Necrobiosis

Necrobiosis Necrobiosis known as asymptomatic diabeticorum shows bright spots which enlarge over time, until red-brown to yellow, atrophic by degeneration of collagen and granulomatous response, storing fat and thickening of blood vessel walls. The exact cause is not known but the widely accepted theory include diabetic microangiopathy. Other theories suggest trauma or inflammation.
Necrobiosis lipoidica is described in 0. 3% of diabetics. The presence and progression of this condition is not related to diabetes management. Treatment is not satisfactory. Chronic disease progression is variable and scars. Skin cancer has been reported in people with Necrobiosis lipoidica with ulceration and previous trauma. Intralesional corticosteroids are used, but with minor effects. Antiagregare therapy with aspirin and dipyridamole have been tried as Necrobiosis lipoidica is caused by vascular occlusion or platelet-mediated immune mechanisms. And immunomodulators are used with variable success. Therapy includes surgical excision and grafting, but recurrent vascular damage is secondary. The surgical wound is healing slowly. You can try laser therapy.
Necrobiosis lipoidica is the main accused in ulceration that occurs after trauma. Infection can occur but are unusual. Were squamous cell carcinoma reported develop and diversify into chronic lesions of Necrobiosis lipoidica. The prognosis for this disease is unfavorable cosmetic. Treatment is helpful in stopping the expansion of lesions tend to present a chronic evolution. Ulcers can be painful, infected and heal with scarring.
Pathogenesis and causes
Necrobiosis lipoidica is a condition in collagen degeneration with granulomatous response, thickening of the walls of blood vessels and fat storage. Pathogenesis has not been shown to be related to genetic factors. Because of the close links between diabetes Necrobiosis lipoidica diabeticorum many studies have targeted this etiology. Microangiopathy in the disease could trigger the disease.Another theory is based on the deposit of immunoglobulins, complement and fibrinogen in the blood vessel walls. It is considered to be an antibody-mediated vasculitis disease. An additional theory of Necrobiosis lipoidica observed abnormal collagen, other theories include trauma, inflammatory and metabolic changes as a possible etiology.
Signs and symptoms
Necrobiosis lipoidica is 3 times more common in women than in men. Mean age of onset is 30 years old but can develop at any age. In patients with diabetes tends to occur early. Asymptomatic patients shows bright spots which enlarge slowly in a few months or years. Red-brown spots are initially yellow and then become depressed, atrophic. Ulcers can occur after trauma and are typically associated with pain. The main accusation is patient cosmetic appearance of the lesions. The clinical aspect of necrobiosis lipoidice is distinctive.
Physical ExamThe skin lesions begin by 1-3 mm papules, nodules are well defined or extending an active edge and become atrophic, frosty, spotted the central round. Initially these boards are red, yellow and brown but progressively become atrophic. Most cases occur in the pretibial area, but are reported in the face, scalp, trunk and upper extremities. You may notice multiple teleangiectazii thin epidermis surface. Ulcers at the site of trauma and secondary infection are occasional complications of necrobiosis lipoidice.Koebner phenomenon is present in these patients, particularly those with vasculitis at the site of trauma. In most patients Necrobiosis lipoidica lesions are typically multiple and bilateral. This can become painful due to nerve damage in 75% of cutaneous cases and 25% are in extreme distress.
Diagnosis
Histological examination. The condition shows interstitial granuloma involving dermis and subcutaneous tissue. Granulomas are composed of histiocite, plasma cells and eosinophils. Reduce the number of cutaneous nerve is another feature. The main element is thickening and swelling of vascular endothelial walls found in the deep dermis, similar to diabetic microangiopathy.The differential diagnosis is made with the following conditions: anular granuloma, sarcoidosis, xantoamele.
Treatment
Treatment for Necrobiosis lipoidica is not very effective because the exact etiology is unclear. Because trauma cause localized ulceration and protection legs stockings legs rest are helpful. Topical steroids can reduce inflammation but intralesional early active lesions but with minimal effects on atrophic lesions. To these steroids can cause additional atrophy. We have tried topical tacrolimus, cyclosporine, antiplatelet therapy, etanercept, infliximab. One study used topical bovine collagen to improve granulation tissue and wound healing promoting fibroblast activity and ulceration. Other therapies used with variable success include ultraviolet phototherapy, ticlopidine, nicotinamide, clofazimina, Intralesional injections of heparin, tretinoin, hidroxicloroquina.
Surgical therapy.Excision and grafting are effective, but recurrence is secondary vascular alterations. This shows an impaired wound healing. Have been described and laser regimens.
Prognosis
In terms of cosmetic outcome is negative lipoidice necrobiosis. Treatments can improve chronic ongoing expansion of individual lesions. Ulcers can cause significant morbidity, requiring prolonged wound care. These ulcers can be painful, become infected and heal with scarring.