Case and Research Letter
Periorbital Necrobiosis Lipoidica
Necrobiosis lipoidica periorbitaria
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"apellidos" => "Sanz-Trélles" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731012005467" "doi" => "10.1016/j.ad.2012.12.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731012005467?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013001522?idApp=UINPBA000044" "url" => "/15782190/0000010400000007/v1_201308270818/S1578219013001522/v1_201308270818/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "Periorbital Necrobiosis Lipoidica" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "636" "paginaFinal" => "638" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "G. Pitarch, F. Giner" "autores" => array:2 [ 0 => array:4 [ "nombre" => "G." "apellidos" => "Pitarch" "email" => array:1 [ 0 => "gerardpitarch@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "F." "apellidos" => "Giner" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital General de Castellón, Castellón, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital General de Castellón, Castellón, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Necrobiosis lipoidica periorbitaria" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1112 "Ancho" => 1500 "Tamanyo" => 367300 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Inflammatory infiltrate composed of histiocytes with degenerated collagen and lipid deposits (hematoxylin-eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×40).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Necrobiosis lipoidica (NL) is a granulomatous disease of unknown etiology that typically occurs in diabetic patients. It is characterized by sclerotic plaques that most often appear on the legs.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 15-year-old girl was admitted to our hospital with facial lesions that had appeared 5 months earlier. She had previously consulted with a surgeon who had suggested surgical excision of the lesions. Physical examination revealed yellowish nodules and plaques with superficial telangiectasias on the upper and lower eyelids of the left eye (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The patient had been diagnosed with type 1 diabetes mellitus at age 6 years and had a history of marked insulin resistance and chronic poor blood glucose control (hemoglobin A<span class="elsevierStyleInf">1c</span>, 13%). Skin biopsy revealed an inflammatory infiltrate in the reticular dermis and hypodermis, predominantly composed of histiocytes that had aggregated to form granulomas surrounded by degenerated collagen fibers. Other findings included extracellular lipid deposits and no increase in stromal mucin. Plasma cells and multinucleated giant cells were also observed (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). A diagnosis of NL was established on the basis of clinical and histologic findings and the patient's past history. Because the site of the skin lesions made the use of topical or intralesional corticosteroids inadvisable, treatment was started with twice daily applications of 0.1% tacrolimus ointment. After 2 months of treatment with no improvement, oral pentoxifylline (600<span class="elsevierStyleHsp" style=""></span>mg/12 h) was added but was subsequently discontinued owing to gastrointestinal intolerance. When the lesions had resolved only partially after 4 months of treatment, topical tacrolimus was replaced with acetylsalicylic acid (300<span class="elsevierStyleHsp" style=""></span>mg/d). After a further 10 weeks of treatment, the periocular plaques had clearly improved, but other plaques of NL, including 1 with ulceration, appeared in the pretibial region. The pretibial plaques were treated with intralesional corticosteroids and hyperbaric oxygen therapy and resolved almost completely. After 2 years of treatment with acetylsalicylic acid, the periocular lesions had decreased in size until only a few small, infiltrated, slightly erythematous plaques remained. Ten months after withdrawal of the treatment, the plaques had not increased in size.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">NL is 3 times more common in women than in men, with the age of onset usually between 30 and 40 years. It is often associated with type 1 diabetes mellitus; between 75% and 90% of patients with NL have or will develop diabetes, although NL is present in only 0.3% to 3% of diabetic patients. NL has also been associated with autoimmune thyroid disease, rheumatoid arthritis, inflammatory bowel disease, and sarcoidosis.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Although NL lesions are typically located on the anterior and lateral aspects of the legs, cases affecting the trunk, upper limbs, face, and penis have also been described. NL lesions in the periocular region are extremely rare, but they have been found both in isolation<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and in association with NL lesions in other areas.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The lesion begins as an erythematous papule or plaque, which extends peripherally, developing a yellowish atrophic center and a raised erythematous border. The main complication of NL is ulceration, which occurs in 25% to 33% of patients. Atypical lesions on the face and the edge of the scalp have been described<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a> in association with Miescher granuloma, actinic granuloma, granuloma multiforme, and necrobiotic xanthogranuloma.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">NL is histologically characterized by a normal or atrophic—and frequently ulcerated—epidermis and necrobiotic collagen with sclerosis. In the dermis, palisading granulomas arranged in layers parallel to the epidermis can be observed. The dermal inflammatory infiltrate is composed of histiocytes, multinucleated giant cells, lymphocytes, and plasma cells. The histopathological differential diagnosis must primarily rule out granuloma annulare, rheumatoid nodules, and necrobiotic xanthogranuloma.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In cases with periorbital involvement it is essential to rule out the possibility of necrobiotic xanthogranuloma, a form of histiocytosis associated with paraproteinemia that usually occurs in periorbital sites. This disorder manifests as yellowish-red indurated nodules or plaques, frequently with atrophy, ulceration, and telangiectasias. Histologically, necrobiotic xanthogranuloma is differentiated from NL by its denser infiltrate of histiocytes, more pronounced inflammation and more severe degeneration of the subcutaneous cell tissue, and the presence of foamy histiocytes, Touton giant cells, bizarre foreign-body giant cells, and cholesterol clefts.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">NL is treated for cosmetic reasons or to avoid ulceration and the risk of secondary infection and deep tissue destruction. Topical and intralesional corticosteroids are the drugs most widely used to treat NL. Other drugs that have been used include acetylsalicylic acid, ticlopidine, pentoxifylline, tretinoin, clofazimine, mycophenolate mofetil, tumor necrosis factor (TNF) inhibitors, ciclosporin, thalidomide, fumaric acid esters, hydroxychloroquine, niacinamide, photodynamic therapy,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> psoralen–UV-A,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> and topical tacrolimus.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Blood glucose control and treatment for diabetes do not appear to have any beneficial effect on NL lesions. Surgical excision of the affected area can ensure resolution of the lesions but may also lead to considerable cosmetic and functional sequelae in the case of periorbital lesions.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In conclusion, when NL lesions occur in atypical sites, a high index of suspicion is required if we are to avoid misdiagnoses and inappropriate treatment decisions. Although it was only partially effective in the case of our patient, topical tacrolimus appears to be effective and particularly safe for the treatment of periocular NL lesions.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: G. Pitarch, Giner F. Necrobiosis lipoidica periorbitaria. Actas Dermosifiliogr. 2013;104:636–8.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1138 "Ancho" => 1500 "Tamanyo" => 243877 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Yellowish-red plaques in the periocular region.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1112 "Ancho" => 1500 "Tamanyo" => 367300 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Inflammatory infiltrate composed of histiocytes with degenerated collagen and lipid deposits (hematoxylin-eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×40).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Periorbital necrobiosis lipoidica diabeticorum: case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 10 | 13 | 23 |
| 2024 Octubre | 72 | 62 | 134 |
| 2024 Septiembre | 103 | 43 | 146 |
| 2024 Agosto | 115 | 65 | 180 |
| 2024 Julio | 78 | 43 | 121 |
| 2024 Junio | 87 | 32 | 119 |
| 2024 Mayo | 60 | 43 | 103 |
| 2024 Abril | 75 | 38 | 113 |
| 2024 Marzo | 82 | 45 | 127 |
| 2024 Febrero | 68 | 38 | 106 |
| 2024 Enero | 80 | 41 | 121 |
| 2023 Diciembre | 96 | 29 | 125 |
| 2023 Noviembre | 86 | 38 | 124 |
| 2023 Octubre | 78 | 25 | 103 |
| 2023 Septiembre | 75 | 46 | 121 |
| 2023 Agosto | 82 | 27 | 109 |
| 2023 Julio | 107 | 51 | 158 |
| 2023 Junio | 116 | 32 | 148 |
| 2023 Mayo | 96 | 29 | 125 |
| 2023 Abril | 63 | 35 | 98 |
| 2023 Marzo | 64 | 50 | 114 |
| 2023 Febrero | 65 | 39 | 104 |
| 2023 Enero | 43 | 40 | 83 |
| 2022 Diciembre | 62 | 43 | 105 |
| 2022 Noviembre | 33 | 31 | 64 |
| 2022 Octubre | 38 | 25 | 63 |
| 2022 Septiembre | 28 | 52 | 80 |
| 2022 Agosto | 33 | 40 | 73 |
| 2022 Julio | 24 | 41 | 65 |
| 2022 Junio | 46 | 41 | 87 |
| 2022 Mayo | 54 | 76 | 130 |
| 2022 Abril | 65 | 60 | 125 |
| 2022 Marzo | 70 | 80 | 150 |
| 2022 Febrero | 62 | 45 | 107 |
| 2022 Enero | 71 | 54 | 125 |
| 2021 Diciembre | 53 | 43 | 96 |
| 2021 Noviembre | 59 | 50 | 109 |
| 2021 Octubre | 65 | 60 | 125 |
| 2021 Septiembre | 59 | 52 | 111 |
| 2021 Agosto | 55 | 31 | 86 |
| 2021 Julio | 42 | 34 | 76 |
| 2021 Junio | 43 | 37 | 80 |
| 2021 Mayo | 85 | 59 | 144 |
| 2021 Abril | 297 | 71 | 368 |
| 2021 Marzo | 86 | 40 | 126 |
| 2021 Febrero | 74 | 18 | 92 |
| 2021 Enero | 56 | 24 | 80 |
| 2020 Diciembre | 47 | 19 | 66 |
| 2020 Noviembre | 26 | 13 | 39 |
| 2020 Octubre | 27 | 14 | 41 |
| 2020 Septiembre | 26 | 15 | 41 |
| 2020 Agosto | 24 | 21 | 45 |
| 2020 Julio | 16 | 14 | 30 |
| 2020 Junio | 32 | 43 | 75 |
| 2020 Mayo | 26 | 30 | 56 |
| 2020 Abril | 32 | 30 | 62 |
| 2020 Marzo | 32 | 21 | 53 |
| 2020 Febrero | 4 | 16 | 20 |
| 2020 Enero | 0 | 4 | 4 |
| 2019 Diciembre | 4 | 7 | 11 |
| 2019 Noviembre | 0 | 6 | 6 |
| 2019 Octubre | 0 | 2 | 2 |
| 2019 Septiembre | 7 | 10 | 17 |
| 2019 Agosto | 0 | 7 | 7 |
| 2019 Julio | 1 | 13 | 14 |
| 2019 Junio | 1 | 9 | 10 |
| 2019 Mayo | 3 | 9 | 12 |
| 2019 Abril | 0 | 14 | 14 |
| 2019 Marzo | 1 | 11 | 12 |
| 2019 Febrero | 6 | 4 | 10 |
| 2019 Enero | 0 | 3 | 3 |
| 2018 Diciembre | 4 | 4 | 8 |
| 2018 Noviembre | 0 | 3 | 3 |
| 2018 Octubre | 5 | 0 | 5 |
| 2018 Septiembre | 4 | 0 | 4 |
| 2018 Junio | 0 | 1 | 1 |
| 2018 Abril | 0 | 1 | 1 |
| 2018 Marzo | 8 | 2 | 10 |
| 2018 Febrero | 36 | 7 | 43 |
| 2018 Enero | 47 | 3 | 50 |
| 2017 Diciembre | 48 | 7 | 55 |
| 2017 Noviembre | 37 | 5 | 42 |
| 2017 Octubre | 31 | 3 | 34 |
| 2017 Septiembre | 43 | 5 | 48 |
| 2017 Agosto | 56 | 6 | 62 |
| 2017 Julio | 43 | 8 | 51 |
| 2017 Junio | 64 | 6 | 70 |
| 2017 Mayo | 47 | 7 | 54 |
| 2017 Abril | 39 | 13 | 52 |
| 2017 Marzo | 37 | 45 | 82 |
| 2017 Febrero | 32 | 11 | 43 |
| 2017 Enero | 30 | 9 | 39 |
| 2016 Diciembre | 38 | 5 | 43 |
| 2016 Noviembre | 67 | 20 | 87 |
| 2016 Octubre | 104 | 20 | 124 |
| 2016 Septiembre | 160 | 8 | 168 |
| 2016 Agosto | 140 | 9 | 149 |
| 2016 Julio | 38 | 9 | 47 |
| 2016 Junio | 14 | 5 | 19 |
| 2016 Mayo | 9 | 7 | 16 |
| 2016 Abril | 6 | 2 | 8 |
| 2016 Marzo | 6 | 1 | 7 |
| 2016 Febrero | 9 | 4 | 13 |
| 2016 Enero | 10 | 1 | 11 |
| 2015 Diciembre | 11 | 2 | 13 |
| 2015 Noviembre | 17 | 3 | 20 |
| 2015 Octubre | 9 | 4 | 13 |
| 2015 Septiembre | 2 | 0 | 2 |
| 2015 Agosto | 3 | 2 | 5 |
| 2015 Julio | 56 | 3 | 59 |
| 2015 Junio | 30 | 3 | 33 |
| 2015 Mayo | 46 | 12 | 58 |
| 2015 Abril | 30 | 9 | 39 |
| 2015 Marzo | 29 | 2 | 31 |
| 2015 Febrero | 21 | 6 | 27 |
| 2015 Enero | 29 | 5 | 34 |
| 2014 Diciembre | 29 | 7 | 36 |
| 2014 Noviembre | 20 | 3 | 23 |
| 2014 Octubre | 33 | 5 | 38 |
| 2014 Septiembre | 27 | 5 | 32 |
| 2014 Agosto | 34 | 8 | 42 |
| 2014 Julio | 24 | 7 | 31 |
| 2014 Junio | 33 | 6 | 39 |
| 2014 Mayo | 32 | 9 | 41 |
| 2014 Abril | 34 | 7 | 41 |
| 2014 Marzo | 38 | 9 | 47 |
| 2014 Febrero | 31 | 7 | 38 |
| 2014 Enero | 31 | 6 | 37 |
| 2013 Diciembre | 31 | 2 | 33 |
| 2013 Noviembre | 16 | 6 | 22 |
| 2013 Octubre | 17 | 7 | 24 |
| 2013 Septiembre | 21 | 7 | 28 |
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