Ginocchio Luke, Draghi Lisa, Darvishian Farbod, Ross Frank L
Luke Ginocchio, BS, is a Medical Student; Lisa Draghi, RPA-c, is a Physician Assistant; and Farbod Darvishian, MD, is Associate Professor, NYU Langone Medical Center, New York, New York. Frank L. Ross, MD, FACS, is Associate Director, Helen L. and Martin S. Kimmel Hyperbaric and Advanced Wound Healing Center; and Associate Professor of Surgery, NYU Langone Medical Center New York, New York.
Adv Skin Wound Care. 2017 Oct;30(10):469-472. doi: 10.1097/01.ASW.0000521867.98577.a5.
To report a case of refractory ulcerated necrobiosis lipoidica (NL) with significant response to treatment with topical tacrolimus.
A 55-year-old woman without diabetes and with a previous history of NL presented to the Helen L. and Martin S. Kimmel Hyperbaric and Advanced Wound Healing Center of NYU Langone Medical Center, New York, with bilateral lower-leg ulcerations resistant to wound healing techniques at other institutions.
Repeat biopsy performed at the author's institution confirmed the diagnosis of NL. Initial therapy was based on reports of other successful treatment methods, which included collagen wound grafts and collagen-based dressings coupled with compression. These methods initially showed promising results; however, the wounds reulcerated, and any gains in wound healing were lost. Alternative options were initiated, including topical clobetasol and narrowband ultraviolet B; however, no significant improvement was observed. The patient's lower-extremity wounds began to deteriorate. The patient also refused systemic therapy. Treatment was changed to topical 0.1% tacrolimus ointment and was applied daily for 10 months with multilayer compression wraps.
Both lower-extremity ulcerations began to show significant improvement, with the ulcers progressing toward closure except for 1 very small area on the left lower extremity.
Topical tacrolimus seems to be an effective treatment option for patients with refractory chronic ulcerated NL who do not want systemic oral therapy. The authors found that successful wound closure may require a multimodal approach, which promotes wound healing, but also concurrently addresses the underlying disease process.
报告一例难治性溃疡性类脂质渐进性坏死（NL）患者，其对局部应用他克莫司治疗有显著反应。
一名55岁女性，无糖尿病史，既往有NL病史，就诊于纽约大学朗格尼医学中心的海伦·L.和马丁·S.金梅尔高压与高级伤口愈合中心，双侧小腿溃疡，在其他机构采用伤口愈合技术治疗无效。
在作者所在机构进行的重复活检确诊为NL。初始治疗基于其他成功治疗方法的报告，包括胶原伤口移植和基于胶原的敷料并结合加压治疗。这些方法最初显示出有希望的结果；然而，伤口再次溃疡，伤口愈合所取得的任何进展都丧失了。开始采用其他治疗方案，包括外用氯倍他索和窄谱中波紫外线；然而，未观察到明显改善。患者下肢伤口开始恶化。患者也拒绝全身治疗。治疗改为局部应用0.1%他克莫司软膏，每天应用，同时使用多层加压绷带，持续10个月。
双下肢溃疡均开始显示出明显改善，溃疡逐渐愈合，仅左下肢有1个非常小的区域除外。
对于不愿接受全身口服治疗的难治性慢性溃疡性NL患者，局部应用他克莫司似乎是一种有效的治疗选择。作者发现，成功的伤口闭合可能需要多模式方法，这种方法既能促进伤口愈合，又能同时解决潜在的疾病过程。
