tacrolimus and Necrobiosis-Lipoidica

To report a case of refractory ulcerated necrobiosis lipoidica (NL) with significant response to treatment with topical tacrolimus.. A 55-year-old woman without diabetes and with a previous history of NL presented to the Helen L. and Martin S. Kimmel Hyperbaric and Advanced Wound Healing Center of NYU Langone Medical Center, New York, with bilateral lower-leg ulcerations resistant to wound healing techniques at other institutions.. Repeat biopsy performed at the author's institution confirmed the diagnosis of NL. Initial therapy was based on reports of other successful treatment methods, which included collagen wound grafts and collagen-based dressings coupled with compression. These methods initially showed promising results; however, the wounds reulcerated, and any gains in wound healing were lost. Alternative options were initiated, including topical clobetasol and narrowband ultraviolet B; however, no significant improvement was observed. The patient's lower-extremity wounds began to deteriorate. The patient also refused systemic therapy. Treatment was changed to topical 0.1% tacrolimus ointment and was applied daily for 10 months with multilayer compression wraps.. Both lower-extremity ulcerations began to show significant improvement, with the ulcers progressing toward closure except for 1 very small area on the left lower extremity.. Topical tacrolimus seems to be an effective treatment option for patients with refractory chronic ulcerated NL who do not want systemic oral therapy. The authors found that successful wound closure may require a multimodal approach, which promotes wound healing, but also concurrently addresses the underlying disease process.

Topics: Administration, Topical; Biopsy, Needle; Chronic Disease; Compression Bandages; Female; Follow-Up Studies; Humans; Immunohistochemistry; Leg Ulcer; Long-Term Care; Middle Aged; Necrobiosis Lipoidica; Severity of Illness Index; Tacrolimus; Treatment Outcome; Wound Healing

Topics: Disease Progression; Face; Female; Humans; Middle Aged; Necrobiosis Lipoidica; Ointments; Skin; Tacrolimus

Topics: Adolescent; Diabetes Mellitus, Type 1; Humans; Male; Necrobiosis Lipoidica; Skin; Tacrolimus

Necrobiosis lipoidica presents with a distinctive appearance making it an important clinical diagnosis.. To describe a case of necrobiosis lipoidica in a patient with type 1 diabetes mellitus, and to discuss differential diagnoses and management.. Necrobiosis lipoidica is most commonly found on the shins, presenting as a well-defined plaque. Management is challenging and options are discussed. Avoiding ulceration is a key concern.

Topics: Adult; Diabetes Mellitus, Type 1; Diagnosis, Differential; Female; Humans; Immunosuppressive Agents; Leg Ulcer; Necrobiosis Lipoidica; Risk Factors; Tacrolimus

Topics: Adolescent; Diabetes Mellitus, Type 1; Diagnosis, Differential; Eye; Facial Dermatoses; Female; Giant Cells; Granuloma; Histiocytes; Humans; Immunosuppressive Agents; Necrobiosis Lipoidica; Necrobiotic Xanthogranuloma; Plasma Cells; Tacrolimus

The art of diagnosis consists in the recognition of signs and symptoms and their interpretation under the light of individual circumstances obtained from the patient's history. In medicine we encounter cases that are straightforward and cases that are complex as they are the result of a rare disease or of uncommon presentation of a common disorder. We present in this paper the case of a patient with a non-healing traumatic wound to her shin, which after unsuccessful treatments was biopsied and an unexpected diagnosis of necrobiosis lipoidica diabeticorum was made. This led to the institution of disease-targeted wound care leading to complete resolution in a short period of time.

Topics: Anemia, Sickle Cell; Female; Guidelines as Topic; Humans; Immunosuppressive Agents; Leg Injuries; Middle Aged; Necrobiosis Lipoidica; Skin Ulcer; Tacrolimus; Treatment Outcome; Wound Healing

Necrobiosis lipoidica (NL) is a chronic inflammatory skin disease that is difficult to treat. The etiology is unknown, but vascular abnormalities and immunologic factors have been implicated. We treated a patient with long-standing NL with multiple vascular risk factors (diabetes mellitus, protein S-deficiency, and antiphospholipid syndrome) with topical tacrolimus, a non-steroidal immunomodulator that causes no skin atrophy. After 12 weeks of topical tacrolimus (0.1%) ointment, our patient already showed a good remission with a significant decrease in inflammatory signs.

Topics: Administration, Topical; Aged; Female; Humans; Immunosuppressive Agents; Necrobiosis Lipoidica; Tacrolimus; Treatment Outcome

Topics: Adult; Anti-Inflammatory Agents; Betamethasone; Clofazimine; Female; Humans; Immunosuppressive Agents; Necrobiosis Lipoidica; Stockings, Compression; Tacrolimus

Topics: Chronic Disease; Female; Humans; Immunosuppressive Agents; Middle Aged; Necrobiosis Lipoidica; Ointments; Tacrolimus

Topics: Administration, Topical; Adolescent; Adult; Child; Female; Granuloma Annulare; Humans; Immunosuppressive Agents; Male; Middle Aged; Necrobiosis Lipoidica; Tacrolimus; Treatment Outcome