Necrobiosis Lipoidica Medication

  • Author: Cheryl J Barnes, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Feb 3, 2012
 

Medication Summary

Double-blind studies of the treatment of necrobiosis lipoidica with aspirin and dipyridamole have had varied results but overall have shown some beneficial effects from the therapy. The treatment is based on a theory that necrobiosis lipoidica results from platelet-mediated vascular occlusion or immune mechanisms that alter platelet survival.[22] These drugs are thought to prolong platelet survival time and, hence, prevent further worsening of necrobiosis lipoidica.

Littler and Tschen described the successful use of pentoxifylline to treat a case of necrobiosis lipoidica.[23] Pentoxifylline inhibits platelet aggregation and is believed to decrease blood viscosity by increasing fibrinolysis and red blood cell deformity.

Uncontrolled studies have suggested that ticlopidine,[13] nicotinamide,[14] clofazimine,[15, 16] and perilesional heparin injections[17] can benefit some patients with necrobiosis lipoidica.

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Hemorheologic Agents

Class Summary

These agents reduce complications resulting from increased blood viscosity.

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Pentoxifylline (Trental)

 

Pentoxifylline may alter the rheology of red blood cells, consequently reducing blood viscosity. It increases fibrinolysis and red blood cell deformity and also inhibits platelet aggregation.

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Antiplatelet Agents

Class Summary

These drugs inhibit platelet aggregation. The drugs are thought to prolong platelet survival time and, hence, prevent further worsening of necrobiosis lipoidica. They also help prevent cerebrovascular accidents and improve renal and systemic function.

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Ticlopidine

 

Ticlopidine is a second-line antiplatelet therapy for patients who fail aspirin therapy.

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B Vitamins

Class Summary

These agents may inhibit the synthesis of low-density lipoprotein and very-low-density lipoprotein. This inhibition results in a decrease of total plasma cholesterol. Nicotinamide, and not niacin or other niacin preparations, is a treatment option.[14] Nicotinamide is the physiologically active form of niacin, vitamin B-3. Unlike niacin, nicotinamide in high doses does not lower lipid levels or cause flushing. However, it does exert significant anti-inflammatory effects.

Nicotinamide

 

Nicotinamide moderates inflammatory reactions by inhibiting leukocytic chemotaxis and leukocytic release of lysosomal enzymes. It has been shown to inhibit lymphocytic transformation, antibody production, and mast cell degranulation.[31]

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Immunomodulators

Class Summary

Immunomodulators inhibit key factors responsible for the inflammatory response to tissue insult.

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Clofazimine (Lamprene)

 

Clofazimine is known to have anti-inflammatory properties in controlling erythema nodosum leprosum reactions, but its mechanism of action is unknown.

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Anticoagulants, Hematologic

Class Summary

Anticoagulants inhibit the formation of blood clots resulting from blood disorders.

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Heparin

 

Heparin augments the activity of antithrombin III and prevents the conversion of fibrinogen to fibrin. It does not actively lyse, but it can inhibit further thrombogenesis. Heparin prevents the reaccumulation of clots after spontaneous fibrinolysis.

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Retinoid-like Agents, Topical

Class Summary

Retinoids regulate cell growth and differentiation.

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Tretinoin topical (Avita, Retin-A, Tretin-X, Atralin)

 

Tretinoin inhibits microcomedo formation and eliminates existing lesions. It makes keratinocytes in sebaceous follicles less adherent and easier to remove. The drug is available as a 0.025%, 0.05%, or 0.1% cream and as a 0.01% or 0.025% gel.

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Contributor Information and Disclosures
Author

Cheryl J Barnes, MD  Dermatologist, McIntosh Clinic, PC

Cheryl J Barnes, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Loretta Davis, MD  Professor, Department of Internal Medicine, Division of Dermatology, Medical College of Georgia

Loretta Davis, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

David F Butler, MD Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Edward F Chan, MD Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Gregory J Raugi, MD, PhD Professor, Department of Internal Medicine, Division of Dermatology, University of Washington at Seattle; Chief, Dermatology Section, Primary and Specialty Care Service, Veterans Administration Medical Center of Seattle

Gregory J Raugi, MD, PhD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Lim C, Tschuchnigg M, Lim J. Squamous cell carcinoma arising in an area of long-standing necrobiosis lipoidica. J Cutan Pathol. Aug 2006;33(8):581-3. [Medline].

  2. Clement M, Guy R, Pembroke AC. Squamous cell carcinoma arising in long-standing necrobiosis lipoidica. Arch Dermatol. Jan 1985;121(1):24-5. [Medline].

  3. Rollins TG, Winkelmann RK. Necrobiosis lipoidica granulomatosis. Necrobiosis lipoidica diabeticorum in the nondiabetic. Arch Dermatol. Oct 1960;82:537-43. [Medline].

  4. Miller RA. The Koebner phenomenon. Int J Dermatol. May 1982;21(4):192-7. [Medline].

  5. Mistry N, Chih-Ho Hong H, Crawford RI. Pretibial angioplasia: a novel entity encompassing the clinical features of necrobiosis lipoidica and the histopathology of venous insufficiency. J Cutan Med Surg. Jan-Feb 2011;15(1):15-20. [Medline].

  6. Ullman S, Dahl MV. Necrobiosis lipoidica. An immunofluorescence study. Arch Dermatol. Dec 1977;113(12):1671-3. [Medline].

  7. Clayton TH, Harrison PV. Successful treatment of chronic ulcerated necrobiosis lipoidica with 0.1% topical tacrolimus ointment. Br J Dermatol. Mar 2005;152(3):581-2. [Medline].

  8. Stanway A, Rademaker M, Newman P. Healing of severe ulcerative necrobiosis lipoidica with cyclosporin. Australas J Dermatol. May 2004;45(2):119-22. [Medline].

  9. Spenceri EA, Nahass GT. Topically applied bovine collagen in the treatment of ulcerative necrobiosis lipoidica diabeticorum. Arch Dermatol. Jul 1997;133(7):817-8. [Medline].

  10. De Rie MA, Sommer A, Hoekzema R, Neumann HA. Treatment of necrobiosis lipoidica with topical psoralen plus ultraviolet A. Br J Dermatol. Oct 2002;147(4):743-7. [Medline].

  11. Beattie PE, Dawe RS, Ibbotson SH, Ferguson J. UVA1 phototherapy for treatment of necrobiosis lipoidica. Clin Exp Dermatol. Mar 2006;31(2):235-8. [Medline].

  12. Heidenheim M, Jemec GB. Successful treatment of necrobiosis lipoidica diabeticorum with photodynamic therapy. Arch Dermatol. Dec 2006;142(12):1548-50. [Medline].

  13. Rhodes EL. Necrobiosis lipoidica treated with ticlopidine. Acta Derm Venereol. 1986;66(5):458. [Medline].

  14. Handfield-Jones S, Jones S, Peachey R. High dose nicotinamide in the treatment of necrobiosis lipoidica. Br J Dermatol. May 1988;118(5):693-6. [Medline].

  15. Mensing H. [Clofazimine--therapeutic alternative in necrobiosis lipoidica and granuloma anulare]. Hautarzt. Feb 1989;40(2):99-103. [Medline].

  16. Benedix F, Geyer A, Lichte V, Metzler G, Rocken M, Strölin A. Response of ulcerated necrobiosis lipoidica to clofazimine. Acta Derm Venereol. Nov 2009;89(6):651-2. [Medline].

  17. Jetton RL, Lazarus GS. Minidose heparin therapy for vasculitis of atrophie blanche. J Am Acad Dermatol. Jan 1983;8(1):23-6. [Medline].

  18. Heymann WR. Necrobiosis lipoidica treated with topical tretinoin. Cutis. Jul 1996;58(1):53-4. [Medline].

  19. Durupt F, Dalle S, Debarbieux S, Balme B, Ronger S, Thomas L. Successful treatment of necrobiosis lipoidica with antimalarial agents. Arch Dermatol. Jan 2008;144(1):118-9. [Medline].

  20. Marr TJ, Traisman HS, Griffith BH, Schafer MA. Necrobiosis lipoidica diabeticorum in a juvenile diabetic: treatment by excision and skin grafting. Cutis. Mar 1977;19(3):348-50. [Medline].

  21. Moreno-Arias GA, Camps-Fresneda A. Necrobiosis lipoidica diabeticorum treated with the pulsed dye laser. J Cosmet Laser Ther. Sep 2001;3(3):143-6. [Medline].

  22. Eldor A, Diaz EG, Naparstek E. Treatment of diabetic necrobiosis with aspirin and dipyridamole. N Engl J Med. May 4 1978;298(18):1033. [Medline].

  23. Littler CM, Tschen EH. Pentoxifylline for necrobiosis lipoidica diabeticorum. J Am Acad Dermatol. Aug 1987;17(2 Pt 1):314-6. [Medline].

  24. Boyd AS. Treatment of necrobiosis lipoidica with pioglitazone. J Am Acad Dermatol. Nov 2007;57(5 Suppl):S120-1. [Medline].

  25. Yki-Jarvinen H. Thiazolidinediones. N Engl J Med. Sep 9 2004;351(11):1106-18. [Medline].

  26. Ellis CN, Varani J, Fischer GJ, Zeigler ME, Pershadsingh HA, Benson SC, et al. Troglitazone improves psorasis and normalizes models of proliferative skin disease:ligand for perioxisome proliferators-activated receptor - gamma inhibit keratinocyte proliferation. Arch Dermatol. May/2000;136:609-616.

  27. Zeichner JA, Stern DW, Lebwohl M. Treatment of necrobiosis lipoidica with the tumor necrosis factor antagonist etanercept. J Am Acad Dermatol. Mar 2006;54(3 Suppl 2):S120-1. [Medline].

  28. Zhang KS, Quan LT, Hsu S. Treatment of necrobiosis lipoidica with etanercept and adalimumab. Dermatol Online J. Dec 15 2009;15(12):12. [Medline].

  29. Kolde G, Muche JM, Schulze P, Fischer P, Lichey J. Infliximab: a promising new treatment option for ulcerated necrobiosis lipoidica. Dermatology. 2003;206(2):180-1. [Medline].

  30. Kukreja T, Petersen J. Thalidomide for the treatment of refractory necrobiosis lipoidica. Arch Dermatol. Jan 2006;142(1):20-2. [Medline].

  31. Fivenson DP. The mechanisms of action of nicotinamide and zinc in inflammatory skin disease. Cutis. Jan 2006;77(1 Suppl):5-10. [Medline].

 
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Typical presentation of necrobiosis lipoidica on the lower pretibial legs.
Red-brown plaque with yellow atrophic center on lower leg.
 
 
 
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