Healing of Chronic Necrobiosis Lipoidica Lesions in a Type 1 Diabetic Patient After Pancreas-kidney Transplantation: a Case Report

Overview

Journal J Endocrinol Invest

Publisher Springer

Specialty Endocrinology

Date 2007 May 17

PMID 17505163

Citations 2

Authors

D Gullo

A Latina

L Tomaselli

M L Arpi

S Squatrito

S Curatolo

S La Greca

R Vigneri

Affiliations

Soon will be listed here.

Abstract

Necrobiosis lipoidica (NL) is a degenerative disease of dermal connective tissue of unknown etiology characterized by erythematous plaques preferentially localized to distal extremities. Skin lesions show a chronic relapsing nature. NL is often associated with diabetes mellitus and satisfactory treatment options are lacking. We describe the spontaneous healing of NL lesions after pancreas and kidney transplantation in a Type 1 diabetic patient with chronic NL recalcitrant to a variety of standard treatments. The 31-yr-old male patient had experienced NL lesions for more than 15 yr; despite various systemic and topical treatments, the skin lesions had pregressively enlarged. Because of end-stage renal disease, a simultaneous pancreas and kidney transplantation was performed and immunosuppressive therapy with tacrolimus (TAC), mycophenolate mofetil (MMF), and prednisone was started. Pancreatic transplantation maintained satisfactory metabolic control with no need of exogenous insulin. After transplantation, skin lesions slowly healed without any specific treatment, leaving residual areas of fibrotic scars. A skin biopsy confirmed the absence of typical NL lymphocytic and histiocytic inflammatory response. Clinical remission of NL lesions may probably be explained by the concomitant effect of multiple-drug regimen for immunosuppression (TAC, MMF, and prednisone) and improved skin microcirculation secondary to the good metabolic control provided by pancreas transplantation.

Citing Articles

Treatment Modalities of Necrobiosis Lipoidica: A Concise Systematic Review.

Feily A, Mehraban S Dermatol Reports. 2015; 7(2):5749.

PMID: 26236446 PMC: 4500868. DOI: 10.4081/dr.2015.5749.

[Topical tacrolimus in necrobiosis lipoidica].

Barth D, Harth W, Treudler R, Simon J Hautarzt. 2010; 62(6):459-62.

PMID: 20953573 DOI: 10.1007/s00105-010-2058-9.

References

Taniguchi Y, Sakamoto T, Shimizu M . A case of necrobiosis lipoidica treated with systemic corticosteroid. J Dermatol. 1993; 20(5):304-7. DOI: 10.1111/j.1346-8138.1993.tb01396.x. View

Noz K, Korstanje M, Vermeer B . Ulcerating necrobiosis lipoidica effectively treated with pentoxifylline. Clin Exp Dermatol. 1993; 18(1):78-9. DOI: 10.1111/j.1365-2230.1993.tb00977.x. View

Ryan E, Lakey J, Rajotte R, Korbutt G, Kin T, Imes S . Clinical outcomes and insulin secretion after islet transplantation with the Edmonton protocol. Diabetes. 2001; 50(4):710-9. DOI: 10.2337/diabetes.50.4.710. View

Cohen O, Yaniv R, Karasik A, Trau H . Necrobiosis lipoidica and diabetic control revisited. Med Hypotheses. 1996; 46(4):348-50. DOI: 10.1016/s0306-9877(96)90184-x. View

Clayton T, Harrison P . Successful treatment of chronic ulcerated necrobiosis lipoidica with 0.1% topical tacrolimus ointment. Br J Dermatol. 2005; 152(3):581-2. DOI: 10.1111/j.1365-2133.2005.06388.x. View

Fiorina P, Folli F, Bertuzzi F, Maffi P, Finzi G, Venturini M . Long-term beneficial effect of islet transplantation on diabetic macro-/microangiopathy in type 1 diabetic kidney-transplanted patients. Diabetes Care. 2003; 26(4):1129-36. DOI: 10.2337/diacare.26.4.1129. View

Ngo B, Hayes K, DiMiao D, Srinivasan S, Huerter C, Rendell M . Manifestations of cutaneous diabetic microangiopathy. Am J Clin Dermatol. 2005; 6(4):225-37. DOI: 10.2165/00128071-200506040-00003. View

Harth W, Linse R . Topical tacrolimus in granuloma annulare and necrobiosis lipoidica. Br J Dermatol. 2004; 150(4):792-4. DOI: 10.1111/j.0007-0963.2004.05899.x. View

Petzelbauer P, Wolff K, Tappeiner G . Necrobiosis lipoidica: treatment with systemic corticosteroids. Br J Dermatol. 1992; 126(6):542-5. DOI: 10.1111/j.1365-2133.1992.tb00097.x. View

10.

Reinhard G, Lohmann F, Uerlich M, Bauer R, Bieber T . Successful treatment of ulcerated necrobiosis lipoidica with mycophenolate mofetil. Acta Derm Venereol. 2000; 80(4):312-3. DOI: 10.1080/000155500750012315. View

11.

Ullman S, Dahl M . Necrobiosis lipoidica. An immunofluorescence study. Arch Dermatol. 1977; 113(12):1671-3. View

12.

Imtiaz K, Khaleeli A . Squamous cell carcinoma developing in necrobiosis lipoidica. Diabet Med. 2001; 18(4):325-8. DOI: 10.1046/j.1464-5491.2001.00452.x. View

13.

Hocqueloux L, Gautier J, Lebbe C, Jellal M, Vexiau P, Morel P . [Ulcerated necrobiosis lipoidica associated with insulin-dependent diabetes mellitus. Beneficial effect of corticosteroid therapy by oral administration]. Presse Med. 1996; 25(1):25-7. View

14.

Gillard P, Ling Z, Lannoo M, Maes B, Maleux G, Pipeleers D . Beta-cell transplantation restores metabolic control and quality of life in a patient with subcutaneous insulin resistance. Diabetes Care. 2004; 27(9):2243-4. DOI: 10.2337/diacare.27.9.2243. View

15.

Alegre V, Winkelmann R . A new histopathologic feature of necrobiosis lipoidica diabeticorum: lymphoid nodules. J Cutan Pathol. 1988; 15(2):75-7. DOI: 10.1111/j.1600-0560.1988.tb00523.x. View

16.

Kelly W, Nicholas J, Adams J, Mahmood R . Necrobiosis lipoidica diabeticorum: association with background retinopathy, smoking, and proteinuria. A case controlled study. Diabet Med. 1993; 10(8):725-8. DOI: 10.1111/j.1464-5491.1993.tb00155.x. View

17.

Stride A, Lambert P, Burden A, Mansell P, Page S, Hattersley A . Necrobiosis lipodica is a clinical feature of maturity-onset diabetes of the young. Diabetes Care. 2002; 25(7):1249-50. DOI: 10.2337/diacare.25.7.1249. View

18.

Sawada Y . Successful treatment of ulcerated necrobiosis: lipoidica diabeticorum with prostaglandin E1 and skin flap transfer--a case report. J Dermatol. 1985; 12(5):449-54. DOI: 10.1111/j.1346-8138.1985.tb02871.x. View

19.

Muller S, Winkelmann R . Necrobiosis lipoidica diabeticorum. A clinical and pathological investigation of 171 cases. Arch Dermatol. 1966; 93(3):272-81. DOI: 10.1001/archderm.93.3.272. View

20.

Eberl N, Piehlmeier W, Dachauer S, Konig A, Land W, Landgraf R . Blood flow in the skin of type 1 diabetic patients before and after combined pancreas/kidney transplantation. Diabetes Metab Res Rev. 2005; 21(6):525-32. DOI: 10.1002/dmrr.555. View