Treatment of recalcitrant disseminated ulcerative necrobiosis lipoidica with ustekinumab

McMullan, Patrick; Khan, Aziz; Aðalsteinsson, Jónas A.; Waldman, Reid A.; Stewart, Campbell L.; Sloan, Brett; Rothe, Marti Jill

doi:10.1016/j.jdcr.2023.06.040

Cited by 2 publications

(2 citation statements)

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“…Even though the exact mechanism of action in NL is unclear, doxycycline seems to have anti-inflammatory properties and inhibit matrix metalloproteinases (MMPs), which play a role in tissue inflammation [41]. Other treatments, including biologic agents [21][22][23][24][25][26][27][28][29][42][43][44][45][46][47][48][49], Janus Kinase (JAK) inhibitors [50][51][52], and skin grafting [53,54], have shown improvement in individual cases but lack comprehensive data. Specifically, the use of TNF-α inhibitors, including infliximab, etanercept, and adalimumab, is increasingly recognized, with case reports and case series confirming their therapeutical efficacy, especially in ulcerative lesions [21,22,[24][25][26][27][28][29]43,48,49].…”

Section: Discussionmentioning

confidence: 99%

“…Both IL-12 and IL-23 play roles in the formation and persistence of granulomas in infectious and non-infectious conditions. However, the use of ustekinumab for NL is currently limited to small case reports and case series [44][45][46][47]. Regarding the newest JAK inhibitors, Damsky et al conducted an immunohistochemical analysis revealing increased staining for phosphorylated (p)-STAT1 and (p)-STAT3 in NL lesions, suggesting constitutive activation of JAK/STAT signaling in the disease, providing a potential mechanistic basis for JAK inhibitor use.…”

Section: Discussionmentioning

confidence: 99%

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Shedding Light on Photodynamic Therapy in the Treatment of Necrobiosis Lipoidica: A Multicenter Real-Life Experience

Li Pomi,

Motolese,

Paganelli

et al. 2024

IJMS

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Necrobiosis Lipoidica (NL) is a dermatological condition characterized by the development of granulomatous inflammation leading to the degeneration of collagen and subsequent formation of yellowish-brown telangiectatic plaques usually localized on the pretibial skin of middle-aged females. Due to its rarity and unclear etiopathogenesis, therapeutic options for NL are not well-standardized. Among them, photodynamic therapy (PDT) is an emerging tool, although its efficacy has primarily been evaluated in single case reports or small case series. This study reports the real-life experience of a cohort of NL patients treated with PDT at the Section of Dermatology of the University Hospital of Messina and Reggio-Emilia. From 2013 to 2023, 17 patients were enrolled —5 males (29%) and 12 females (71%) aged between 16 and 56 years (mean age: 42 ± 13 years), with a median duration of NL of 8 years. The overall complete clearance (>75% lesion reduction) was 29%, while the partial clearance (25–75% lesion reduction) was 59%, with 12% being non-responders. This study adds to the little amount of evidence present in the literature regarding the effectiveness of PDT in the treatment of NL. Variability in treatment responses among patients underscores the need for personalized protocols, optimizing photosensitizers, light sources, and dosimetry. The standardization of treatment protocols and consensus guidelines are essential to ensure reproducibility and comparability across studies.

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