Laser and light therapies for the treatment of necrobiosis lipoidica
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REVIEW ARTICLE
Laser and light therapies for the treatment of necrobiosis lipoidica Ali Rajabi-Estarabadi 1 & Divya J. Aickara 1 & Melanie Hirsch 1 & Natalie M. Williams 1 & Eric L. Maranda 1 & Evangelos Van Badiavas 1 Received: 16 August 2020 / Accepted: 14 September 2020 # Springer-Verlag London Ltd., part of Springer Nature 2020
Abstract Necrobiosis lipoidica (NL) is a rare, inflammatory granulomatous skin disorder involving collagen degeneration. In recent years, several light and laser therapies have been proposed and used in the treatment of NL with variable outcomes. The aim of the study was to investigate the efficacy and safety of lasers and light therapies for the treatment of NL. A review of PubMed was conducted to search for studies using laser and light therapies for the treatment of NL. Articles that employed a combination of treatment modalities were excluded. Twenty-four studies were reviewed. Light and laser therapies used in these studies included CO2 laser, pulsed dye laser, methyl aminolevulinate (MAL)-photodynamic therapy (PDT), aminolevulinic acid (ALA)-PDT, ultraviolet A1 (UVA1) phototherapy, and psoralen plus ultraviolet-A (PUVA). PUVA was identified as the modality with the most available evidence (7 studies), followed by MAL-PDT and ALA-PDT (5 studies each), pulsed dye laser and UVA1 (3 studies each), and lastly CO2 laser (2 studies). Most modalities demonstrated variable efficacies and side effects with the exception of PDL, which consistently showed successful outcomes. Multiple dermatologic light and laser therapies have been investigated for the treatment of NL, including PUVA, ALA-PDT, MAL-PDT, pulsed dye laser, UVA1, and CO2 laser. However, a clear consensus on the preferred treatment is yet to be addressed. Each treatment option demonstrates both advantages and disadvantages that should be discussed with patients when selecting the treatment modality. Keywords Necrobiosis lipoidica . Phototherapy . Psoralen ultraviolet a therapy . CO2 laser . Pulsed dye laser . PDT . Photodynamic therapy
Introduction Necrobiosis lipoidica (NL) is a rare, inflammatory granulomatous skin disorder involving collagen degeneration. The disease is typically linked to diabetes mellitus; however, it may occur in non-diabetics as well [1]. NL is generally characterized by yellow-brown, atrophic telangiectatic plaques that are commonly found around the pretibial areas. In its earlier stage, lesions appear as small, firm, red-brown papules that form into atrophic plaques over time. NL is usually a clinical diagnosis,
Ali Rajabi-Estarabadi and Divya J. Aickara contributed equally to this work. * Ali Rajabi-Estarabadi [email protected] 1
Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1150 NW 14th St., Miami, FL 33136, USA
but a biopsy may be necessary to differentiate NL from similar-appearing skin diseases such as sarcoidosis, necrobiotic xanthogranuloma, and granuloma annulare [2]. While it is believed that the primary cause of NL is
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