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Review
. 2024 Mar 20;25(6):3482.
doi: 10.3390/ijms25063482.

A Breakthrough in the Treatment of Necrobiosis Lipoidica? Update on Treatment, Etiopathogenesis, Diagnosis, and Clinical Presentation

Maciej Naumowicz  1 , Stefan Modzelewski  1 , Angelika Macko  1 , Bartosz Łuniewski  1 , Anna Baran  1 , Iwona Flisiak  1
Affiliations
Review

A Breakthrough in the Treatment of Necrobiosis Lipoidica? Update on Treatment, Etiopathogenesis, Diagnosis, and Clinical Presentation

Maciej Naumowicz et al. Int J Mol Sci. .

Abstract

Necrobiosis lipoidica (NL) is a rare granulomatous disease of a not fully understood etiopathogenesis. Classically, NL is associated with insulin-dependent diabetes mellitus. The disease often fails to respond to conventional treatments and adversely affects patients' quality of life. First-line medications are usually topical corticosteroids, but patients respond to them with varying degrees of success. Other options include tacrolimus, phototherapy, cyclosporine, fumaric acid esters, and biologics (adalimumab, etanercept, and infliximab). Our review aims to present new therapeutic approaches potentially effective in patients with refractory lesions, describe the presumed etiopathogenesis, and provide diagnostic guidance for clinicians. The review concludes that Janus kinase inhibitors and biologics such as ustekinumab and secukinumab can be used effectively in patients with recalcitrant NL. Another promising treatment option is tapinarof (an aryl hydrocarbon receptor agonist). However, studies on larger groups of patients are still needed to evaluate the effectiveness of different therapeutic options and to define consistent treatment regimens for NL. It is advisable to improve the awareness of physicians of various specialties regarding necrobiosis lipoidica as lesions diagnosed earlier usually have a better response to treatment.

Keywords: Janus kinase inhibitors; biologics; etiopathogenesis; necrobiosis lipoidica; treatment.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Mechanism of action of JAK inhibitors. (DNA—deoxyribonucleic acid). Based on Kisseleva et al., Roskoski et al. [87,88].
Figure 2
Figure 2
Mechanism of action of tapinarof. (Abbreviations: OVOL1—ovo-like transcriptional repressor 1; ARNT—aryl hydrocarbon receptor nuclear translocator; NRF2—nuclear factor erythroid 2-related factor 2). Based on Furue et al., Bissonnette et al. [103,104,105].
See this image and copyright information in PMC

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