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Ulceration in an area of necrobiosis lipoidica diabeticorum is a frequent complication but malignant transformation is rare. One such case is reported in a diabetic patient and the literature is reviewed.
A 58-year-old diabetic woman with necrobiosis lipoidica diabeticorum demonstrated lesions with raised, prominent borders. These areas were found on biopsy to have transepidermal elimination of elastic fibers. We present this case as a unique finding and review the characteristics and possible mechanisms of transepidermal elimination.
A case of necrobiosis lipoidica in a patient with idiopathic hemochromatosis and diabetes mellitus is presented. Histologic examination revealed excessive amounts of iron pigment in macrophages in the corium of the necrobiotic skin. There were no iron deposits in the normal skin.
Fourteen patients with a clinical and histological diagnosis of necrobiosis lipoidica were treated in a double-blind control study with either an aspirin dipyridamole combination or a matching placebo for an 8-week period. None of the patients in the aspirin dipyridamole group showed a significant improvement.
Neutrophils and monocytes from patients with necrobiosis lipoidica (NL) and granuloma annulare (GA) were studied in vitro in order to detect functional abnormality. Phagocytosis of latex particles and zymosan-induced release of beta-glucuronidase were similar in patients and controls. Plasma from these patients did not enhance or inhibit phagocytosis or enzyme release from normal cells. Our studies suggest that peripheral blood leucocyte function in patients with GA and NL is normal, but this does not exclude a functional abnormality in the lesions.
Skin blood flow was measured by the laser Doppler technique in lesional and clinically normal skin of 10 diabetic patients with necrobiosis lipoidica during and after treatment with 40 mg acetylsalicylic acid (ASA) daily. The measurements showed that the blood flow during ASA treatment was significantly decreased in the central lesional skin without changes in the peripheral part of the lesions and normal skin. In view of these findings we suggest that low-dose ASA may not be the best treatment for necrobiosis lipoidica.
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Microangiopathy is an essential component in diabetic vascular pathology. We report ultrastructural observations of ballooning degeneration involving isolated endothelial cells of cutaneous capillaries, while leaving adjacent endothelial cells relatively intact in six diabetic patients with early lesions of necrobiosis lipoidica induced by trauma. Focal proliferation of endothelial cells encroaching upon the vascular lumina (obliterative endarteritis) was also observed. Lectin studies on biopsy specimens of older lesions of necrobiosis lipoidica revealed paucity of dermal blood vessels. These observations enable us to gain further insight into the pathophysiological mechanisms that underlie diabetic microvascular disease.
Necrobiosis lipoidica (NL) is a granulomatous disease that usually presents on the lower extremities of patients with diabetes mellitus. We present a rare case of NL köbnerizing in a surgical scar on the upper extremity of a patient with diabetes. NL is generally refractory to treatment.
We review the literature on the surgical treatment of necrobiosis lipoidica diabeticorum, and we describe 7 cases treated at Stanford University Medical Center. Experiences with them prompt us to recommend surgical excision of the lesions down to the deep fascia, ligation of the associated perforating blood vessels, and the use of split-skin grafts to cover the defects. There were no recurrences when we did all these things.
The neutrophil mobility in patients with granuloma annulare, necrobiosis lipoidica, and sarcoidosis was tested using both in vivo and in vitro techniques. Use of a skin window chamber for measurement of chemotaxis in vivo demonstrated defective neutrophil migration in each group. This contrasted with the finding that, in vitro, chemotaxis toward casein and endotoxin-activated sera was normal. The importance of this dissociation is discussed. Abnormal neutrophil accumulation at sites of inflammation may be of importance in the pathogenesis of these granulomatous disorders.
Direct immunofluorescence studies in granuloma annulare, necrobiosis lipoidica and granulomatosis disciformis Miescher are reported. In all 29 cases fibrillar deposits of fibrin in the necrobiotic areas have been found. Complement, mainly C3, was present in the region of the dermo-epidermal junction in 83% of the cases. Although the walls of the vessels in the superficial layers of the dermis showed a positive staining with antifibrinogen and complement, those around the necrobiotic areas were negative in most of the cases. The possible significance of these findings for the pathogenesis has been discussed.
A case of necrobiosis lipoidica diabeticorum (NLD) in a 12-year-old male patient is described. Diabetes mellitus (DM) was diagnosed at the age of 1.5 years. The onset of the first NLD lesion had been previously observed at the age of 7, on the back of the left foot. Three new lesions appeared at the age of 8, one on the left leg, the others on the thighs. At the age of 12, four infiltrated, reddish patches, with slight central atrophy were evident on his lower extremities. Histopathological features showed foci of collagen degeneration with sclerosis, surrounded by a chronic, mainly perivascular, granulomatous infiltrate, made up of lymphocytes and histiocytes. The patient is now 19-year old, with no eye or kidney failure, owing to a constant metabolic control of DM. A constant follow-up of the patient demonstrated a self-resolution of NLD plaques, with no evidence of further lesions.
A case of nine dermatofibromata, including a giant one, associated with necrobiosis lipoidica and diabetes mellitus type II is reported. This case is unusual because of the number and size of the tumors and their association with the above-mentioned pathologic conditions.
Rheologic parameters of the blood were examined in 17 patients with necrobiosis lipoidica before and over the course of trental (pentoxyphyllin) therapy. The study has revealed an unchanged hematocrit in the presence of significantly increased blood viscosity, red cell aggregation and stability of red cell aggregates. Another finding was a deterioration of the red cell deformability; red cell mechanical resistance was found liable to alter. Trental therapy has resulted in positive shifts in respect of the skin symptoms; a tendency to normalization of the examined blood rheologic parameters was observed in all the patients.
Necrobiosis lipoidica (NL) is a rare disorder that usually appears in the lower extremities and it is often related with diabetes mellitus (DM). There are few reported cases of NL in children. Transfollicular elimination of necrotic material has been described in adult patients with NL diabeticorum. Here we describe two new cases of NL in two girls with type I diabetes mellitus (DM). One of the cases is the first case, to our knowledge, of transfollicular elimination in a girl. The other case is the second case reported of lesions on the arms in a child with DM.
We have found a previously undescribed histopathologic feature of necrobiosis lipoidica diabeticorum among 310 biopsied cases: lymphoid nodules. This feature does not correlate with unique clinical lesions or forms of the disease. The lymphoid nodules are similar in appearance to those in other chronic dermal inflammations.
A 36-year-old healthy man with atypical necrobiosis lipoidica of the face is described. The lesions were annular with a raised erythematous palpable border. The centres were slightly depigmented and atrophic, without telangiectasia or hair loss. Histopathological changes revealed prominent giant cells in small groups without clear granuloma formation. They were located at all levels of the drmis between the collagen bundles.