Skin blood flow in necrobiosis lipoidica diabeticorum*

Ngo, Binh; Wigington, Greg; Hayes, Kristie; Huerter, Christopher J.; Hillman, Brandon G.; Adler, Matt; Rendell, Marc

doi:10.1111/j.1365-4632.2008.03549.x

Cited by 43 publications

(33 citation statements)

References 35 publications

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“…Without dispute there is a strong correlation for necrobiosis lipoidica particularly with diabetes mellitus. A study using Doppler flowmetry showed that necrobiosis lipoidica is improbable to be due to microvascular ischaemia, but rather can be caused by inflammation (42). This suggests that ulcerating necrobiosis lipoidica can be seen as part of a generalised inflammatory reaction due to a systemic metabolic syndrome.…”

Section: Necrobiosis Lipoidica -A Systemic Inflammatory Disease?mentioning

confidence: 97%

Ulcerated necrobiosis lipoidica as a rare cause for chronic leg ulcers: case report series of ten patients

Franklin

Stoffels-Weindorf

Hillen

et al. 2013

International Wound Journal

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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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Section: Necrobiosis Lipoidica -A Systemic Inflammatory Disease?mentioning

confidence: 97%

Ulcerated necrobiosis lipoidica as a rare cause for chronic leg ulcers: case report series of ten patients

Franklin

Stoffels-Weindorf

Hillen

et al. 2013

International Wound Journal

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“…Duration of the heating to obtain maximum vasodilation: in five studies the skin was heated for less than 20 min [42, 44–47], while in eight studies heating was applied for 20 min or more [43, 48–54]. There were three locations of measurements: eight studies measured on the forearm [42, 43, 46–48, 52–54], three on the pretibial surface of the leg [49–51], and two on the quadriceps muscle [44, 45]. …”

Section: Resultsmentioning

confidence: 99%

The association between diabetes and dermal microvascular dysfunction non-invasively assessed by laser Doppler with local thermal hyperemia: a systematic review with meta-analysis

Fuchs

Dupon

Schaap

et al. 2017

Cardiovasc Diabetol

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Background/IntroductionDiabetes and cardiovascular disease develop in concert with metabolic abnormalities mirroring and causing changes in the vasculature, particularly the microcirculation. The microcirculation can be affected in different parts of the body of which the skin is the most easily accessible tissue.PurposeThe association between diabetes and dermal microvascular dysfunction has been investigated in observational studies. However, the strength of the association is unknown. Therefore we conducted a systematic review with meta-analysis on the association between diabetes and dermal microvascular dysfunction as assessed by laser Doppler/laser speckle contrast imaging with local thermal hyperaemia as non-invasive indicator of microvascular functionality.Methods PubMed and Ovid were systematically searched for eligible studies through March 2015. During the first selection, studies were included if they were performed in humans and were related to diabetes or glucose metabolism disorders and to dermal microcirculation. During the second step we selected studies based on the measurement technique, measurement location (arm or leg) and the inclusion of a healthy control group. A random effects model was used with the standardised mean difference as outcome measure. Calculations and imputation of data were done according to the Cochrane Handbook.ResultsOf the 1445 studies found in the first search, thirteen cross-sectional studies were included in the meta-analysis, comprising a total of 857 subjects. Resting blood flow was similar between healthy control subjects and diabetes patients. In contrast, the microvascular response to local skin heating was reduced in diabetic patients compared to healthy control subjects [pooled effect of −0.78 standardised mean difference (95% CI −1.06, −0.51)]. This effect is considered large according to Cohen’s effect size definition. The variability in effect size was high (heterogeneity 69%, p < 0.0001). However, subgroup analysis revealed no difference between the type and duration of diabetes and other health related factors, indicating that diabetes per se causes the microvascular dysfunction.ConclusionOur meta-analysis shows that diabetes is associated with a large reduction of dermal microvascular function in diabetic patients. The local thermal hyperaemia methodology may become a valuable non-invasive tool for diagnosis and assessing progress of diabetes-related microvascular complications, but standardisation of the technique and quality of study conduct is urgently required.Electronic supplementary materialThe online version of this article (doi:10.1186/s12933-016-0487-1) contains supplementary material, which is available to authorized users.

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“…Investigators think an inflammatory process is more influential in the pathogenesis than small vessel occlusions. 12 Collagen Collagen abnormalities are seen at the level of the collagen fibrils. Absent cross striations are the most prominent finding, with some cases even showing a complete loss of collagen and elastin.…”

Section: Blood Vesselsmentioning

confidence: 98%

Necrobiosis Lipoidica

Sibbald¹,

Reid²,

Alavi³

2015

Dermatologic Clinics

110

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Necrobiosis lipoidica is a granulomatous condition presenting as indolent atrophic plaques, often on the lower extremities. There is a multitude of case reports suggesting possible associations and documenting different therapeutic alternatives with varied success. Important complications include ulceration and the development of squamous cell carcinoma. The disease course is often indolent and recurrent despite treatment. This article reviews the etiopathogenesis, clinical presentations, and evidence for treatment alternatives of this condition.

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Skin blood flow in necrobiosis lipoidica diabeticorum*

Abstract: Our findings refute the hypothesis that NLD is a manifestation of microvascular ischemic disease of the skin. The increased blood flow seen in NLD lesions suggests an ongoing inflammatory process.

Cited by 43 publications

References 35 publications

Ulcerated necrobiosis lipoidica as a rare cause for chronic leg ulcers: case report series of ten patients

Ulcerated necrobiosis lipoidica as a rare cause for chronic leg ulcers: case report series of ten patients

The association between diabetes and dermal microvascular dysfunction non-invasively assessed by laser Doppler with local thermal hyperemia: a systematic review with meta-analysis

Necrobiosis Lipoidica

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