Necrobiosis lipoidica diabeticorum (NLD) is a rare, chronic granulomatous skin disorder primarily affecting individuals with diabetes mellitus. It is characterized by progressive collagen degeneration, inflammation, and the formation of necrotic granulomas, typically presenting as well-demarcated, atrophic, yellowish-orange plaques on the pretibial region. Although most commonly associated with type 1 or type 2 diabetes—seen in approximately 58.5% of cases—it can also occur in patients without diabetes, particularly those with autoimmune or inflammatory conditions such as sarcoidosis, rheumatoid arthritis (RA), inflammatory bowel disease, and hematological disorders. The condition carries significant morbidity due to complications including ulceration, scarring, and an increased risk of cutaneous malignancy. Despite its clinical significance, no standardized treatment exists, and therapeutic options remain largely empirical.
Commonly employed therapies include topical corticosteroids, tacrolimus, systemic immunosuppressants such as methotrexate, cyclosporine, mycophenolate mofetil, and anti-tumor necrosis factor (TNF)-alpha agents. Additional approaches involve phototherapy and pentoxifylline, though efficacy varies widely among patients. Recently, targeted therapies inhibiting the Janus kinase (JAK) signaling pathway have shown promise in managing inflammatory diseases. These orally administered inhibitors block JAK1 and JAK2 enzymes, which are crucial for transmitting cytokine signals from cell surface receptors to the nucleus, thereby regulating numerous proinflammatory mediators involved in immune responses.CLDN1 Protein custom synthesis
We report a case of a 64-year-old woman with long-standing type 1 diabetes (diagnosed in 2001, managed with insulin pump since 2005) who developed NLD lesions on both shins in 2016.PPIL6 Antibody custom synthesis Her diabetes was well-controlled (HbA1c between 6.PMID:34605127 3% and 7.3% since 2014), complicated only by mild peripheral neuropathy. Physical examination revealed erythematous-bordered papules on the right shin and multiple reddish-brown plaques with telangiectasia on the left. Skin biopsy confirmed granulomatous inflammation with necrotic collagen, consistent with NLD diagnosis. Over two years, she received multiple treatments—including topical corticosteroids, tacrolimus, and methotrexate—without noticeable improvement.
In 2017, she developed rheumatoid arthritis with bilateral hand nodules poorly controlled by methotrexate. As second-line therapy, baricitinib, a dual JAK1/JAK2 inhibitor, was initiated at 4 mg daily in December 2018. After six months of treatment, her RA was fully controlled, and remarkably, her NLD lesions had completely resolved. No major adverse effects were observed during follow-up. This represents the first documented case of complete remission of diabetes-associated NLD following baricitinib therapy.
Previous reports have noted successful resolution of NLD-like lesions in patients treated with ruxolitinib (a JAK2 inhibitor) for polycythemia vera, suggesting that modulation of the JAK-STAT pathway may play a key role in the pathogenesis of NLD. Given the rapid onset of action, favorable safety profile, and oral administration of JAK inhibitors, they emerge as a promising therapeutic option for refractory NLD. Further studies are warranted to validate their efficacy and establish guidelines for use in this rare dermatological condition.MedChemExpress (MCE) offers a wide range of high-quality research chemicals and biochemicals (novel life-science reagents, reference compounds and natural compounds) for scientific use. We have professionally experienced and friendly staff to meet your needs. We are a competent and trustworthy partner for your research and scientific projects.Related websites: https://www.medchemexpress.com
