Does pancreas transplant in diabetic patients affect the evolution of necrobiosis lipoidica?

Necrobiosis lipoidica (NL) is a non-infectious granulomatous skin disorder, with average age of onset is between 30 to 41 years, and female : male ratio of 3 : 1. The strongest systemic disease associated is diabetes mellitus (DM). Many treatment options are used for NL with variable success. To verify if reversal of the diabetic state is related to improvement of NL, we compared the evolution of NL lesions in patients who received a pancreas transplant with those who received a kidney.

Retrospective chart review of diabetic patients with NL who underwent transplant.

A total of fifteen patients were identified and divided into two groups: group I (n = 11) consisted of patients who underwent pancreas only or pancreas plus kidney transplant, group II (n = 4) underwent kidney only transplant. Of the eleven patients in Group I, five had NL lesions at the time of transplant and all achieved resolution of these lesions. One patient experienced recurrence of NL associated with transplant rejection. In group II, one patient who had NL lesions at the time of transplant had persistent lesions after the transplant. Resolution of NL was observed in 45% (five/eleven) of the cases in the pancreas +/- kidney transplant group, whereas the one patient who had active NL and kidney transplant failed to demonstrate improvement of the lesion after the procedure, despite the concomitant use of immunosuppressant therapy.

Patients experienced improvement of NL within 2-8 weeks following pancreas transplantation. Metabolic changes, improvement of the microcirculation and normalization of blood glucose levels may be playing a role in the resolution of NL.