Evidence-Based Treatment of Chronic Leg Ulcers in A Patient with Necrobiosis Lipoidica Diabeticorum_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Weiping ¹ , YUAN Nanbing ¹ , WANG Chun ¹ , WANG Yan ¹ , YU Tingting ¹ , WU Xueyan ² ,  Ran Xingwu ¹

1. Diabetic Foot Care Center, Department of Endocrinology, West China Hospital, Sichuan University, Chengdu 610041, China2. Endocrinology Department, People’s Hospital of Guangyuan, Sichuan Province;

Corresponding?author：

Ran Xingwu, Email: ranxingwu@yahoo.com.cn

Keywords：

Necrobiosis lipoidica diabeticorum; Ulcer; Granulocyte colony-stimulating factor; Therapy

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Objective 　To identify the best therapy regimen for a patient with rare chronic leg ulcer in necrobiosis lipoidica diabeticorum (NLD).
Methods 　We searched the Cochrane Library (Issue 3, 2006), PubMed (1966-July 2006), EMbase (1974-July 2006) and CBM (1978-July 2006) to identify relevant evidence. The quality of the retrieved studies was critically assessed.
Results 　A total of 153 records were retrieved. No clinical guidelines, systematic reviews or clinical randomized studies were identified. Thirty treatment-related studies involving 17 interventions showed that, fumaric acid esters, oral pentoxifylline, topical use of growth factors and surgical skin flap transplant were relatively more effective and safer than conventional therapies.
Conclusion 　After treatment with tropical granulocyte colony-stimulating factor, the patient with chronic leg ulcers was healed.

Citation： WANG Weiping,YUAN Nanbing,WANG Chun,WANG Yan,YU Tingting,WU Xueyan,Ran Xingwu. Evidence-Based Treatment of Chronic Leg Ulcers in A Patient with Necrobiosis Lipoidica Diabeticorum. Chinese Journal of Evidence-Based Medicine, 2007, 07(11): 320-325. doi: Copy

1.	Xiang J, Wei L, Wang JM, et al. Necrobiosis lipodica: a case report.Chin J Derm Venereol, 2001, 15(3): 198, 208.
2.	Li YL, Wang L, Li YP. Necrobiosis Lipodica: A Case Report andLiterature Review. Chin Gen Pract, 2006, 9(18): 1559.
3.	Paron NG, Lambert PW. Cutaneous manifestations of diabetes mellitus. Prim Care, 2000, 27(2): 371-383.
4.	Romano G, Moretti G, Di Benedetto A, et al. Skin lesions in diabetes mellitus: prevalence and clinical correlations. Diabetes Res Clin Pract, 1998, 39(2): 101-106.
5.	Jel inek JE. Cutaneous manifestations of diabetes mellitus. Int J Dermatol, 1994, 33(9): 605-617.
6.	Muller SA, Winkelman RK. Necrobiosis lipoidica diabeticorum, a clinical and pathological examination of 171 cases. Arch Dermatol,1966, 93: 272-281.
7.	O’Toole EA, Kennedy U, Nolan JJ, et al. Necrobiosis lipoidica: onlya minority of patients have diabetes mellitus. Br J Dermatol, 1999,140(2): 283-286.
8.	Heng MC, Allen SG, Song MK, et al. Focal endothelial celldegeneration and proliferative endarteritis in trauma-induced early lesions of necrobiosis lipoidica diabeticorum. Am J Dermatopathol,1991, 13(2): 108-114.
9.	Koh MS, Majewski BB, Barter S, et al. Increased plasma fibronectin in diabetes mellitus, necrobiosis lipoidica and widespread granuloma annulare. Clin Exp Dermatol, 1984, 9(3): 293-297.
10.	Quimby SR, Muller SA, Schroe t e r AL. The cutaneous immunopathology of necrobiosis lipoidica diabeticorum. Arch Dermatol, 1988, 124(9): 1364-1371.
11.	Imakado S, Satomi H, Iskikawa M, et al. Diffuse necrobiosis lipoidica diabeticorum associated with non-insulin dependent diabetes mellitus. Clin Exp Dermatol, 1998, 23(6): 271-273.
12.	Kobbah M, Ewald U, Tuvemo T. Vascular reactivity during the first year of diabetes in children. Acta Paediatr Scand Suppl, 1985, 320:.
13.	Jel inek JE. Cutaneous aspects of diabetes mellitus. In: Bowker JH,Pfeiffer MA, editors. Levin and O’Neal’s the diabetic foot. 6th ed. St Louis (MO): Mosby, 2001: 197-211.
14.	Kreuter A, Knierim C, Stücker M, et al. Fumaric acid esters innecrobiosis lipoidica: results of a prospective noncontrolled study.Br J Dermatol, 2005, 153(4): 802-807.
15.	Tan E, Patel V, Berth-Jones J. Systemic corticosteroids for the outpatient treatment of necrobiosis lipoidica in a diabetic patient. J Dermatolog Treat, 2007, 18(4): 246-248.
16.	Hocqueloux L, Gautier JF, Lebbe C, et al. Ulcerated necrobiosis lipoidica associated with insulin-dependent diabetes mellitus.Beneficial effect of corticosteroid therapy by oral administration.Presse Med, 1996, 25(1): 25-27.
17.	Petzelbauer P, Wolff K, Tappeiner G. Necrobiosis lipoidica:treatment with systemic corticosteroids. Br J Dermatol, 1992, 126(6):.
18.	Stanway A, Rademaker M, Newman P. Healing of severe ulcerative necrobiosis lipoidica with cyclosporin. Australas J Dermatol, 2004,.
19.	Basaria S, Braga-Basaria M. Necrobiosis lipoidica diabeticorum:response to pentoxi phyll ine. J Endocrinol Invest, 2003, 26(10): 1037-1040.
20.	Kolde G, Muche JM, Schulze P, et al. Infliximab: a promising new treatment option for ulcerated necrobiosis lipoidica. Dermatology,2003, 206(2): 180-181.
21.	向進, 衛利, 王俊民, 等. 類脂質漸進性壞死1例. 中國皮膚性病學雜志, 2001, 15(3): 198, 208.
22.	李艷玲, 王凌, 李玉平. 類脂質漸進性壞死一例及文獻回顧. 中國全科醫學, 2006, 9(18): 1559.
23.	Boyd AS. Tretinoin treatment of necrobiosis lipoidica diabeticorum.Diabetes Care, 1999, 22(10): 1753-1754.
24.	Stephens E, Robinson JA, Gottlieb PA. Becaplermin and necrobiosis lipoidicum diabeticorum: results of a case control pilot study. J Diabetes Complications, 2001, 15(1): 55-56.
25.	. Remes K, Rönnemaa T. Healing of chronic leg ulcers in diabetic necrobiosis lipoidica with local granulocyte-macrophage colonystimulating factor treatment. J Diabetes Complications, 1999, 13(2):115-118.
26.	Evans AV, Atherton DJ. Recalcitrant ulcers in necrobiosis lipoidica diabeticorum healed by topical granulocyte-macrophage colonystimulating factor. Br J Dermatol, 2002, 147(5): 1023-1025.
27.	Owen CM, Murphy H, Yates VM. Tissue-engineered dermal skin grafting in the treatment of ulcerated necrobiosis lipoidica. Clin Exp Dermatol, 2001, 26(2): 176-178.
28.	Youshock E, Beninson J. Necrobiosis lipoidica: treatment with porcine dressings, spl it-thickness skin grafts and pressure garments.A case report and review of treatment modalities. Angiology, 1985,36(11): 821-826.
29.	Dubin BJ, Kaplan EN. The surgical treatment of necrobiosis lipoidica diabeticorum. Plast Reconstr Surg, 1977, 60(3): 421-428.
30.	Heidenheim M, Jemec GB. Successful treatment of necrobiosis lipoidica diabeticorum with photodynamic therapy. Arch Dermatol,2006, 142(12): 1548-1550.
31.	Cianfarani F, Tommasi R, Failla CM, et al. Granulocyte/macrophage colony-stimulating factor treatment of human chronic ulcers promotes angiogenesis associated with de novo vascular endothelial growth factor transcription in the ulcer bed. Br J Dermatol, 2006,154(1): 34-41.
32.	Stagno F, Gugl ielmo P, Consol i U, et al. Successful healing of hydroxyurea-related leg ulcers with topical granulocyte-macrophagecolony-stimulating factor. Blood, 1999, 94(4): 1479-1480.
33.	(2): 119-122.
34.	-63.
35.	-545.

1. Xiang J, Wei L, Wang JM, et al. Necrobiosis lipodica: a case report.Chin J Derm Venereol, 2001, 15(3): 198, 208.
2. Li YL, Wang L, Li YP. Necrobiosis Lipodica: A Case Report andLiterature Review. Chin Gen Pract, 2006, 9(18): 1559.
3. Paron NG, Lambert PW. Cutaneous manifestations of diabetes mellitus. Prim Care, 2000, 27(2): 371-383.
4. Romano G, Moretti G, Di Benedetto A, et al. Skin lesions in diabetes mellitus: prevalence and clinical correlations. Diabetes Res Clin Pract, 1998, 39(2): 101-106.
5. Jel inek JE. Cutaneous manifestations of diabetes mellitus. Int J Dermatol, 1994, 33(9): 605-617.
6. Muller SA, Winkelman RK. Necrobiosis lipoidica diabeticorum, a clinical and pathological examination of 171 cases. Arch Dermatol,1966, 93: 272-281.
7. O’Toole EA, Kennedy U, Nolan JJ, et al. Necrobiosis lipoidica: onlya minority of patients have diabetes mellitus. Br J Dermatol, 1999,140(2): 283-286.
8. Heng MC, Allen SG, Song MK, et al. Focal endothelial celldegeneration and proliferative endarteritis in trauma-induced early lesions of necrobiosis lipoidica diabeticorum. Am J Dermatopathol,1991, 13(2): 108-114.
9. Koh MS, Majewski BB, Barter S, et al. Increased plasma fibronectin in diabetes mellitus, necrobiosis lipoidica and widespread granuloma annulare. Clin Exp Dermatol, 1984, 9(3): 293-297.
10. Quimby SR, Muller SA, Schroe t e r AL. The cutaneous immunopathology of necrobiosis lipoidica diabeticorum. Arch Dermatol, 1988, 124(9): 1364-1371.
11. Imakado S, Satomi H, Iskikawa M, et al. Diffuse necrobiosis lipoidica diabeticorum associated with non-insulin dependent diabetes mellitus. Clin Exp Dermatol, 1998, 23(6): 271-273.
12. Kobbah M, Ewald U, Tuvemo T. Vascular reactivity during the first year of diabetes in children. Acta Paediatr Scand Suppl, 1985, 320:.
13. Jel inek JE. Cutaneous aspects of diabetes mellitus. In: Bowker JH,Pfeiffer MA, editors. Levin and O’Neal’s the diabetic foot. 6th ed. St Louis (MO): Mosby, 2001: 197-211.
14. Kreuter A, Knierim C, Stücker M, et al. Fumaric acid esters innecrobiosis lipoidica: results of a prospective noncontrolled study.Br J Dermatol, 2005, 153(4): 802-807.
15. Tan E, Patel V, Berth-Jones J. Systemic corticosteroids for the outpatient treatment of necrobiosis lipoidica in a diabetic patient. J Dermatolog Treat, 2007, 18(4): 246-248.
16. Hocqueloux L, Gautier JF, Lebbe C, et al. Ulcerated necrobiosis lipoidica associated with insulin-dependent diabetes mellitus.Beneficial effect of corticosteroid therapy by oral administration.Presse Med, 1996, 25(1): 25-27.
17. Petzelbauer P, Wolff K, Tappeiner G. Necrobiosis lipoidica:treatment with systemic corticosteroids. Br J Dermatol, 1992, 126(6):.
18. Stanway A, Rademaker M, Newman P. Healing of severe ulcerative necrobiosis lipoidica with cyclosporin. Australas J Dermatol, 2004,.
19. Basaria S, Braga-Basaria M. Necrobiosis lipoidica diabeticorum:response to pentoxi phyll ine. J Endocrinol Invest, 2003, 26(10): 1037-1040.
20. Kolde G, Muche JM, Schulze P, et al. Infliximab: a promising new treatment option for ulcerated necrobiosis lipoidica. Dermatology,2003, 206(2): 180-181.
21. 向進, 衛利, 王俊民, 等. 類脂質漸進性壞死1例. 中國皮膚性病學雜志, 2001, 15(3): 198, 208.
22. 李艷玲, 王凌, 李玉平. 類脂質漸進性壞死一例及文獻回顧. 中國全科醫學, 2006, 9(18): 1559.
23. Boyd AS. Tretinoin treatment of necrobiosis lipoidica diabeticorum.Diabetes Care, 1999, 22(10): 1753-1754.
24. Stephens E, Robinson JA, Gottlieb PA. Becaplermin and necrobiosis lipoidicum diabeticorum: results of a case control pilot study. J Diabetes Complications, 2001, 15(1): 55-56.
25. . Remes K, Rönnemaa T. Healing of chronic leg ulcers in diabetic necrobiosis lipoidica with local granulocyte-macrophage colonystimulating factor treatment. J Diabetes Complications, 1999, 13(2):115-118.
26. Evans AV, Atherton DJ. Recalcitrant ulcers in necrobiosis lipoidica diabeticorum healed by topical granulocyte-macrophage colonystimulating factor. Br J Dermatol, 2002, 147(5): 1023-1025.
27. Owen CM, Murphy H, Yates VM. Tissue-engineered dermal skin grafting in the treatment of ulcerated necrobiosis lipoidica. Clin Exp Dermatol, 2001, 26(2): 176-178.
28. Youshock E, Beninson J. Necrobiosis lipoidica: treatment with porcine dressings, spl it-thickness skin grafts and pressure garments.A case report and review of treatment modalities. Angiology, 1985,36(11): 821-826.
29. Dubin BJ, Kaplan EN. The surgical treatment of necrobiosis lipoidica diabeticorum. Plast Reconstr Surg, 1977, 60(3): 421-428.
30. Heidenheim M, Jemec GB. Successful treatment of necrobiosis lipoidica diabeticorum with photodynamic therapy. Arch Dermatol,2006, 142(12): 1548-1550.
31. Cianfarani F, Tommasi R, Failla CM, et al. Granulocyte/macrophage colony-stimulating factor treatment of human chronic ulcers promotes angiogenesis associated with de novo vascular endothelial growth factor transcription in the ulcer bed. Br J Dermatol, 2006,154(1): 34-41.
32. Stagno F, Gugl ielmo P, Consol i U, et al. Successful healing of hydroxyurea-related leg ulcers with topical granulocyte-macrophagecolony-stimulating factor. Blood, 1999, 94(4): 1479-1480.
33. (2): 119-122.
34. -63.
35. -545.

Chinese Journal of Evidence-Based Medicine

Evidence-Based Treatment of Chronic Leg Ulcers in A Patient with Necrobiosis Lipoidica Diabeticorum

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