Ulcerative Necrobiosis Lipoidica: Is There a Place for Anti-TNFα Treatment?

Guedes, Rita; Leite, Inês; Baptista, Armando; Rocha, Nelson Studart

doi:10.1155/2012/854738

Cited by 11 publications

(7 citation statements)

References 5 publications

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“…The main reason is the low number of cases, especially of ulcerating necrobiosis lipoidica, and the remarkable number of side effects of most therapies that a lot of patients are not willing to tolerate, considering that -in many cases -just the non-ulcerated patches do not cause strain. Recorded treatment options are intralesional and topical steroids or tacrolimus (16), topical PUVA (17,18) or UVA1 (19,20), systemic steroids, doxycycline (21), antimalarial drugs (22), fumaric acid esters (FAEs) (23), pentoxifylline (24), cyclosporine A (25), biological agents (26,27) and surgery with excision followed by skin grafting (Tables 2 and 3). The foundation of any therapy of ulcerated necrobiosis lipoidica is good and regular wound care.…”

Section: Treatmentmentioning

confidence: 99%

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: Treatmentmentioning

confidence: 99%

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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“…12,13 We searched MEDLINE and Embase databases and identified several case reports supporting the use of TNF-α inhibitors for NL (Table 1). However, the majority of these reports use etanercept 16,17,20,23 or infliximab, 14,15,18,21,22,25 with the literature on use of adalimumab in NL being limited.…”

Section: Discussionmentioning

confidence: 99%

The role of anti-tumour necrosis factor in wound healing: A case report of refractory ulcerated necrobiosis lipoidica treated with adalimumab and review of the literature

Sandhu

Alavi

2019

SAGE Open Medical Case Reports

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Necrobiosis lipoidica is a chronic granulomatous disease historically associated with diabetes. Necrobiosis lipoidica commonly presents with erythematous papules or plaques on the anterior lower extremities, which can be ulcerated in up to 30% of patients. The pathophysiology of necrobiosis lipoidica is unknown but proposed to be predominantly linked to microangiopathy. No treatment option for necrobiosis lipoidica has shown consistent efficacy. Previous case reports have shown immune-modulating agents to be reasonable treatment options for ulcerative necrobiosis lipoidica. However, evidence for the tumour necrosis factor-alpha inhibitor, adalimumab, is limited and contradictory. We report a case of a 74-year-old type 2 diabetic female with a 2-year history of multiple ulcerated necrobiosis lipoidica plaques resistant to topical and systemic therapy. Treatment with adalimumab showed complete re-epithelization of all ulcers by week 28. Adalimumab may be an effective treatment option for ulcerated necrobiosis lipoidica that has failed traditional therapies. Further reports of adalimumab treatment of necrobiosis lipoidica and other chronic inflammatory wounds are needed.

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“…Für andere Systemtherapien wie Rheologika, Dapson oder Antimalaria-Mittel, die für andere entzündliche Dermatosen erfolgreich eingesetzt werden, existieren nur einzelne Fallberichte [23]. Diese schwache Datenlage gilt auch für die Anwendung von Biologika, wenn auch für anti-TNF-α Agentien wie Infliximab oder Etanercept eindrucksvolle Einzel-Erfolge gerade bei therapieresistenten Fällen mit Ulzeration in der Literatur zu finden sind [31,32] Auch wenn derzeit keine spezifischen Therapierichtlinien existieren und placebokontrollierte randomisierte Studien aufgrund der Seltenheit der Erkrankung fehlen, so gibt es einige therapeutische Ansätze zur Therapie der NL. Die Anwendung von topischen Glukokortikoiden, Kompressionstherapie, Calcineurin-Inhibitoren und Phototherapie gelten als etablierte und wirkungsvolle Optionen in der lokalen Behandlung der NL.…”

Section: Therapieoptionenunclassified

Necrobiosis lipoidica – Klinische Charakteristika und therapeutische Ansätze

Erfurt‐Berge

Schliep

2019

Akt Dermatol

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ZusammenfassungDie Necrobiosis lipoidica ist eine seltene granulomatöse Dermatose, die sich vornehmlich an den Streckseiten der unteren Extremitäten mit gelblich-bräunlichen Plaques manifestiert. Ulzerationen können den Verlauf erschweren. Klare Therapieempfehlungen fehlen, da aufgrund der geringen Patientenzahlen keine großen randomisierten Studien vorliegen. Neben dem Einsatz von Glukokortikoiden scheinen Fumarsäureester und Biologika therapeutisch vielversprechend.

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Ulcerative Necrobiosis Lipoidica: Is There a Place for Anti-TNFα Treatment?

Cited by 11 publications

References 5 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 role of anti-tumour necrosis factor in wound healing: A case report of refractory ulcerated necrobiosis lipoidica treated with adalimumab and review of the literature

Necrobiosis lipoidica – Klinische Charakteristika und therapeutische Ansätze

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