Clinical Improvement of Necrobiosis Lipoidica Diabeticorum with Opzelura (Ruxolitinib) Cream: A Case Report

Main Article Content

Annie Vu
Cheldon Alcantara
Diem Q. Pham

Keywords

opzelura, necrobiosis lipoidica, JAK inhibitor, granulomatous disorders, ruxolitinib

Abstract

Necrobiosis lipoidica (NL) is an idiopathic granulomatous, inflammatory skin disorder, traditionally linked to diabetes mellitus but often occurs independently of glucose metabolism abnormalities. Proposed pathogenic mechanisms include microangiopathy, collagen devitalization, metabolic changes, trauma, and immune dysregulation. Management of NL is limited by data on treatment efficacy but includes high-potency topical steroids, intralesional steroids, topical immunomodulators, psoralen-ultraviolet A photochemotherapy, hydroxychloroquine, or TNF-alpha inhibitors, pentoxifylline, topical ALA-PDT, and more recently Janus kinase (JAK) inhibitors. This case discusses a 66-year-old female with type 2 diabetes that presents with necrobiosis lipiodica diabeticorum (NLD) who was refractory to high-potency topical corticosteroid but showed improvement after use of Opzelura cream.

References

1. Hashemi, D.A., et al., Clinical Features and Comorbidities of Patients With Necrobiosis Lipoidica With or Without Diabetes. JAMA Dermatol, 2019. 155(4): p. 455-459.

2. Sibbald, C., S. Reid, and A. Alavi, Necrobiosis Lipoidica. Dermatol Clin, 2015. 33(3): p. 343-60.

3. Wee, E. and R. Kelly, Pentoxifylline: An effective therapy for necrobiosis lipoidica. Australas J Dermatol, 2017. 58(1): p. 65-68.

4. Borgia, F., et al., Ulcerative necrobiosis lipoidica successfully treated with photodynamic therapy: case report and literature review. Photodiagnosis Photodyn Ther, 2014. 11(4): p. 516-8.

5. Chapman, S., L.S. Gold, and H.W. Lim, Janus kinase inhibitors in dermatology: Part II. A comprehensive review. J Am Acad Dermatol, 2022. 86(2): p. 414-422.

6. Barbet-Massin, M.A., et al., Remission of necrobiosis lipoidica diabeticorum with a JAK1/2 inhibitor: A case report. Diabetes Metab, 2021. 47(4): p. 101143.

7. Damsky, W., et al., Treatment of necrobiosis lipoidica with combination Janus kinase inhibition and intralesional corticosteroid. JAAD Case Rep, 2020. 6(2): p. 133-135.

8. Nugent, S., et al., Improvement of necrobiosis lipoidica with topical ruxolitinib cream after prior nonresponse to compounded topical tofacitinib cream. JAAD Case Rep, 2022. 29: p. 25-26.

9. Janßen, S. and T.M. Jansen, Ulcerated necrobiosis lipoidica successfully treated with tofacitinib. Int J Dermatol, 2022. 61(6): p. 739-741.

10. Lim, C., M. Tschuchnigg, and J. Lim, Squamous cell carcinoma arising in an area of long-standing necrobiosis lipoidica. J Cutan Pathol, 2006. 33(8): p. 581-3.

11. Schwartz, D.M., et al., JAK inhibition as a therapeutic strategy for immune and inflammatory diseases. Nat Rev Drug Discov, 2017. 17(1): p. 78.

12. Roskoski, R., Janus kinase (JAK) inhibitors in the treatment of inflammatory and neoplastic diseases. Pharmacological Research, 2016. 111: p. 784-803.