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Joachim Dissemond - One of the best experts on this subject based on the ideXlab platform.
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ulcerated Necrobiosis lipoidica as a rare cause for chronic leg ulcers case report series of ten patients
International Wound Journal, 2015Co-Authors: Cindy Franklin, M Stoffelsweindorf, Uwe Hillen, Joachim DissemondAbstract:: 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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Erfolgreiche Behandlung einer Patientin mit therapierefraktärer, exulzerierter Necrobiosis lipoidica non diabeticorum mit Adalimumab
Der Hautarzt, 2013Co-Authors: L. Leister, Arne Korber, Joachim DissemondAbstract:Necrobiosis lipoidica is a rare inflammatory granulomatous skin disease of unknown etiology which is associated with diabetes mellitus in about 60 % of the patients. In up to 30 % of these patients extremely painful and often hard-to-heal ulcerations occur in the course of the disease. We present a new therapeutic option using adalimumab to treat refractory ulcerated Necrobiosis lipoidica non diabeticorum. The clinical efficacy of adalimumab probably reflects an immunomodulatory effect through the specific TNF-α inhibition which is one central aspect of the underlying inflammation. Thus, adalimumab could represent promising new treatment option, especially for patients with otherwise therapy-refractory ulcerated Necrobiosis lipoidica. Die Necrobiosis lipoidica ist eine seltene, entzündliche granulomatöse Hauterkrankung unklarer Ätiologie, die bei mindestens 60 % der Patienten mit einem Diabetes mellitus assoziiert ist und bei bis zu 30 % der Patienten im Verlauf der Erkrankung zu äußerst schmerzhaften und oft therapierefraktären Ulzerationen führen kann. Wir möchten anhand eines Fallberichtes eine neue Therapieoption mit Adalimumab bei einem therapierefraktären Verlauf einer exulzerierenden Necrobiosis lipoidica non diabeticorum vorstellen. Die klinische Wirksamkeit von Adalimumab kann über die immunmodulatorische Wirkung durch die spezifische Hemmung des für die Vermittlung der Inflammation verantwortlichen TNF-α gesehen werden. Somit könnte Adalimumab zukünftig insbesondere für Patienten mit ansonsten therapierefraktären Verläufen der exulzerierten Necrobiosis lipoidica eine hoffnungsvolle neue Behandlungsoption darstellen.
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erfolgreiche behandlung einer patientin mit therapierefraktarer exulzerierter Necrobiosis lipoidica non diabeticorum mit adalimumab
Hautarzt, 2013Co-Authors: L. Leister, Arne Korber, Joachim DissemondAbstract:Die Necrobiosis lipoidica ist eine seltene, entzundliche granulomatose Hauterkrankung unklarer Atiologie, die bei mindestens 60 % der Patienten mit einem Diabetes mellitus assoziiert ist und bei bis zu 30 % der Patienten im Verlauf der Erkrankung zu auserst schmerzhaften und oft therapierefraktaren Ulzerationen fuhren kann. Wir mochten anhand eines Fallberichtes eine neue Therapieoption mit Adalimumab bei einem therapierefraktaren Verlauf einer exulzerierenden Necrobiosis lipoidica non diabeticorum vorstellen. Die klinische Wirksamkeit von Adalimumab kann uber die immunmodulatorische Wirkung durch die spezifische Hemmung des fur die Vermittlung der Inflammation verantwortlichen TNF-α gesehen werden. Somit konnte Adalimumab zukunftig insbesondere fur Patienten mit ansonsten therapierefraktaren Verlaufen der exulzerierten Necrobiosis lipoidica eine hoffnungsvolle neue Behandlungsoption darstellen.
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Erfolgreiche Therapie einer exulzerierten Necrobiosis lipoidica non diabeticorum mit Ciclosporin
Der Hautarzt, 2007Co-Authors: E. Aslan, Arne Korber, Stephan Grabbe, Joachim DissemondAbstract:Die Necrobiosis lipoidica ist eine entzündliche granulomatöse Hauterkrankung unklarer Ätiologie, die bei etwa 60% der Patienten mit einem Diabetes mellitus assoziiert ist. Bei 15–35% der betroffenen Patienten kommt es im Krankheitsverlauf – meist nach Minimaltrauma – zum Auftreten von Ulzerationen, die sich äußerst therapierefraktär und schmerzhaft zeigen können. Aufgrund des bislang ungeklärten Pathomechanismus sind die therapeutischen Optionen limitiert. Wir berichten über eine 68-jährige Patientin mit einer seit 18 Jahren bestehenden, therapierefraktären, exulzerierten Necrobiosis lipoidica non diabeticorum beider Unterschenkel, die erfolgreich mit der systemischen Gabe von Ciclosporin therapiert werden konnte. Anhand dieses Fallberichtes wird die Rolle von Ciclosporin bei Patienten mit Necrobiosis lipoidica im Zusammenhang mit der Pathogenese der Erkrankung diskutiert. Necrobiosis lipoidica is an inflammatory granulomatous skin disease of unknown etiology which is associated with diabetes mellitus in about 60% of the patients. In 15–35% of the affected patients painful ulcerations may occur after minimal trauma which can be extremely refractory to therapy. Because of the unknown pathomechanisms, current therapeutic options are limited. We report on a 68-year-old patient with an 18 year history of ulcerated Necrobiosis lipoidica non diabeticorum of both lower limbs, which responded to systemic cyclosporine A. Based on this case, we discuss the role of cyclosporine A in patients with Necrobiosis lipoidica in the context of the disease etiology.
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erfolgreiche therapie einer exulzerierten Necrobiosis lipoidica non diabeticorum mit ciclosporin
Hautarzt, 2007Co-Authors: E. Aslan, Arne Korber, Stephan Grabbe, Joachim DissemondAbstract:Die Necrobiosis lipoidica ist eine entzundliche granulomatose Hauterkrankung unklarer Atiologie, die bei etwa 60% der Patienten mit einem Diabetes mellitus assoziiert ist. Bei 15–35% der betroffenen Patienten kommt es im Krankheitsverlauf – meist nach Minimaltrauma – zum Auftreten von Ulzerationen, die sich auserst therapierefraktar und schmerzhaft zeigen konnen. Aufgrund des bislang ungeklarten Pathomechanismus sind die therapeutischen Optionen limitiert. Wir berichten uber eine 68-jahrige Patientin mit einer seit 18 Jahren bestehenden, therapierefraktaren, exulzerierten Necrobiosis lipoidica non diabeticorum beider Unterschenkel, die erfolgreich mit der systemischen Gabe von Ciclosporin therapiert werden konnte. Anhand dieses Fallberichtes wird die Rolle von Ciclosporin bei Patienten mit Necrobiosis lipoidica im Zusammenhang mit der Pathogenese der Erkrankung diskutiert.
G Tappeiner - One of the best experts on this subject based on the ideXlab platform.
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Necrobiosis lipoidica treatment with systemic corticosteroids
British Journal of Dermatology, 2008Co-Authors: Peter Petzelbauer, Klaus Wolff, G TappeinerAbstract:Summary In an attempt to find an effective therapy for Necrobiosis lipoidica, we have treated six patients with this disease with a 5-week course of systemic corticosteroids. This treatment resulted in complete cessation of disease activity in all patients and no recurrence in a mean follow-up period of 7 months; however, restitution of atrophic skin lesions could not be achieved. The therapy was well tolerated and did not pose problems, even in diabetic patients. These results strongly suggest that short-course therapy of Necrobiosis lipoidica with corticosteroids is of lasting benefit to these patients and should probably be considered early in the course of their skin disease.
Peter Petzelbauer - One of the best experts on this subject based on the ideXlab platform.
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Necrobiosis lipoidica treatment with systemic corticosteroids
British Journal of Dermatology, 2008Co-Authors: Peter Petzelbauer, Klaus Wolff, G TappeinerAbstract:Summary In an attempt to find an effective therapy for Necrobiosis lipoidica, we have treated six patients with this disease with a 5-week course of systemic corticosteroids. This treatment resulted in complete cessation of disease activity in all patients and no recurrence in a mean follow-up period of 7 months; however, restitution of atrophic skin lesions could not be achieved. The therapy was well tolerated and did not pose problems, even in diabetic patients. These results strongly suggest that short-course therapy of Necrobiosis lipoidica with corticosteroids is of lasting benefit to these patients and should probably be considered early in the course of their skin disease.
Reinhard W Holl - One of the best experts on this subject based on the ideXlab platform.
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risk factors for Necrobiosis lipoidica in type 1 diabetes mellitus
Diabetic Medicine, 2017Co-Authors: E Hammer, E Lilienthal, Sabine E Hofer, S Schulz, Esther Bollow, Reinhard W HollAbstract:AIMS: To compare the clinical and metabolic characteristics of patients with Type 1 diabetes and Necrobiosis lipoidica with those of patients with Type 1 diabetes who do not have Necrobiosis lipoidica. A multicentre analysis was performed. METHODS: Clinical and laboratory data were obtained from 64 133 patients (aged 0-25 years) with Type 1 diabetes with and without Necrobiosis lipoidica who were registered in the German/Austrian Diabetes Prospective Documentation Initiative registry. Data were analysed using multivariable regression modelling. Age, diabetes duration, treatment year and sex were considered as confounding factors. RESULTS: Results adjusted for demographic variables are presented. In patients with Necrobiosis lipoidica, metabolic control was worse (HbA1c 72 vs. 67 mmol/mol, 8.7% vs. 8.3%; P = 0.0065) and the duration of diabetes was longer [6.24 (3.28-9.97) vs. 5.11 (2.08-8.83) years; P = 0.014; not adjusted]. Patients with Necrobiosis lipoidica required higher insulin doses than those without (1.02 vs. 0.92 U/kg/day; P < 0.0001). There was no significant difference in the frequency of microvascular complications (microalbuminuria and retinopathy) between the groups. Furthermore, 24.8% and 17.5% of patients with Type 1 diabetes with and without Necrobiosis lipoidica, respectively, had elevated thyroid antibodies (P = 0.051). Necrobiosis lipoidica was correlated with coeliac disease in patients with Type 1 diabetes (3.4% vs. 1.0%; P = 0.0035). CONCLUSIONS: Our data indicate a strong correlation between hyperglycaemia and the development of Necrobiosis lipoidica. We postulate that the underlying pathogenic processes differ from those leading to microalbuminuria and retinopathy, and additional immunological mechanisms may play a role.
A A Khaleeli - One of the best experts on this subject based on the ideXlab platform.
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squamous cell carcinoma developing in Necrobiosis lipoidica
Diabetic Medicine, 2001Co-Authors: K E Imtiaz, A A KhaleeliAbstract: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.
