Online citations, reference lists, and bibliographies.

Clinical Features And Comorbidities Of Patients With Necrobiosis Lipoidica With Or Without Diabetes

David A. Hashemi, Z. Brown-Joel, E. Tkachenko, C. Nelson, M. Noe, S. Imadojemu, R. A. Vleugels, A. Mostaghimi, K. Wanat, M. Rosenbach
Published 2019 · Medicine

Cite This
Download PDF
Analyze on Scholarcy
Share
Importance Necrobiosis lipoidica (NL) is a rare granulomatous condition. Current knowledge of its key features is based on a limited number of studies and case reports, leading to wide variability in the characterization of its defining features, with limited comparison of patients with or without diabetes. Objective To evaluate the epidemiologic characteristics, clinical features, and disease associations of NL in patients with or without type 1 or 2 diabetes. Design, Setting, and Participants This multicenter retrospective review included 236 patients aged 15 to 84 years who were evaluated and received a diagnosis of NL at the University of Pennsylvania Health System between January 1, 2008, and July 15, 2018; University of Iowa Hospitals and Clinics between January 1, 2000, and June 15, 2018; and Brigham and Women’s Hospital and Massachusetts General Hospital between January 1, 2000, and February 15, 2018. Main Outcomes and Measures Patient demographics, clinical features, medical comorbidities, and biopsy status. Results Of the 236 patients with NL, 200 were women and 36 were men, and 182 were white, with a median age at presentation of 50.0 years (interquartile range, 33.0-59.0 years). The diagnosis was biopsy proven in 156 patients (66.1%). Of the 230 patients with location specified, 225 (97.8%) had NL on the lower legs. A total of 138 patients with NL (58.5%; 95% CI, 52.7%-65.3%) had diabetes. The median hemoglobin A1c for patients with diabetes was 8.00% (interquartile range, 6.68%-9.50%) (to convert hemoglobin A1c to proportion of total hemoglobin, multiply by 0.01). Patients with diabetes were significantly younger than patients without diabetes (median age, 45.0 vs 52.0 years; P = .005), and slightly less likely to be female (112 of 138 [81.2%] vs 87 of 96 [90.6%]; P = .046), but lesion characteristics were otherwise comparable. Other notable comorbidities included obesity in 95 of 184 patients (51.6%; 95% CI, 44.4%-58.9%), hypertension in 104 of 230 patients (45.2%), dyslipidemia in 98 of 225 patients (43.6%), and thyroid disease in 56 of 229 patients (24.5%). Conclusions and Relevance This study of NL supports its associations with diabetes as well as obesity, hypertension, dyslipidemia, and thyroid disease. Younger age and female sex were observed more frequently in patients with diabetes. Otherwise, NL lesions in patients with or without diabetes shared many clinical features, suggesting that risk factors outside of elevated blood glucose may play an important role in the disease. Future studies should evaluate these associations with the goal of further elucidating NL’s underlying pathophysiologic characteristics.
This paper references
10.1001/archderm.1966.01600250007001
Necrobiosis lipoidica diabeticorum histopathologic study of 98 cases.
S. Muller (1966)
10.1016/j.jaad.2013.05.034
Update on necrobiosis lipoidica: a review of etiology, diagnosis, and treatment options.
S. D. Reid (2013)
10.1684/ejd.2015.2636
Updated results of 100 patients on clinical features and therapeutic options in necrobiosis lipoidica in a retrospective multicentre study
Cornelia Erfurt-Berge (2015)
10.2337/diab.39.9.1116
Prevalence of Complications in IDDM by Sex and Duration: Pittsburgh Epidemiology of Diabetes Complications Study II
T. Orchard (1990)
10.1016/S0190-9622(88)70076-6
Necrobiosis lipoidica diabeticorum: a clinicopathologic study.
A. J. Boulton (1988)
The prevalence, severity, and impact of painful diabetic peripheral neuropathy in type 2 diabetes
M Davies (2006)
10.1016/j.det.2015.03.003
Necrobiosis Lipoidica.
Cathryn Sibbald (2015)
10.1001/archderm.1966.01600210008002
Necrobiosis lipoidica diabeticorum. A clinical and pathological investigation of 171 cases.
S. Muller (1966)
10.1111/dme.13138
Risk factors for necrobiosis lipoidica in Type 1 diabetes mellitus
E. Hammer (2017)
10.1684/ejd.2012.1839
Update on clinical and laboratory features in necrobiosis lipoidica: a retrospective multicentre study of 52 patients.
Cornelia Erfurt-Berge (2012)
10.1056/NEJM199507133330203
Natural history of peripheral neuropathy in patients with non-insulin-dependent diabetes mellitus.
J. Partanen (1995)
10.1111/ddg.12749
Cofactors and comorbidities of necrobiosis lipoidica: analysis of the German DRG data from 2012
F. Jockenhöfer (2016)
10.2337/diacare.1.3.168
Diabetes Mellitus and Its Degenerative Complications: A Prospective Study of 4,400 Patients Observed Between 1947 and 1973
J. Pirart (1978)
10.1001/archdermatol.2009.6
Treatment of refractory ulcerative necrobiosis lipoidica diabeticorum with infliximab: report of a case.
S. Hu (2009)
Continuing medical education : necrobiosis lipoidica
M. Lowitt (1991)
10.1046/j.1365-2133.1999.02663.x
Necrobiosis lipoidica: only a minority of patients have diabetes mellitus
O'Toole (1999)



This paper is referenced by
Semantic Scholar Logo Some data provided by SemanticScholar