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    Ustekinumab to target granulomatous dermatitis in recalcitrant ulcerative necrobiosis lipoidica: case report and proposed mechanism.
    Dermatol Online J 2017 Jul 15;23(7). Epub 2017 Jul 15.
    Department of Dermatology, University of California Davis School of Medicine, Sacramento, California.
    We present a 42-year-old woman with no history of diabetes or glucose intolerance who had a 5-year history of ulcerative necrobiosis lipoidica (NL). Despite failure of multiple medications, she experienced clearing of her ulcers after her treatment was changed to ustekinumab. We discuss our patient's disease course and elaborate upon mechanistic reasons for her improvement related to ustekinumab therapy. Read More

    The long-term effect of pulsed dye laser on Necrobiosis Lipoidica: A case study.
    J Cosmet Laser Ther 2018 Feb 20:1-2. Epub 2018 Feb 20.
    a Plastic Surgery Center of Pennsylvania , Erie , PA , USA.
    A 57-year-old female was presented with an irrepressible case of Necrobiosis Lipoidica considering the possibility of a surgical skin graft. Instead, a pulsed dye laser treatment was used as an alternate treatment. Previous case studies have been found in the literature on the effect of pulsed dye laser on Necrobiosis Lipoidica. Read More

    Cutaneous Granulomatosis: a Comprehensive Review.
    Clin Rev Allergy Immunol 2018 Feb;54(1):131-146
    Clinique de Dermatologie, Hôpitaux Universitaires de Genève, Rue Gabrielle Perret-Gentil 4, CH-1211, Genève, Switzerland.
    Cutaneous granulomatosis is a heterogeneous group of diseases, characterized by a skin inflammatory reaction triggered by a wide variety of stimuli, including infections, foreign bodies, malignancy, metabolites, and chemicals. From a pathogenic point of view, they are divided into non-infectious and infectious granulomas. Pathophysiological mechanisms are still poorly understood. Read More

    Miscellaneous skin disease and the metabolic syndrome.
    Clin Dermatol 2018 Jan - Feb;36(1):94-100. Epub 2017 Sep 8.
    Department of Dermatology, Istanbul Medeniyet University, Medical School, Istanbul, Turkey. Electronic address:
    The link between the metabolic syndrome (MetS) and skin diseases is increasingly important, with new associations being discovered. The association between MetS and psoriasis or MetS and hidradenitis suppurativa is well known, although the relationship between MetS and various autoimmune or inflammatory diseases has only recently attracted interest. Some inflammatory skin diseases, such as vitiligo, scleredema, recurrent aphthous stomatitis, Behçet disease, rosacea, necrobiosis lipoidica, granuloma annulare, skin tags, knuckle pads, and eruptive xanthomas, have possible associations with MetS. Read More

    Dermatologic manifestations of endocrine disorders.
    Transl Pediatr 2017 Oct;6(4):300-312
    The Ohio State University College of Medicine, Columbus, OH, USA.
    The skin serves as a window for clinicians to understand, diagnose, and monitor endocrine disease. Dermatologic manifestations of endocrinopathies contribute significantly to an individual's health and quality of life. In this review, we outline various disorders of the hypothalamic-pituitary axis, thyroid gland, pancreas, adrenal gland, and androgen axis as well as hereditary endocrine syndromes. Read More

    Refractory Ulcerated Necrobiosis Lipoidica: Closure of a Difficult Wound with Topical Tacrolimus.
    Adv Skin Wound Care 2017 Oct;30(10):469-472
    Luke Ginocchio, BS, is a Medical Student; Lisa Draghi, RPA-c, is a Physician Assistant; and Farbod Darvishian, MD, is Associate Professor, NYU Langone Medical Center, New York, New York. Frank L. Ross, MD, FACS, is Associate Director, Helen L. and Martin S. Kimmel Hyperbaric and Advanced Wound Healing Center; and Associate Professor of Surgery, NYU Langone Medical Center New York, New York.
    Objective: To report a case of refractory ulcerated necrobiosis lipoidica (NL) with significant response to treatment with topical tacrolimus.

    Subject: A 55-year-old woman without diabetes and with a previous history of NL presented to the Helen L. and Martin S. Read More

    Xanthoma-like Skin Changes in an Elderly Woman with a Normal Lipid Profile.
    Acta Dermatovenerol Croat 2017 Jul;25(2):167-169
    Professor Joanna Maj, MD, PhD, Department and Clinic of Dermatology, Venereology and Allergology, Wroclaw Medical University, Chałubińskiego 1, PL-50-368 Wrocław, Poland;
    Dear Editor, An 83-year-old woman developed yellow-brownish infiltrates, nodules, and tumors mimicking xanthomas, mostly involving the periorbital and chest area within three months (Figure 1). She had no abnormalities in serum cholesterol or triglycerides levels. A detailed laboratory analysis revealed the presence of mild monoclonal gammopathy with a presence of immunoglobulin G (IgG) kappa light chains; however, according to hematologist consultation, it did not require medical intervention. Read More

    Interstitial Granulomatous Dermatitis (IGD).
    Open Access Maced J Med Sci 2017 Jul 21;5(4):543-544. Epub 2017 Jul 21.
    Department of Dermatology, Venereology and Dermatologic Surgery, Medical Institute of Ministry of Interior, and Onkoderma Polyclinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria.
    We report the case of a 42 years old male patient suffering from skin changes, which appeared in the last 7-8 years. Two biopsies were performed during the evolution of the lesion. Both showed similar findings that consisted in a busy dermis with interstitial, superficial and deep infiltrates of lymphocytes and histiocytes dispersed among collagen bundles, with variable numbers of neutrophils scattered throughout. Read More

    A systematic review of the relationship between glycemic control and necrobiosis lipoidica diabeticorum in patients with diabetes mellitus.
    Int J Dermatol 2017 Dec 26;56(12):1319-1327. Epub 2017 Jun 26.
    Department of Medicine (Dermatology), University of Toronto, Toronto, Ontario, Canada.
    The association of specific skin disorders with diabetes mellitus (DM) has been well established. Current literature suggests that approximately 30-91% of patients with diabetes will experience at least one cutaneous manifestation of this systemic disease in their lifetime. To date, there are limited articles summarizing the link between necrobiosis lipoidica diabeticorum (NLD) prognosis and glycemic control in patients with diabetes. Read More

    [Chronic leg ulcers].
    Hautarzt 2017 Aug;68(8):614-620
    Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland.
    Chronic wounds often manifest as ulcers on the lower legs. The main causes of chronic leg ulcers are chronic venous insufficiency and/or peripheral arterial occlusive disease in approximately 80% of all patients. However, there are also numerous other potentially relevant factors which can cause or almost impede the healing of chronic leg ulcers. Read More

    [Evidence of compression therapy].
    Hautarzt 2017 Aug;68(8):625-631
    Klinik- und Poliklinik für Haut- und Geschlechtskrankheiten, Universitätsmedizin Greifswald, F.-Sauerbruchstr., 17475, Greifswald, Deutschland.
    Background: Medical compression therapy is widely used to treat phlebologic diseases. Compression bandages as well as compression stockings are used. Compression has been identified to be an effective conservative therapy for the healing of venous ulcers and other indications. Read More

    [Clinical and histological spectrum of palisaded granulomatous dermatitides : Granuloma annulare, necrobiosis lipoidica, rheumatoid nodules, and necrobiotic xanthogranuloma].
    Hautarzt 2017 Jul;68(7):536-541
    Hautklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
    The palisading granulomatous dermatitides comprise a group of different skin diseases with similar histomorphologic forms of granuloma in the skin. Histopathologically characteristic are areas in the reticular dermis and subcutaneous fat with degenerated bundles of collagen surrounded by histiocytes and multinucleate giant cells aligned in a palisade (necrobiotic granuloma). Within the center of palisaded granulomas, mucin or fibrin can be found. Read More

    Cutaneous Manifestations of Diabetes Mellitus: A Review.
    Am J Clin Dermatol 2017 Aug;18(4):541-553
    Department of Dermatology, University Hospital Jena, Erfurter Straße 35, 07740, Jena, Germany.
    Diabetes mellitus is a widespread endocrine disease with severe impact on health systems worldwide. Increased serum glucose causes damage to a wide range of cell types, including endothelial cells, neurons, and renal cells, but also keratinocytes and fibroblasts. Skin disorders can be found in about one third of all people with diabetes and frequently occur before the diagnosis, thus playing an important role in the initial recognition of underlying disease. Read More

    [First manifestation of leg ulcers : Analysis of data from 1000 patients].
    Hautarzt 2017 Jun;68(6):483-491
    Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland.
    Background: More than 1 million people in Germany suffer from leg ulcers. The diagnosis leg ulcer summarizes many different etiologies. The therapy of leg ulcers is an interdisciplinary and interprofessional challenge. Read More

    What is new in the histogenesis of granulomatous skin diseases?
    J Dermatol 2017 Mar;44(3):297-303
    Department of Dermatology, Kyoto prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan.
    A granuloma is a form of inflammation, which predominantly consists of macrophages. It typically develops when the immune system attempts to enclose substances that are usually insoluble and cannot be eliminated to prevent the spread of these substances to the other body compartments. According to the source of the substances, granulomatous diseases can be divided into two groups: infectious and non-infectious. Read More

    Diabetes mellitus and the skin.
    An Bras Dermatol 2017 Jan-Feb;92(1):8-20
    Department of Dermatology and Radiotherapy - Faculdade de Medicina de Botucatu - Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP) -Botucatu (SP), Brazil.
    Several dermatoses are routinely associated with diabetes mellitus, especially in patients with chronic disease. This relationship can be easily proven in some skin disorders, but it is not so clear in others. Dermatoses such necrobiosis lipoidica, granuloma annulare, acanthosis nigricans and others are discussed in this text, with an emphasis on proven link with the diabetes or not, disease identification and treatment strategy used to control those dermatoses and diabetes. Read More

    Update: Treatment of necrobiosis lipoidica.
    J Dtsch Dermatol Ges 2017 Feb;15(2):151-157
    Department of Dermatology, University Hospital, Jena, Germany.
    Necrobiosis lipoidica (NL) is a rare granulomatous disease of hitherto unclear etiology frequently seen in patients with diabetes. Characterized by its potential for ulcerations, it often presents a serious burden for those affected. There are currently neither German nor European guidelines for the treatment of NL. Read More

    Update: Therapie der Necrobiosis lipoidica.
    J Dtsch Dermatol Ges 2017 Feb;15(2):151-158
    Klinik für Hautkrankheiten, Universitätsklinikum Jena.
    Die Necrobiosis lipoidica ist eine seltene granulomatöse Erkrankung von bisher unzureichend geklärter Ätiologie. Häufig stellt die bei Diabetikern gehäuft zu beobachtende und zur Ulzeration neigende Dermatose eine starke Belastung für die Patienten dar. Bezüglich der Therapie existieren aktuell keine deutschen oder europäischen Leitlinien. Read More

    A granulomatous conundrum: Concurrent necrobiosis lipoidica, cutaneous sarcoidosis and erythema nodosum in a nondiabetic patient.
    Australas J Dermatol 2017 Nov 17;58(4):e232-e235. Epub 2017 Feb 17.
    Australian National University Medical School, Canberra, Australian Capital Territory, Australia.
    Necrobiosis lipoidica (NL) and cutaneous sarcoidosis are granulomatous disorders with a largely unknown aetiopathogenesis. Evidence of co-existing NL and sarcoidosis in the same patient may suggest a degree of overlap between these entities through shared granulomatous inflammatory pathways. Occasionally, one condition can mimic the other, making their distinction difficult. Read More

    Panniculitis: A summary.
    Semin Diagn Pathol 2017 May 27;34(3):261-272. Epub 2016 Dec 27.
    Section of Dermatopathology,Dermatopathology, Division of Surgical Pathology & Cytopathology, University of Virginia Medical Center, Charlottesville, VA, USA. Electronic address:
    The diagnosis of panniculitis is felt to be a confusing topic by some pathologists. This summarical article presents inflammatory diseases of the subcutis in a systematic fashion, based on whether they are centered on fibrovascular septa or the adipose lobules, and whether morphologic vasculitis is present or not. Septocentric, non-vasculitis disorders include erythema nodosum, panniculitis that follows the use of "biological" therapeutic agents, lipodermatosclerosis, post-irradiation panniculitis, morphea profunda, and necrobiosis lipodica profunda. Read More

    Granulomatous & histiocytic dermatitides.
    Semin Diagn Pathol 2017 May 14;34(3):301-311. Epub 2016 Dec 14.
    Section of Dermatopathology, Division of Surgical & Cytological Pathology, University of Virginia Medical Center, Charlottesville, VA, USA. Electronic address:
    Granulomas of the skin may be classified in several ways. They are either infectious or non-infectious in character, and they contain areas of necrobiosis or necrosis, or not. Responsible infectious agents may be mycobacterial, fungal, treponemal, or parasitic organisms, and each case of granulomatous dermatitis should be assessed histochemically for those microbes. Read More


    Specific skin signs as a cutaneous marker of diabetes mellitus and the prediabetic state - a systematic review.
    Dan Med J 2017 Jan;64(1)
    Introduction: Diabetes mellitus and the prediabetic state are associated with a number of skin manifestations. This study is a systematic review of the following manifestations: acanthosis nigricans (AN), skin tags (ST), diabetic dermopathy (DD), rubeosis faciei (RF), pruritus (PR), granuloma annulare (GA), necrobiosis lipoidica (NL), scleroedema diabeticorum (SD) and bullosis diabeticorum (BD). These conditions possibly relate to underlying diabetogenic mechanisms. Read More

    Subcutaneous dirofilariasis: a masquerade of a palisaded granulomatous dermatitis.
    J Cutan Pathol 2017 Apr 15;44(4):373-375. Epub 2017 Feb 15.
    Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
    Dirofilaria species are roundworms responsible for "heartworm" in canines. On occasion, humans are an accidental host, resulting in pulmonary (Dirofilaria immitis) or extrapulmonary (Dirofilaria repens) manifestations. Of the extrapulmonary sites of involvement, subcutaneous involvement is particularly common. Read More

    Dermoscopy could be useful in differentiating sarcoidosis from necrobiotic granulomas even after treatment with systemic steroids.
    Dermatol Pract Concept 2016 Jul 31;6(3):17-22. Epub 2016 Jul 31.
    Dermatology Department Cairo University, Cairo, Egypt.
    Background: Diagnosing cutaneous sarcoidosis and necrobiotic granulomas is challenging.

    Objective: Assessing the value of dermoscopy in differentiating cutaneous sarcoidosis from necrobiotic granulomas and evaluating whether their dermoscopic features will be altered after treatment.

    Methods: Nineteen cutaneous sarcoidosis and 11 necrobiotic granuloma patients (2 necrobiosis lipoidica, 4 granuloma annulare and 5 rheumatoid nodule) were included in this study. Read More

    An atrophic plaque on the breast six years after breast reconstruction surgery.
    Dermatol Online J 2016 Jun 15;22(6). Epub 2016 Jun 15.
    Department of Dermatology, Sidney Kimmel Medical College at Thomas Jefferson University.
    Necrobiosis lipoidica (NL) is a cutaneous disease entity that typically manifests as atrophic yellow plaques with telangiectasias on the anterior tibial region. Although NL is commonly associated with diabetes mellitus, the role of trauma in disease development is less commonly emphasized. The relationship between NL and the Köbner phenomenon has been established, as a few cases of NL occurring in surgical scars have been reported in the literature. Read More

    Dermoscopy in General Dermatology: A Practical Overview.
    Dermatol Ther (Heidelb) 2016 Dec 9;6(4):471-507. Epub 2016 Sep 9.
    Department of Experimental and Clinical Medicine, Institute of Dermatology, University of Udine, Udine, Italy.
    Over the last few years, dermoscopy has been shown to be a useful tool in assisting the noninvasive diagnosis of various general dermatological disorders. In this article, we sought to provide an up-to-date practical overview on the use of dermoscopy in general dermatology by analysing the dermoscopic differential diagnosis of relatively common dermatological disorders grouped according to their clinical presentation, i.e. Read More

    Ultraviolet A1 phototherapy: One center's experience.
    Indian J Dermatol Venereol Leprol 2017 Jan-Feb;83(1):60-65
    Department of Dermatology and Photobiology, Ninewells University Hospital, Dundee, DD1 9SY, Scotland, UK.
    Background: Ultraviolet A1(UVA1) phototherapy is increasingly being used in the treatment of morphea, atopic dermatitis, lupus and some other recalcitrant dermatoses. We present a retrospective review of our experience with this modality.

    Aim: To evaluate the treatment response rates for various dermatoses and adverse effects of UVA1 phototherapy. Read More

    Risk factors for necrobiosis lipoidica in Type 1 diabetes mellitus.
    Diabet Med 2017 01 21;34(1):86-92. Epub 2016 May 21.
    Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.
    Aims: To compare the clinical and metabolic characteristics of patients with Type 1 diabetes and necrobiosis lipoidica with those of patients with Type 1 diabetes who do not have necrobiosis lipoidica. A multicentre analysis was performed.

    Methods: Clinical and laboratory data were obtained from 64 133 patients (aged 0-25 years) with Type 1 diabetes with and without necrobiosis lipoidica who were registered in the German/Austrian Diabetes Prospective Documentation Initiative registry. Read More

    Dermatological and musculoskeletal assessment of diabetic foot: A narrative review.
    Diabetes Metab Syndr 2016 Apr-Jun;10(2 Suppl 1):S158-64. Epub 2016 Mar 12.
    Health Research Institute, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Electronic address:
    Aims: Diabetic Foot Syndrome (DFS) is the most costly and devastating complication of diabetes mellitus (DM), which early effective assessment can reduce the severity of complications including ulceration and amputations. This study aimed to review dermatological and musculoskeletal assessment of diabetic foot.

    Materials And Methods: In this review article, we searched for articles published between March 1, 1980 and July 28, 2015 in PubMed, Science Direct, Embase, Web of Science, and Scopus, for both English and non-English language articles with the following keywords: "Diabetic foot syndrome", "Ulceration", "Amputation", "Foot assessment", "Skin disorders" and "Musculoskeletal deformities". Read More

    Sarcoidal Necrobiosis Lipoidica in a Nondiabetic Patient: Usefulness of Skin Ultrasound.
    Actas Dermosifiliogr 2016 Jul-Aug;107(6):525-7. Epub 2016 Mar 19.
    Departamentos de Radiología y Dermatología, Instituto de Investigación y Diagnóstico por Imágenes en Piel y Tejidos Blandos (IDIEP), Clínica Servet, Facultad de Medicina, Universidad de Chile, Santiago, Región Metropolitana, Chile.

    Anti-TNFα treatment for recalcitrant ulcerative necrobiosis lipoidica diabeticorum: A case report and review of the literature.
    Metabolism 2016 Apr 7;65(4):569-73. Epub 2016 Jan 7.
    First Department of Propaedeutic Medicine, Medical School, National and Kapodistrian University of Athens, 17 Agiou Thoma St, Goudi, Athens, Greece. Electronic address:
    Introduction: Necrobiosis lipoidica diabeticorum (NLD) is a rare degenerative connective tissue disorder associated with diabetes mellitus, which usually presents with red papules or plaques with raised edges and occasional ulceration. Ulcerating NLD is notoriously difficult to treat. We present a young patient with ulcerative NLD who was successfully treated with the anti-TNFα agent infliximab. Read More

    Cofactors and comorbidities of necrobiosis lipoidica: analysis of the German DRG data from 2012.
    J Dtsch Dermatol Ges 2016 Mar;14(3):277-84
    Department of Dermatology, Venereology, and Allergology, University Hospital Essen, Essen, Germany.
    Background: Necrobiosis lipoidica (NL) is a rare granulomatous inflammatory skin disease of unknown pathophysiology. Its potential association with diabetes mellitus is well known. Other relevant cofactors and comorbidities are subject to controversial debate. Read More

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