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(physiology) the normal degeneration and death of living cells (as in various epithelial cells) (同)cell_death

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/07/16 17:33:55」(JST)

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Necrobiosis lipoidica is a necrotising skin condition that usually occurs in patients with diabetes but can also be associated with Rheumatoid Arthritis.^[1] In the former case it may be called necrobiosis lipoidica diabeticorum (NLD). NLD occurs in approximately 0.3% of the diabetic population, with the majority of sufferers being women (approximately 3:1 females to males affected).

The severity or control of diabetes in an individual does not affect who will or will not get NLD.^[2] Better maintenance of diabetes after being diagnosed with NLD will not change how quickly the NLD will resolve.

Signs and symptoms

NL/NLD most frequently appears on the patient's shins, often on both legs, although it may also occur on forearms, hands, trunk, and, rarely, nipple, penis, and surgical sites. The lesions are often asymptomatic but may become tender and ulcerate when injured. The first symptom of NL is often a "bruised" appearance (erythema) that is not necessarily associated with a known injury. The extent to which NL is inherited is unknown.

NLD appears as a hardened, raised area of the skin. The center of the affected area usually has a yellowish tint while the area surrounding it is a dark pink. It is possible for the affected area to spread or turn into an open sore. When this happens the patient is at greater risk of developing ulcers. If an injury to the skin occurs on the affected area, it may not heal properly or it will leave a dark scar.

Pathophysiology

Although the exact cause of this condition is not known, it is an inflammatory disorder characterised by collagen degeneration, combined with a granulomatous response. It always involves the dermis diffusely, and sometimes also involves the deeper fat layer. Commonly, dermal blood vessels are thickened (microangiopathy).^[2]

It can be precipitated by local trauma, though it often occurs without any injury.^[3]

Diagnosis

Micrograph showing necrobiosis lipoidica in a punch biopsy.

NL is diagnosed by a skin biopsy, demonstrating superficial and deep perivascular and interstitial mixed inflammatory cell infiltrate (including lymphocytes, plasma cells, mononucleated and multinucleated histiocytes, and eosinophils) in the dermis and subcutis, as well as necrotising vasculitis with adjacent necrobiosis and necrosis of adnexal structures. Areas of necrobiosis are often more extensive and less well defined than in granuloma annulare. Presence of lipid in necrobiotic areas may be demonstrated by Sudan stains. Cholesterol clefts, fibrin, and mucin may also be present in areas of necrobiosis. Depending on the severity of the necrobiosis, certain cell types may be more predominant. When a lesion is in its early stages, neutrophils may be present, whereas in later stages of development lymphocytes and histiocytes may be more predominant.

Treatment

There is no clearly defined cure for necrobiosis.^[4] Although there are some techniques that can be used to diminish the signs of necrobiosis such as a steroid cream or injection into the affected area, this process may be effective for only a small amount of those treated.

References

^ James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0.
^ ^a ^b Klaus J. Busam (15 January 2009). Dermatopathology. Elsevier Health Sciences. p. 54. ISBN 978-0-443-06654-2. Retrieved 22 August 2011.
^ Michael I. Greenberg (2005). Greenberg's text-atlas of emergency medicine. Lippincott Williams & Wilkins. p. 416. ISBN 978-0-7817-4586-4. Retrieved 22 August 2011.
^ AOCD Website

External links

Information and image at NIH
Image AOCD

UpToDate Contents

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1. リポイド類壊死症 necrobiosis lipoidica
2. サルコイドーシスの皮膚症状 cutaneous manifestations of sarcoidosis
3. 1型糖尿病を有する小児および思春期の患者における合併症およびスクリーニング complications and screening in children and adolescents with type 1 diabetes mellitus
4. 環状肉芽腫 granuloma annulare
5. 壊疽性膿皮症：病因、臨床症状、および診断 pyoderma gangrenosum pathogenesis clinical features and diagnosis

English Journal

Treatment of intractable skin ulcers caused by vascular insufficiency with allogeneic cultured dermal substitute: a report of eight cases.

Taniguchi T, Amoh Y, Tanabe K, Katsuoka K, Kuroyanagi Y.SourceDepartment of Dermatology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan, jksmhtt@gmail.com.
Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs.J Artif Organs.2011 Aug 23. [Epub ahead of print]
Chronic leg ulcers have various causes and can be difficult to treat, although topical treatments, including basic fibroblast growth factor and PGE1, have been used. We applied an allogeneic cultured dermal substitute (CDS) to eight patients with intractable ulcers. The patients had various underlyi
PMID 21861088

Japanese Journal

症例報告静脈に沿って分枝状を呈したリポイド類壊死の1例

大野美咲,佐藤良博,寺木祐一 [他]
臨床皮膚科 65(7), 497-500, 2011-06
NAID 40018874324

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リンク元	「リポイド類壊死症」「脂肪類壊死症」「類脂質性壊死症」
拡張検索	「necrobiosis lipoidica diabeticorum」
関連記事	「necrobiosis」