Title : Use of punch grafting and platelet-rich plasma in treating necrobiosis lipoidica in a Filipino female, a case report

Necrobiosis lipoidica (NL) is a rare inflammatory granulomatous skin disorder often associated with diabetes mellitus, its pathogenesis remains unclear. Ulcerated necrobiosis lipoidica occurs in approximately 15% of NL patients. Various medications and treatment options have been explored; however, none have showed consistent efficacy in treating the condition. Herein, we report a case of a 52-year-old Filipino female with a five-month history of a solitary ulcer on her right lower leg. Histopathology revealed the presence of granulomatous inflammation with a “tiered cake” appearance confirming the diagnosis of necrobiosis lipoidica. Initial management involved the use of topical agents such as clobetasol 0.05% ointment and tacrolimus 0.1% ointment. However, there was note of an increase in size of the ulcer with no improvement in pain reduction. The patient then underwent punch grafting, during which grafts were collected from the donor site (abdomen) and transplanted to the recipient site (ulcer on the right lower leg). The patient was then advised to follow-up on day seven for change of dressing and for her first session of platelet rich plasma (PRP) injections. Change of dressing and PRP injections were done weekly for six consecutive weeks. Both punch grafting and PRP injections are simple, cost-effective treatments that can be performed on an outpatient basis. This study suggests that the combination of punch grafting and platelet-rich plasma injections accelerates wound re-epithelialization, resulting in faster healing and a substantial reduction in pain compared to other treatments.

Dr. Marysia Frances Maliwat Urgel is a senior dermatology resident at Jose R. Reyes Memorial Medical Center. She leads the Pediatric Dermatology Core Team and is an active member of the Psoriasis and Dermato-pathology/Bullous Disease core teams. Dr. Urgel earned her MD from the University of the East Ramon Magsaysay Memorial Medical Center, where she previously served as a post-graduate intern, and completed her BS Biology degree at the University of the Philippines Cebu. A volunteer physician for several national organizations, she has published work on parasitic infections in both international and local journals.