.5 J/cm(2), 585-nm wavelength, 5-mm spot size, and 450 micro(s) pulse duration at 8-week intervals. The patient was given routine skin care advice with emollient cream and sunscreen (SPF 15) until the following session. RESULTS: Overall cosmetic improvement was achieved, with a decrease of erythema and telangiectasis, and stabilization in terms of progression (size) in the left half of the lesion, with no modification of atrophy or pigmentary changes. The right upper quadrant of the lesion showed an erythematous peripheral halo with minimal reduction in the erythema and telangiectasia, and discrete size increase. CONCLUSION: Pulsed dye laser may be a useful treatment for improving the telangiectasia and erythematous component of necrobiosis lipoidica.

Adult↗
PubMed1983

[Necrobiosis lipoidica (diabeticorum) and its association to Miescher's granulomatosis disciformis chronica et progressiva].

Morphologically, clinically and histologically the picture of necrobiosis lipoidica with and without diabetes represents an entity. In our opinion, granulomatosis disciformis chronica et progressiva Miescher reflects a specific reaction type of necrobiosis lipoidica being influenced by genetic factors. Its histological appearance is characterised by tuberculoid or sarcoid-like structures, in which the damage of the collagen as defined by necrobiosis, is variable but never absent. With regard to the factor of age, the concurrence of necrobiosis lipoidica sine diabete with granulomatosis disciformis Miescher in the middle of the period of life also speaks in favour of the similarity of both skin disorders. An injury seems to represent one of the conditional factors for the outbreak of the disease. The analysis of the histological slides revealed furthermore that the damage of the skin is confined to the clinically recognizable lesion. For its pathogenesis a local disturbance of the metabolism in the skin seems to be decisive i.e., the disturbance of the carbohydrate metabolism (shift from the citrate cycle to the pentosephosphate cycle, associated with the stimulation of fatty acid production). In the abnormal metabolism of the carbohydrates, the diabetes mellitus must be considered as the most important factor, however not excluding others as yet still unknown.

Diagnosis, Differential↗
PubMed1983

HLA antigens and necrobiosis lipoidica diabeticorum--a comparison between insulin-dependent diabetics with and without necrobiosis.

To investigate whether HLA-A, -B, -C, and -DR alloantigen frequencies are different in diabetic patients with and without necrobiosis lipoidica diabeticorum we studied 37 insulin-dependent (Type I) diabetics, 15 with and 22 without necrobiosis, and 96 normal control subjects. Compared to controls Type I diabetics had increased frequencies of B8, CW3, and DR4 and decreased frequencies of DR5 and DR7. Diabetics with necrobiosis differed from diabetics without necrobiosis only in that HLA-A2 was significantly less frequent in patients with necrobiosis. It is suggested that the lack of major differences between patients with and without necrobiosis argues in favour of the role of metabolic and/or vascular rather than genetic factors in the aetiology of necrobiosis.

Adult↗
PubMed2001

Expression of the human erythrocyte glucose transporter Glut-1 in areas of sclerotic collagen in necrobiosis lipoidica.

BACKGROUND: Glut-1 is the human erythrocyte glucose transporter which mediates facilitative transport of glucose across epithelial and endothelial barrier tissues. A primary abnormality in glucose transport and Glut-1 cell-surface content has been observed in fibroblasts from NIDDM and obese individuals. With the strong correlation between necrobiosis lipoidica and diabetes mellitus, we investigated the expression of Glut-1 in diabetic individuals with necrobiosis lipoidica (NL). METHODS: A polyclonal anti-Glut-1 antibody was used with a standard immunoperoxidase technique to determine Glut-1 expression by fibroblasts in areas of sclerotic collagen from specimens taken from diabetic individuals with necrobiosis lipoidica,and non-diabetic individuals with scars and granuloma annulare (GA). RESULTS: Our results showed Glut-1 expression in the areas of sclerotic collagen in patients with NL, possibly contributing to insulin resistance in these tissues. CONCLUSIONS: Our findings raises the question as to whether abnormalities in glucose transport by fibroblasts in individuals with necrobiosis lipoidica contribute to the histopathologic changes.

Cicatrix↗
PubMed1988

Granuloma annulare, necrobiosis lipoidica, and diabetic disease.

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.

Adolescent↗
PubMed1990

Epidermal dendritic S100 positive cells in necrobiosis lipoidica and granuloma annulare.

Using an antibody to S100 protein, the number of dendritic cells above the basal layer in the epidermis was assessed in necrobiosis lipoidica and granuloma annulare. A statistically significantly higher number of these cells was found within the epidermis in necrobiosis lipoidica compared with granuloma annulare and normal skin. The numbers were similar to those seen in sarcoidosis and tuberculous reactions in the skin, which raises the possibility of an immune pathogenesis for necrobiosis lipoidica.

Cell Count↗
PubMed1987

Necrobiosis lipoidica: ultrastructural and biochemical demonstration of a collagen defect.

Ten patients with necrobiosis lipoidica lesions were studied. Five patients had diabetes mellitus. The age of the patients varied from 15 to 73 years and the duration of the skin lesions was from 2 to 20 years. Histologically, the lesions were characterized by degeneration of collagen and elastin. In some lesions elastin fibers could be seen in areas devoid of normal-looking collagen. Electron microscopy revealed loss of cross-striation of collagen fibrils and a marked variation in the diameter of individual collagen fibrils. The concentration of collagen, measured by assay of hydroxy-proline, a collagen-specific amino acid, was markedly decreased in the lesional skin, but the ratio of type I/III collagen was unchanged in the affected skin. Fibroblasts established from affected skin synthesized less collagen than cells derived from healthy-looking skin. The decreased collagen synthesis was due to a decreased amount of messenger RNA for type I procollagen, measured by hybridization with a specific human cDNA clone. The production of collagenase by these fibroblasts was not increased. Our results thus indicate that in necrobiosis lipoidica lesions, collagen fibrils are defective and the amount of collagen is reduced, probably due to decreased synthesis of collagen by affected fibroblasts.

Adolescent↗
PubMed2002

Treatment of necrobiosis lipoidica with topical psoralen plus ultraviolet A.

BACKGROUND: Necrobiosis lipoidica (NL) is a rare skin disease, mostly seen on the legs and often occurring in patients with diabetes mellitus. The disease belongs to the idiopathic cutaneous palisading granulomatous dermatitides associated with a degeneration of collagen, thus leading to skin atrophy. Application of topical corticosteroids is the most widely used treatment but the results are not always satisfactory and may worsen skin atrophy. Preliminary studies in patients with NL have shown a clinical response with psoralen plus ultraviolet (UV) A (PUVA). Objectives To study the effect of topical PUVA on NL in a multicentre prospective study. METHODS: Thirty patients (27 women and three men) including 13 with insulin-dependent diabetes mellitus, with a diagnosis of NL proven by histopathology, were included. All patients had been unsuccessfully treated with topical and/or intralesional corticosteroids. Patients were treated twice weekly with an aqueous gel containing 0.005% psoralen followed by irradiation with UVA. Clinical photographs were taken for evaluation. In addition, 20-MHz high-frequency ultrasound analysis was performed in 10 patients to evaluate the thickness and density of the dermis during topical PUVA therapy. RESULTS: Five patients (17%) showed complete clearing (healing of ulceration and disappearance of erythema) after a mean of 22 exposures (range 15-30). Eleven patients (37%) showed improvement, defined as healing of ulceration and/or reduction of erythema, after a mean of 23 exposures (range 11-42). Ten patients (33%) showed no effect and four patients (13%) worsened during topical PUVA therapy. The treatment results of the patients who suffered from diabetes mellitus were not different from those who did not have diabetes mellitus. No difference was seen in mean dermal thickness (1666 vs. 1706 micro m) and density (17 vs. 16 units) before and after topical PUVA therapy. Side-effects were seen in 10 patients: hyperpigmentation (n = 4), blistering (n = 4) and bacterial infection (n = 2). CONCLUSIONS: Topical PUVA may be a useful treatment modality for NL in patients not responding to topical or intralesional corticosteroids.

Adolescent↗
PubMed2003

Ulcerated necrobiosis lipoidica: a combined treatment approach with dermatosurgery and PUVA.

Ulcerated necrobiosis lipoidica is one of the differential diagnoses in leg ulcers. The diagnosis is confirmed by histopathology. The authors report on a 68-year-old female patient with a history of chronic venous insufficiency who developed a chronic leg ulcer that did not respond to good ulcer care and compression bandaging. Skin biopsies revealed necrobiosis lipoidica. The patient was recently discovered to have diabetes mellitus that was treated orally by ascarose. Phlebosurgery and mesh grafting were performed, and the patient was given pentoxyfiline, dapsone, and clofazimine, but none of these treatments was successful. Therefore, topical PUVA therapy was introduced that resulted in partial remission and stabilizing of the residual pathology. Based on these experiences, the use of surgical methods alone is questionable.

Journal Article↗
PubMed2001

Squamous cell carcinoma developing in necrobiosis lipoidica.

We describe a case of squamous cell carcinoma arising in long-standing necrobiosis lipoidica in a type 1 female diabetic patient. The tumour and the skin lesion were successfully excised and repaired with full thickness skin graft. The development of squamous cell carcinoma in association with this skin disorder is rare (only four cases reported in literature since 1966), but should be considered in chronic, non-healing and recalcitrant ulcers developing within areas of necrobiosis lipoidica.

Adult↗
PubMed1993

Ulcerating necrobiosis lipoidica effectively treated with pentoxifylline.

A 30-year-old man had suffered from persistent ulceration within an area of necrobiosis lipoidica diabeticorum for 13 months. The ulcerating necrobiosis lipoidica was resistant to topical therapy and oral therapy with acetylsalicylic acid. However, the ulcers healed completely within 8 weeks of administration of 400 mg pentoxifylline twice daily.

Administration, Oral↗
PubMed1979

[Peripheral blood flow in patients with necrobiosis lipoidica (diabeticorum)].

For the judgment of the peripheral blood supply 16 insulin-dependent diabetics with necrobiosis lipoidica at the lower extremities were compared with 15 insulin-dependent diabetics without necrobiosis lipoidica. The vascular changes in form of retinopathy, nephropathy, neuropathy, hypertension, the results of the radiologically provable vascular changes, oscillograms and impedance plethysmograms as well as the results of the muscle and skin clearance and angioscintigraphy were evaluated. The at last mentioned methods give an insight into the microangiopathy. The apparantly contradicting findings of the muscle clearance (smaller blood supply) and of the skin clearance (increased blood flow) find their explanation by the angioscintigraphically proved different regional parameters of blood flow in the necrobiotic regions. The angiopathic findings are characterized by the enrichment of activity in the marginal seam as a sign of hyperemia and decreased accumulation in the centre as an expression of necrobiosis. The changes of the connective tissue and their causes of development are discussed. Angiopathic and traumatic influences conditioned by metabolism, apart from local peculiarities are taken into consideration.

Adolescent↗