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September 1988, Vol 124, No. 9 >
Article | September 1988

Immunofluorescence, Necrobiosis Lipoidica, and Blood Vessels: Title and subTitle BreakFluorescent Lights in the Tunnels

Mark V. Dahl, MD
[+] Author Affiliations

Department of Dermatology Box 98 University of Minnesota Medical School Minneapolis, MN 55455


Arch Dermatol. 1988;124(9):1417-1419. doi:10.1001/archderm.1988.01670090073017
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In this issue of the Archives, Quimby et al1 discuss the cutaneous immunopathology of necrobiosis lipoidica diabeticorum (NLD). They studied biopsy specimens obtained from 12 patients with NLD by direct immunofluorescence and found the following fluorescing immunoreactants in involved skin of 11 patients: IgM (six patients), C3 (nine patients), IgG (one patient), and IgA (two patients). Even in uninvolved skin, vessels contained deposits. IgM was deposited in vessels in three patients, C3 in four, and IgA in one.

Ullman and I2,3 first examined blood vessels of patients with NLD for the presence of immune deposits a decade ago because the histologic features suggested a vasculopathy. Nonetheless, we were a bit surprised to find them. Immune complexes in vessels are frequently associated with a vasculitis. Yet, the indolent plaques of necrobiosis do not reek with the clinical signs of vasculitis—purpura, edema, and necrosis. Furthermore, the inflammation around blood vessels

REFERENCES

1 +
Quimby SR, Muller SA, Schroeter AL:  The cutaneous immunopathy of necrobiosis lipoidica diabeticorum . Arch Dermatol 1988;;124:1364-1371.
2 +
Dahl MV, Ullman S, Fisher I:  Direct immunofluorescence of granuloma annulare and necrobiosis lipoidica , abstracted. Clin Res 1976;;24:95.
3 +
Ullman S, Dahl MV:  Necrobiosis lipoidica: An immunofluorescence study . Arch Dermatol 1977;;113:1671-1673.
4 +
Umbert P, Winkelmann RK:  Granuloma annulare: Direct immunofluorescence study . Br J Dermatol 1976;;95:487-492.
5 +
Nieboer C, Kalsbeek GL:  Direct immunofluorescence studies in granuloma annulare, necrobiosis lipoidica, and granulomatosis disciformis Miescher . Dermatologica 1979;;158:427-432.
6 +
Laukkanen A, Fräki JE, Väätäinen N, et al:  Necrobiosis lipoidica: Clinical and immunofluorescent study . Dermatologica 1986;;172:89-92.
7 +
Muller SA, Winkelmann RK:  Necrobiosis lipoidica diabeticorum: Histopathologic study of 98 cases . Arch Dermatol 1966;;94: 1-10.
8 +
Laymon CW, Fisher I:  Necrobiosis lipoidica (diabeticorum?): A histologic study and comparison with granuloma annulare . Arch Dermatol 1949;:59:150-167.
9 +
Engel MF, Hammack WJ:  Necrobiosis lipoidica diabeticorum: A biochemical and electrophoretic study . Arch Dermatol 1958;;78:73-81.
10 +
Bauer MF, Hirsh P, Bullock WK, et al:  Necrobiosis lipoidica diabeticorum: A cutaneous manifestation of diabetic microangiopathy . Arch Dermatol 1964;;90:558-566.
11 +
Larsson O:  Studies of small vessels in patients with diabetes: A clinical, histological and immunohistochemical study of diabetic and nondiabetic subjects with special reference to the occurrence of various plasma proteins in the dermal vessel walls . Acta Med Scand Suppl 1967;;480:1-66.
12 +
Fans I, Nielsen HV, Henriksen O, et al:  Impaired autoregulation of blood flow in skeletal muscle and subcutaneous tissue in long-term type I (insulin-dependent) diabetic patients with microangiopathy . Diabetologia 1983;;25:486-488.
13 +
Jílek M, Jaz̆ková Z:  Immunologiske Reaktionen bei Nekrobiosis Lipoidica Diabeticorum . Dermatol Monatsschr 1968;; 154:918-922.
14 +
Engel MF, Smith JG:  The pathogenesis of necrobiosis lipoidica . Arch Dermatol 1960;;82:791-796.
15 +
Josephsen PG, Permin H, Juhl F, et al:  Circulating immune complexes, insulin antibodies, and deposits of immunoglobulins in the skin of diabetes . Dan Med Bull 1986;;33:171-174.
16 +
Abrass CK, Heber D, Lieberman J:  Circulating immune complexes in patients with diabetes mellitus . Clin Exp Immunol 1983;;52:164-172.
17 +
Contreas G, Lernmark A, Methieson ER, et al:  Immune complexes in insulin-dependent diabetes . Biomed Biochim Acta 1985;;44:129-132.
18 +
Eisenbarth GS:  Type I diabetes mellitus: A chronic autoimmune disease . N Engl J Med 1987;;314:1360-1368.
19 +
Dobersen MJ:  Humoral autoimmune aspects of insulindependent (type I) diabetes mellitus . Concepts Immunopathol 1985;;2:47-64.
20 +
Dahl MV, Ullman S, Goltz RW:  Vasculitis in granuloma annulare: Histopathology and direct immunofluorescence . Arch Dermatol 1977;;113:463-467.
21 +
Young AC:  Enhancement of Clq binding activity by IgM rheumatoid factor . J Rheumatol 1985;;12:444-448.
22 +
Dahl MV, Cherney KJ, Jordan RE:  Circulating immune complexes in granuloma annulare , abstracted. Clin Res 1979;; 27:312.
23 +
Rasker JJ, Kuipers FC:  Are rheumatoid nodules caused by vasculitis? A study of 13 early cases . Ann Rheum Dis 1983;;42:384-388.
24 +
Elgor A, Diaz EG, Naparstek E:  Treatment of diabetic necrobiosis with aspirin and dipyridamole . N Engl J Med 1978;; 298:1033.
25 +
Karkavitsas K, Miller JA, David PM, et al:  Aspirin in the management of necrobiosis lipoidica . Acta Derm Venereol 1982;; 62:183.
26 +
Fjellner B:  Treatment of diabetic necrobiosis with aspirin and dipyridamole . N Engl J Med 1978;;299:1366.
27 +
Vinge G, Tornling G:  Treatment of diabetic necrobiosis with aspirin and dipyridamole . N Engl J Med 1978;;299:1366.
28 +
Stratham B, Finlay AY, Marks R:  A randomized double-blind comparison of aspirin-dipyridamole combination vs a placebo in the treatment of necrobiosis lipoidica . Acta Derm Venereol 1981;;61:270-271.
29 +
Graudal C, Anderson AR, Knudsen JB:  En prospectiv dobbelt blind undersogelse over effekten af thrombocytaggregationsh ae immere ved necrobiosis lipoidica diabeticorum . Dansk Dermatol 1982;;15:679.
30 +
Beck HI, Bjerring P, Rasmussen I, et al:  Treatment of necrobiosis lipoidica with low dose acetylsalicylic acid: A randomized double-blind trial . Acta Derm Venereol 1985;;65:230-234.
31 +
Rhodes EL:  Fibrinolytic agents in the treatment of NLD . Angiology 1978;;29:60-64.
32 +
Cunliffe WJ, Menon IS:  Association between cutaneous vasculitis and decreased blood fibrinolytic activity . Br J Dermatol 1971;;84:501-515.
33 +
Handfield JS, Jones SK, Peachey RD:  Nicotinamide treatment in diabetes . Br J Dermatol 1987;;116:277.
34 +
Bonnetblanc JM, Julia A, Rigaud M:  Antithrombotic agents in necrobiosis lipoidica . Acta Derm Venereol 1986;;66:90.
35 +
Rhodes EL:  Fibrinolytic agents in the treatment of necrobiosis lipoidica . Br J Dermatol 1976;;95:673-674.
36 +
Littler CM, Tschen EH:  Pentoxifylline for necrobiosis lipoidica diabeticorum . J Am Acad Dermatol 1987;;17:314-316.
37 +
Dahl MV:  Speculations on the pathogenesis of granuloma annulare . Aust J Dermatol 1985;;26:49-57.

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1 +
Quimby SR, Muller SA, Schroeter AL:  The cutaneous immunopathy of necrobiosis lipoidica diabeticorum . Arch Dermatol 1988;;124:1364-1371.
2 +
Dahl MV, Ullman S, Fisher I:  Direct immunofluorescence of granuloma annulare and necrobiosis lipoidica , abstracted. Clin Res 1976;;24:95.
3 +
Ullman S, Dahl MV:  Necrobiosis lipoidica: An immunofluorescence study . Arch Dermatol 1977;;113:1671-1673.
4 +
Umbert P, Winkelmann RK:  Granuloma annulare: Direct immunofluorescence study . Br J Dermatol 1976;;95:487-492.
5 +
Nieboer C, Kalsbeek GL:  Direct immunofluorescence studies in granuloma annulare, necrobiosis lipoidica, and granulomatosis disciformis Miescher . Dermatologica 1979;;158:427-432.
6 +
Laukkanen A, Fräki JE, Väätäinen N, et al:  Necrobiosis lipoidica: Clinical and immunofluorescent study . Dermatologica 1986;;172:89-92.
7 +
Muller SA, Winkelmann RK:  Necrobiosis lipoidica diabeticorum: Histopathologic study of 98 cases . Arch Dermatol 1966;;94: 1-10.
8 +
Laymon CW, Fisher I:  Necrobiosis lipoidica (diabeticorum?): A histologic study and comparison with granuloma annulare . Arch Dermatol 1949;:59:150-167.
9 +
Engel MF, Hammack WJ:  Necrobiosis lipoidica diabeticorum: A biochemical and electrophoretic study . Arch Dermatol 1958;;78:73-81.
10 +
Bauer MF, Hirsh P, Bullock WK, et al:  Necrobiosis lipoidica diabeticorum: A cutaneous manifestation of diabetic microangiopathy . Arch Dermatol 1964;;90:558-566.
11 +
Larsson O:  Studies of small vessels in patients with diabetes: A clinical, histological and immunohistochemical study of diabetic and nondiabetic subjects with special reference to the occurrence of various plasma proteins in the dermal vessel walls . Acta Med Scand Suppl 1967;;480:1-66.
12 +
Fans I, Nielsen HV, Henriksen O, et al:  Impaired autoregulation of blood flow in skeletal muscle and subcutaneous tissue in long-term type I (insulin-dependent) diabetic patients with microangiopathy . Diabetologia 1983;;25:486-488.
13 +
Jílek M, Jaz̆ková Z:  Immunologiske Reaktionen bei Nekrobiosis Lipoidica Diabeticorum . Dermatol Monatsschr 1968;; 154:918-922.
14 +
Engel MF, Smith JG:  The pathogenesis of necrobiosis lipoidica . Arch Dermatol 1960;;82:791-796.
15 +
Josephsen PG, Permin H, Juhl F, et al:  Circulating immune complexes, insulin antibodies, and deposits of immunoglobulins in the skin of diabetes . Dan Med Bull 1986;;33:171-174.
16 +
Abrass CK, Heber D, Lieberman J:  Circulating immune complexes in patients with diabetes mellitus . Clin Exp Immunol 1983;;52:164-172.
17 +
Contreas G, Lernmark A, Methieson ER, et al:  Immune complexes in insulin-dependent diabetes . Biomed Biochim Acta 1985;;44:129-132.
18 +
Eisenbarth GS:  Type I diabetes mellitus: A chronic autoimmune disease . N Engl J Med 1987;;314:1360-1368.
19 +
Dobersen MJ:  Humoral autoimmune aspects of insulindependent (type I) diabetes mellitus . Concepts Immunopathol 1985;;2:47-64.
20 +
Dahl MV, Ullman S, Goltz RW:  Vasculitis in granuloma annulare: Histopathology and direct immunofluorescence . Arch Dermatol 1977;;113:463-467.
21 +
Young AC:  Enhancement of Clq binding activity by IgM rheumatoid factor . J Rheumatol 1985;;12:444-448.
22 +
Dahl MV, Cherney KJ, Jordan RE:  Circulating immune complexes in granuloma annulare , abstracted. Clin Res 1979;; 27:312.
23 +
Rasker JJ, Kuipers FC:  Are rheumatoid nodules caused by vasculitis? A study of 13 early cases . Ann Rheum Dis 1983;;42:384-388.
24 +
Elgor A, Diaz EG, Naparstek E:  Treatment of diabetic necrobiosis with aspirin and dipyridamole . N Engl J Med 1978;; 298:1033.
25 +
Karkavitsas K, Miller JA, David PM, et al:  Aspirin in the management of necrobiosis lipoidica . Acta Derm Venereol 1982;; 62:183.
26 +
Fjellner B:  Treatment of diabetic necrobiosis with aspirin and dipyridamole . N Engl J Med 1978;;299:1366.
27 +
Vinge G, Tornling G:  Treatment of diabetic necrobiosis with aspirin and dipyridamole . N Engl J Med 1978;;299:1366.
28 +
Stratham B, Finlay AY, Marks R:  A randomized double-blind comparison of aspirin-dipyridamole combination vs a placebo in the treatment of necrobiosis lipoidica . Acta Derm Venereol 1981;;61:270-271.
29 +
Graudal C, Anderson AR, Knudsen JB:  En prospectiv dobbelt blind undersogelse over effekten af thrombocytaggregationsh ae immere ved necrobiosis lipoidica diabeticorum . Dansk Dermatol 1982;;15:679.
30 +
Beck HI, Bjerring P, Rasmussen I, et al:  Treatment of necrobiosis lipoidica with low dose acetylsalicylic acid: A randomized double-blind trial . Acta Derm Venereol 1985;;65:230-234.
31 +
Rhodes EL:  Fibrinolytic agents in the treatment of NLD . Angiology 1978;;29:60-64.
32 +
Cunliffe WJ, Menon IS:  Association between cutaneous vasculitis and decreased blood fibrinolytic activity . Br J Dermatol 1971;;84:501-515.
33 +
Handfield JS, Jones SK, Peachey RD:  Nicotinamide treatment in diabetes . Br J Dermatol 1987;;116:277.
34 +
Bonnetblanc JM, Julia A, Rigaud M:  Antithrombotic agents in necrobiosis lipoidica . Acta Derm Venereol 1986;;66:90.
35 +
Rhodes EL:  Fibrinolytic agents in the treatment of necrobiosis lipoidica . Br J Dermatol 1976;;95:673-674.
36 +
Littler CM, Tschen EH:  Pentoxifylline for necrobiosis lipoidica diabeticorum . J Am Acad Dermatol 1987;;17:314-316.
37 +
Dahl MV:  Speculations on the pathogenesis of granuloma annulare . Aust J Dermatol 1985;;26:49-57.

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