Necrobiosis lipoidica: Clinical and Immunofluorescent Study

Abstract

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.

A Case of Necrobiosis Lipoidica Treated with Systemic Corticosteroid

“…Since Dahl et al (4,5) found the deposition of immunoreactants in vessel walls in involved skin and suggested the possible significance of immunoreactants in the pathogenesis of this disease, there have been controversies about the association of immune-complex with the pathogenesis of NL. Laukkanen et al (6) reported 14 cases of NL with no deposition of immunoglobulins in the lesional skin. They insisted that preceding trauma combined with metabolic and inflammatory changes could be an important triggering factor in the etiology of NL.…”