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Granulomatous Diseases
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Albert Alhatem, Robert A. Schwartz, Muriel W. Lambert, W. Clark Lambert
Laboratory studies: Histologically, there is a large area of necrobiosis (partial necrosis of the dermis) surrounded by a superficial and deep perivascular and interstitial mixed inflammatory cell infiltrate, including lymphocytes, plasma cells, mononucleated and multinucleated histiocytes, and eosinophils in the dermis and subcutis. There may also be necrotizing vasculitis with adjacent necrobiosis and necrosis of adnexal structures (Figure 18.6). The lesion forms a palisading granuloma, but in contrast to granuloma annulare, the granuloma is quite large, and contents are necrobiotic collagen instead of mucin.
Other Complications of Diabetes
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Bacterial and fungal skin infections are often treated with topical antibiotics. Chronic itching can be treated by limiting excessive bathing, especially when the humidity is low. Mild soap containing moisturizers and skin cream can be effective. Diabetic blisters heal on their own, usually without scarring, in approximately 3 weeks. The only treatment is to control blood glucose. Acanthosis nigricans is treated by losing weight and by creams that help improve the appearance of the dark skin spots. Treatment for necrobiosis lipoidica diabeticorum is not required unless the sores break open. Once diabetes is again under control, the lesions of eruptive xanthomatosis disappear.
The skin
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
There are poorly defined foci of necrobiosis, surrounded by palisading histiocytes, throughout the dermis occasionally with extension to the subcutis. Necrobiosis histologically appears as swollen, eosinophilic, degenerate collagen fibres. There is patchy chronic inflammation, comprising lymphocytes and plasma cells (Figure 19.25B). The presence of the latter is useful to distinguish NL from granuloma annulare. The deep dermal vessels variably demonstrate endothelial swelling, intimal proliferation and fibrosis, further suggesting a vascular pathogenesis.
IgG4-related ophthalmic disease in association with adult-onset asthma and periocular xanthogranuloma: a case report
Published in Orbit, 2023
Brigitte M. Papa, H. Miles Prince, Alan A. McNab, Penny McKelvie
Adult xanthogranulomatous disease (XG) of the orbit and ocular adnexa comprises a heterogeneous group of rare fibroinflammatory disorders presenting with orbital masses and often xanthelasma-like lesions of the eyelids.1 There are four distinct subtypes: 1) adult onset xanthogranulomatous disease of the orbit (AOX), 2) adult-onset asthma with peri-ocular xanthogranuloma (AAPOX), 3) necrobiotic xanthogranuloma (NXG), and 4) Erdheim–Chester disease (ECD).1 AOX is a localised disorder of the peri-ocular soft tissues. AAPOX comprises AOX with additional features of adult-onset asthma, often nasal and paranasal sinus disease and reactive lymphadenopathy.1 NXG characteristically presents with periorbital subcutaneous skin lesions, which tend to ulcerate, and histological features of necrobiosis with palisading necrosis.1 ECD can affect the orbit, typically posteriorly, and often has systemic manifestations.1 It has been found to have activating mutations within the MAPK pathway, in particular, BRAF V600E mutations in more than 60% of the cases.2 Compared to the other subtypes of adult XG, ECD has a worse prognosis, but this has been improved with treatment with vemurafenib, a BRAF inhibitor.3 The stereotypical pathological features of XG include an infiltration of foamy xanthomatous macrophages and Touton giant cells.1
Unconventional use of fractional ablative CO2 laser in necrobiosis lipoidica
Published in Journal of Cosmetic and Laser Therapy, 2019
Anissa Zaouak, Ehsen Ben Brahim, Fatma Daoued, Wafa Koubaa, Houda Hammami, Samy Fenniche
A female patient aged 32 years old with a past medical history of diabetes since 5 years was referred to our department for multiple cutaneous lesions located on her left foot and left leg since 3 years. Dermatological examination revealed multiple annular pigmented lesions with central atrophy in her left leg in addition to two annular erythematous plaques with whitish scales on the dorsum of her left foot (Figure 1(a, b)). According to her history and her clinical findings, necrobiosis lipoidica was suspected and a skin biopsy was performed on the affected skin. Histopathological examination revealed palisading granulomas surrounding large foci of necrobiosis involving the entire dermis and extending into the subcutaneous fat septa confirming the diagnosis of necrobiosis lipoidica.
Necrobiosis Lipoidica in a Patient with β-Thalassemia Major: A Case Report and Review of the Literature
Published in Hemoglobin, 2020
Evangelia Vetsiou, Vasileios Mpouras, Christina Nikolaidou, Philippos Klonizakis, Evdokia Mandala, Kyriakos Vamvakis, Kyriakos Psarras, Efthymia Vlachaki
Necrobiosis lipoidica (NL) is a skin disorder most commonly occurring on the pretibial areas. It is characterized by a hardened, raised area of the skin. Early lesions appear as non-diagnostic erythematous papules. Later, they evolve into annular lesions where the center is characterized by epidermal atrophy usually with a yellowish tint. The area surrounding it is dark pink-brownish with dilated vessels. Necrobiosis lipoidica is most commonly found in patients with DM but can also be associated with other diseases such as rheumatoid arthritis (RA) [2]. In this case report, we present a young female suffering from β-TM who developed NL.