title: Necrobiosis lipoidica therapy with biologicals: an ulcerated case responding to etanercept and a review of the literature.
abstract: Necrobiosis lipoidica (NL) is an idiopathic chronic granulomatous skin condition. There is currently no standardized effective treatment of NL. Ulceration occurs in up to 35% of cases. Treatment of ulcerative lesions is challenging and often unsuccessful. On the basis of the implication of the tumor necrosis factor alpha (TNF-alpha) on the formation of granulomas, since 2003 anti-TNF-alpha agents have been employed in cases of NL refractory to other therapeutic agents. We report a 50-year-old white woman with treatment-resistant chronic ulcerative NL of both shins successfully treated with subcutaneous etanercept. A review of the published literature suggests that biological agents (etanercept and infliximab) should be considered as a therapeutic alternative mainly in ulcerative NL unresponsive to prior conventional regimens. The dose and duration of treatment with these agents is not defined, therefore it is required to report management of these patients in order to develop an optimal therapeutic strategy.
authors.affiliation: Department of Dermatology, Complejo Asistencial de León, León, Spain. osuamo@yahoo.es
authors.forename: Oscar
authors.initials: O
authors.lastname: Suárez-Amor
authors.forename: Alicia
authors.initials: A
authors.lastname: Pérez-Bustillo
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Ruiz-González
authors.forename: Manuel Angel
authors.initials: MA
authors.lastname: Rodríguez-Prieto
mesh_terms: D000293:Adolescent; D000328:Adult; D000369:Aged, 80 and over; D001327:Autoimmune Diseases / Q000150:complications; D001688:Biological Products / Q000627:therapeutic use*; D002908:Chronic Disease; D015897:Comorbidity; D003879:Dermatologic Agents / Q000627:therapeutic use*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D000068800:Etanercept; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000150:complications; D007074:Immunoglobulin G / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007871:Leg Ulcer / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009335:Necrobiosis Lipoidica / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D001688:Biological Products; D003879:Dermatologic Agents; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept