• Online Features  This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (10)  • Contact me when this article is cited  Related Content  • Related articles  • Similar articles in this journal  Topic Collections  • Dermatology  • Dermatologic Disorders  • Granulomas  • Dermatologic Disorders, Other  • Drug Therapy  • Drug Therapy, Other  • Endocrine Diseases  • Diabetes Mellitus  • Alert me on articles by topic  Social Bookmarking   What's this?

Report of a Case

Stephanie W. Hu, BS; Caroline Bevona, MD; Laura Winterfield, MD; Abrar A. Qureshi, MD, MPH; Vincent W. Li, MD, MBA

Arch Dermatol. 2009;145(4):437-439.

Background  Necrobiosis lipoidica diabeticorum (NLD) is a rare, granulomatous inflammatory skin disease of unknown origin, sometimes associated with diabetes mellitus. Skin lesions usually develop on the lower extremities and can progress toward ulceration and scarring. Many treatments have been proposed, but few have demonstrated consistent efficacy, and no standard regimens have emerged to date.

Observations  An 84-year-old woman with type 1 diabetes mellitus presented with a 3-year history of chronic right-lower-extremity erythematous papules and plaques that had developed into confluent ulcers with prominent granulation tissue and an orange-yellow hue. The results of a biopsy of the lesion was consistent with a diagnosis of NLD. The wound did not respond to 4 months of intensive local wound care. After the first intravenous infusion of infliximab (5 mg/kg), there was rapid reduction in wound size, pain, and drainage. There was complete wound healing with excellent cosmesis at 6 weeks (total of 3 infusions).

Conclusions  Infliximab should be considered in the treatment of refractory, ulcerative NLD. Its anti–tumor necrosis factor activity may underlie its efficacy in targeting this granulomatous process, and further investigation should be undertaken to confirm these results.

Author Affiliations: Department of Dermatology, Angiogenesis & Wound Healing Center (Ms Hu and Drs Winterfield and Li) and Dermatology-Rheumatology Center (Dr Qureshi), Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts; and Department of Dermatology, Lahey Clinic, Burlington, Massachusetts (Dr Bevona).

CiteULike    Connotea    Delicious    Digg    Facebook    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLES

This Month in Archives of Dermatology
Arch Dermatol. 2009;145(4):371.
FULL TEXT  

Dermatologic Comorbidities of Diabetes Mellitus and Related Issues
William H. Eaglstein and Jeffrey P. Callen
Arch Dermatol. 2009;145(4):467-469.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

13.2.1 Clinical features of type 1 diabetes mellitus
Amiel
Oxford Textbook of Endocrinology and Diabetes 2011;2:med-9780199235292-chapter-med-9780199235292-chapter.
ABSTRACT | FULL TEXT  

TNF-{alpha} antagonists beyond approved indications: stories of success and prospects for the future
Karampetsou et al.
QJM 2010;103:917-928.
ABSTRACT | FULL TEXT  

Dermatologic Comorbidities of Diabetes Mellitus and Related Issues
Eaglstein and Callen
Arch Dermatol 2009;145:467-469.
FULL TEXT