Necrobiosis lipoidica. An immunofluorescence study

Abstract

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.

Necrobiosis lipoidica: Clinical and Immunofluorescent Study

“…Seven patients had ulcers on The results of this study with negative findings of immunoglobulins in affected skin areas of NL and positive findings in only 4 of 12 patients at the histamine injection sites suggest that immune complexes may be im portant only in some of the patients suffering from NL. These results differ from those re ported by Ullman and Dahl [4], who found immunoglobulins in the affected skin areas of NL. We injected histamine in healthy skin of patients' legs to provoke circulating im mune-complex precipitation in dermal ves sel walls.…”

Necrobiosis-Lipoidica-Like Skin Manifestation in Lymphomatoid Granulomatosis (Liebow)

“…Even if the previous diagnosis of necrobiosis lipoidica was correct and some clinical resemblance was seen between the previous and the present skin lesions, the latter should be diagnosed as LYG from the histo logical findings including the presence of angiodestructive feature and cellular atypism. However in the present case, definite differentiation of LYG from necrobiosis lipoidica is quite difficult be cause partial or complete vascular occlusion associated with the deposition of Ig and C often occurs in necrobiosis lipoidica [29]. One possibility is that the cutaneous inva sion of LYG followed onto the preexisting necrobiosis lipoidica, although no good evi dence was obtained to confirm this.…”

The Lupus Band Test: A Review of the Sensitivity and Specificity in the Diagnosis of Lupus Erythematosus

“…The frequency of IgM deposition in isolation or in combination with other immunoglobulins or complement was 82.7%. Deposits of IgM alone were identified at the basement membrane in one case with a positive LBT, however the reciprocal histological and clinical reviews reported a diagnosis of necrobiosis lipoidica, which has been previously reported 21 . IgM deposition at the basement membrane can also be found in actinic keratoses, dermatomyositis and polymorphous light eruption as a result of UV exposure 10,22,23 .…”

“…Deposits of IgM alone were identified at the basement membrane in one case with a positive LBT, however the reciprocal histological and clinical reviews reported a diagnosis of necrobiosis lipoidica, which has been previously reported. 21 IgM deposition at the basement membrane can also be found in actinic keratoses, dermatomyositis and polymorphous light eruption as a result of UV exposure. 10 , 22 , 23 For sun‐protected skin, an interrupted band of IgM deposits at the basement membrane of sun of at least moderate intensity is now accepted as a positive LBT.…”