What is the role of TNF-alpha inhibition in the treatment of necrobiosis lipoidica?

Updated: Mar 06, 2020
  • Author: Cheryl J Barnes, MD; Chief Editor: George T Griffing, MD  more...
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Answer

As previously mentioned, TNF-alpha may have a critical role in conditions such as disseminated granuloma annulare and necrobiosis lipoidica. It occurs in high concentrations in the sera and skin in patients with these conditions.

Boyd reported that the thiazolidinedione drug class has been used with some success in necrobiosis lipoidica. These drugs function as potent agonists for the peroxisome proliferator–activated receptor-gamma (PPARgamma). These receptors have been found in adipose tissue and function as important mediators in lipid storage and adipocyte differentiation. [31] PPARgamma activation diminishes TNF-alpha production and inhibits the action of proinflammatory cytokines, which may help healing in necrobiosis lipoidica. [32, 33]

In several case reports, the TNF-alpha inhibitors etanercept, adalimumab, and infliximab were shown to improve chronic granulomatous skin disorders. [34, 35] Infliximab is a chimeric monoclonal antibody that acts to inhibit TNF-alpha. Kolde et al reported infliximab as a successful treatment option for ulcerated necrobiosis lipoidica. [36] Successful treatment of necrobiosis lipoidica with thalidomide, another drug with anti-TNF effects, has also been reported. [37]


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