Abstract：
BACKGROUND: Necrobiosis lipoidica (NL) is a chronic granulomatous dermatosis usually affecting the lower limbs, although less common sites have been described. Herein we report a series of cases of NL located on the elbow, with an unusual presentation and occurring after trauma or surgery.
METHODS: Our series includes three men and one woman, with a mean age of 64 years. Three had undergone surgery for elbow bursitis and one had had trauma after a fall from a horse, with exposure of subcutaneous tissue prior to healing. Within 5 years, they had all developed an atrophic erythematous annular plaque with papular and telangiectatic edges, with recurrent episodes of ulceration and scarring. Repeated tests for infectious agents were negative. Histological examinations showed granulomas and necrobiosis with palisading or early-stage palisading. Partial healing was achieved in two patients after 6 months of doxycycline. Treatment with adalimumab resulted in disappearance of the ulcers at 6 months in one patient.
CONCLUSIONS: Unusual sites of NL impose consideration of other types of palisading granuloma or mycobacterial infections, which we were able to rule out. Two other cases of NL of the elbow similar to ours are reported in the literature. These cases, involving multiple ulcerations over a very long period of time, probably constitute a distinct entity because of the very distinct character of these 6 cases. Tetracyclines are partially active and tumour necrosis factor alpha (TNF)-alpha inhibitors may offer an option.
METHODS: Our series includes three men and one woman, with a mean age of 64 years. Three had undergone surgery for elbow bursitis and one had had trauma after a fall from a horse, with exposure of subcutaneous tissue prior to healing. Within 5 years, they had all developed an atrophic erythematous annular plaque with papular and telangiectatic edges, with recurrent episodes of ulceration and scarring. Repeated tests for infectious agents were negative. Histological examinations showed granulomas and necrobiosis with palisading or early-stage palisading. Partial healing was achieved in two patients after 6 months of doxycycline. Treatment with adalimumab resulted in disappearance of the ulcers at 6 months in one patient.
CONCLUSIONS: Unusual sites of NL impose consideration of other types of palisading granuloma or mycobacterial infections, which we were able to rule out. Two other cases of NL of the elbow similar to ours are reported in the literature. These cases, involving multiple ulcerations over a very long period of time, probably constitute a distinct entity because of the very distinct character of these 6 cases. Tetracyclines are partially active and tumour necrosis factor alpha (TNF)-alpha inhibitors may offer an option.
摘要：
背景：脂类坏死菌病（NL）是一种慢性肉芽肿性皮肤病，通常影响下肢，虽然不太常见的网站已经被描述。在这里，我们报告了一系列位于肘部的NL病例，有不寻常的表现，并在外伤或手术后发生。
方法：我们的系列包括三个男人和一个女人，平均年龄64岁。三人接受了肘部滑囊炎手术，一人从马上摔下来后受伤，愈合前皮下组织暴露。五年内,他们都出现了萎缩性红斑环状斑块，有丘疹和毛细血管扩张边缘，反复发作的溃疡和疤痕。对感染因子的重复测试均为阴性。组织学检查显示肉芽肿和坏死伴栅栏或早期栅栏。强力霉素治疗6个月后，两名患者获得了部分愈合。阿达木单抗治疗导致一名患者在6个月时溃疡消失。
结论：NL的异常部位会考虑其他类型的栅栏性肉芽肿或分枝杆菌感染，我们能够排除的。文献中还报道了另外两例与我们相似的肘部NL。这些案件,在很长一段时间内涉及多次溃疡，可能构成一个独特的实体，因为这6个案例的特征非常鲜明。四环素类药物具有部分活性，肿瘤坏死因子α（TNF）-α抑制剂可能提供一种选择。
方法：我们的系列包括三个男人和一个女人，平均年龄64岁。三人接受了肘部滑囊炎手术，一人从马上摔下来后受伤，愈合前皮下组织暴露。五年内,他们都出现了萎缩性红斑环状斑块，有丘疹和毛细血管扩张边缘，反复发作的溃疡和疤痕。对感染因子的重复测试均为阴性。组织学检查显示肉芽肿和坏死伴栅栏或早期栅栏。强力霉素治疗6个月后，两名患者获得了部分愈合。阿达木单抗治疗导致一名患者在6个月时溃疡消失。
结论：NL的异常部位会考虑其他类型的栅栏性肉芽肿或分枝杆菌感染，我们能够排除的。文献中还报道了另外两例与我们相似的肘部NL。这些案件,在很长一段时间内涉及多次溃疡，可能构成一个独特的实体，因为这6个案例的特征非常鲜明。四环素类药物具有部分活性，肿瘤坏死因子α（TNF）-α抑制剂可能提供一种选择。
