Necrobiosis lipoidica of the scalp

Necrobiosis lipoidica is a chronic granulomatous skin disease of a vascular-exchange nature from the group of localized skin lipoidosis, accompanied by the development of degenerative changes in the connective tissue.

The reason for the development of necrobiosis lipoidica is unknown, but the most common theory remains the theory of vascular disorders, including the deposition of immune complexes (IgM, complement component C3), microangiopathic changes (deposition of a glycoprotein in the walls of blood vessels), as well as other combinations of inflammatory and structural changes leading to collagen degeneration and decreased perfusion and oxygenation of the skin. Necrobiosis lipoidica occurs in association with systemic diseases (sarcoidosis, autoimmune thyroiditis, inflammatory bowel disease, such as ulcerative colitis, and rheumatoid arthritis) and can also occur in otherwise healthy individuals. Necrobiosis lipoidica is closely associated with diabetes mellitus.

The predominant localization of necrobiosis lipoidica is tibial surface of the legs. Atypical localization is: skin of the scalp and face.

Clinical polymorphism of necrobiosis lipoidica, possibility of transition from one form to another, its combination with other dermatoses can pose difficult diagnostic questions for the doctor.

The article describes our own clinical observation of a patient with complaints of rashes on the skin of the legs and scarring alopecia in the scalp. The focus on the scalp had a tendency to grow and signs of development of scarring alopecia. According to the results of a biopsy performed at the Rakhmanov Department of Skin and Veneral Diseases, I.M. Sechenov First Moscow State Medical University, was diagnosed with "Necrobiosis Lipoidica". The case was interesting due to the extreme rarity of rashes on the skin of the scalp and the absence of dermatoscopic features of lesions in this area. Due to ongoing therapy for a month, there was a positive effect in the form of a lack of growth of existing plaques and the appearance of new ones, a decrease in the brightness of the color of the rash, a partial regression with an outcome in residual hyperpigmentation.

Thus, despite the absence of a gold standard in the treatment of necrobiosis lipoidica, the most well-studied group of drugs for the treatment of the disease at the moment are glucocorticoids, which confirms our experience. Therapy of patients with necrobiosis lipoidica should be carried out by an interdisciplinary team (dermatovenereologist, endocrinologist, therapist).