title: Intralesional infliximab in noninfectious cutaneous granulomas: three cases of necrobiosis lipoidica.
abstract: BACKGROUND
  Necrobiosis lipoidica is a rare granulomatous noninfectious skin disease. Treatment of this chronic debilitating disease is of importance because ulceration of the plaques may induce important psychological and physical morbidity.
  
  
  OBJECTIVE
  Infliximab, an anti-TNF-α chimeric monoclonal antibody used intravenously and intralesionally for other extradermatological granulomatous diseases including Crohn's disease and sarcoidosis, was administered by intradermal injection in necrobiosis lipoidica. The aim of this study was to evaluate the efficacy and safety profile of a locally delivered drug compared to its systemic use.
  
  
  METHODS
  Weekly injections of intralesional infliximab for 3 weeks were followed by a 1-week treatment interruption. This treatment schedule was repeated thrice.
  
  
  RESULTS
  Two patients who benefitted from complete treatment experienced almost complete remission for up to 18 months. The third patient, who had treatment interruptions, showed partial improvement. No serious side effects were noticed, although the injections caused pain.
  
  
  CONCLUSIONS
  This is the first report about the efficacy and safety of a therapy consisting of intralesional injections of infliximab for a granulomatous skin disease. Although this approach was clearly effective for necrobiosis lipoidica, the disease recurred several months after treatment interruption, raising the question of the need for maintenance therapy. Further controlled long-term trials are thus necessary.
authors.affiliation: Department of Clinical Specialities, Dermatology, University Hospital of Geneva, Geneva, Switzerland. caroline.barde@hcuge.ch
authors.forename: C
authors.initials: C
authors.lastname: Barde
authors.forename: E
authors.initials: E
authors.lastname: Laffitte
authors.forename: A
authors.initials: A
authors.lastname: Campanelli
authors.forename: J-H
authors.initials: JH
authors.lastname: Saurat
authors.forename: A-M
authors.initials: AM
authors.lastname: Thielen
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D003879:Dermatologic Agents / Q000008:administration & dosage*; D005260:Female; D006099:Granuloma / Q000188:drug therapy*; D006801:Humans; D000069285:Infliximab; D015552:Injections, Intralesional; D008297:Male; D009335:Necrobiosis Lipoidica / Q000188:drug therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D003879:Dermatologic Agents; D000069285:Infliximab