A Breakthrough in the Treatment of Necrobiosis Lipoidica? Update on Treatment, Etiopathogenesis, Diagnosis, and Clinical Presentation.

Necrobiosis lipoidica (NL) is a rare granulomatous disease of a not fully understood etiopathogenesis. Classically, NL is associated with insulin-dependent diabetes mellitus. The disease often fails to respond to conventional treatments and adversely affects patients' quality of life. First-line medications are usually topical corticosteroids, but patients respond to them with varying degrees of success. Other options include tacrolimus, phototherapy, cyclosporine, fumaric acid esters, and biologics (adalimumab, etanercept, and infliximab). Our review aims to present new therapeutic approaches potentially effective in patients with refractory lesions, describe the presumed etiopathogenesis, and provide diagnostic guidance for clinicians. The review concludes that Janus kinase inhibitors and biologics such as ustekinumab and secukinumab can be used effectively in patients with recalcitrant NL. Another promising treatment option is tapinarof (an aryl hydrocarbon receptor agonist). However, studies on larger groups of patients are still needed to evaluate the effectiveness of different therapeutic options and to define consistent treatment regimens for NL. It is advisable to improve the awareness of physicians of various specialties regarding necrobiosis lipoidica as lesions diagnosed earlier usually have a better response to treatment.

Evaluation of imaging methods in cerebral toxoplasmosis.

Cerebral toxoplasmosis is a parasitic disease resulting, in most cases, from a reactivation of a latent cyst with Toxoplasma gondii. The disease mainly affects immunosuppressed individuals, such as HIV (human immunodeficiency virus)-infected patients. Diagnosis is based on specialized antibody testing, clinical symptoms, neuroimaging methods, and histological examination. The gold standard for diagnosis is a brain biopsy, but more often the response to treatment seen in clinical symptoms and neuroimaging studies is sufficient. The imaging features support the diagnosis of cerebral toxoplasmosis and help assess the effectiveness of treatment.