{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T09:19:29Z","timestamp":1790241569042,"version":"4.1.0"},"reference-count":14,"publisher":"Walter de Gruyter GmbH","issue":"6","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,21]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>We present a unique case of necrobiosis lipoidica (NL) arising within a port-wine stain (PWS), which, to our knowledge, has not been previously reported. NL is a rare granulomatous disorder often associated with diabetes mellitus, characterized by chronic inflammation and microvascular dysfunction. PWS, a congenital vascular malformation, results from defective endothelial differentiation and capillary malformation. The coexistence of these conditions suggests a potential link in their pathophysiological mechanisms, including inflammation, endothelial dysfunction, and shared signaling pathways such as mitogen-activated protein kinase (MAPK), phosphoinositide 3-kinase (PI3K), and tumor necrosis factor (TNF)-alpha. Our patient\u2019s NL lesions demonstrated improvement with topical ruxolitinib, a Janus kinase (JAK) inhibitor, after failing conventional therapies, including clobetasol, tacrolimus, and pulsed dye laser. To our knowledge, this is the first reported case of NL successfully treated with topical ruxolitinib monotherapy. This case highlights the emerging role of JAK inhibitors in managing granulomatous disorders and raises intriguing questions about the shared pathophysiologic mechanisms between inflammatory and vascular processes. Further investigation into cytokine dysregulation, immune responses, and targeted therapies for these overlapping pathologies could inform more effective treatment strategies and improve patient outcomes.<\/jats:p>","DOI":"10.1515\/jom-2025-0057","type":"journal-article","created":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T21:03:22Z","timestamp":1759266202000},"page":"257-260","source":"Crossref","is-referenced-by-count":1,"title":["Necrobiosis lipoidica arising in a port wine stain treated with topical ruxolitinib"],"prefix":"10.1515","volume":"126","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-5244-6631","authenticated-orcid":false,"given":"Neena","family":"Edupuganti","sequence":"first","affiliation":[{"name":"Piedmont Macon Medical Center , Macon , , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3544-0279","authenticated-orcid":false,"given":"Jay","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Dermatology , Kansas City University \u2013 GME Consortium\/Advanced Dermatology & Cosmetic Surgery- Orlando Program, Maitland , FL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4593-5785","authenticated-orcid":false,"given":"Fahad","family":"Siddiqui","sequence":"additional","affiliation":[{"name":"Department of Dermatology , Kansas City University \u2013 GME Consortium\/Advanced Dermatology & Cosmetic Surgery- Orlando Program, Maitland , FL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6251-9519","authenticated-orcid":false,"given":"Victoria","family":"Dukharan","sequence":"additional","affiliation":[{"name":"Department of Dermatology , Kansas City University \u2013 GME Consortium\/Advanced Dermatology & Cosmetic Surgery- Orlando Program, Maitland , FL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajiv","family":"Nathoo","sequence":"additional","affiliation":[{"name":"Sun State Dermatology , Maitland , FL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2025,10,1]]},"reference":[{"key":"2026052012500624372_j_jom-2025-0057_ref_001","doi-asserted-by":"crossref","unstructured":"Reid, SD, Ladizinski, B, Lee, K, Baibergenova, A, Alavi, A. Update on necrobiosis lipoidica: a review of etiology, diagnosis, and treatment options. J\u00a0Am Acad Dermatol 2013;69:783\u201391. https:\/\/doi.org\/10.1016\/j.jaad.2013.05.034.","DOI":"10.1016\/j.jaad.2013.05.034"},{"key":"2026052012500624372_j_jom-2025-0057_ref_002","doi-asserted-by":"crossref","unstructured":"Severson, KJ, Costello, CM, Brumfiel, CM, Patel, MH, Butterfield, RJ, Nelson, SA, et al.. Clinical and morphological features of necrobiosis lipoidica. J\u00a0Am Acad Dermatol 2022;86:1133\u20135. https:\/\/doi.org\/10.1016\/j.jaad.2021.04.034.","DOI":"10.1016\/j.jaad.2021.04.034"},{"key":"2026052012500624372_j_jom-2025-0057_ref_003","doi-asserted-by":"crossref","unstructured":"Nihal, A, Caplan, AS, Rosenbach, M, Damsky, W, Mangold, AR, Shields, BE, et al.. Treatment options for necrobiosis lipoidica: a systematic review. Int J Dermatol 2023;62:1529\u201337. https:\/\/doi.org\/10.1111\/ijd.16856.","DOI":"10.1111\/ijd.16856"},{"key":"2026052012500624372_j_jom-2025-0057_ref_004","doi-asserted-by":"crossref","unstructured":"Johnson, E, Patel, MH, Brumfiel, CM, Severson, KJ, Bhullar, P, Boudreaux, B, et al.. Histopathologic features of necrobiosis lipoidica. J\u00a0Cutan Pathol 2022;49:692\u2013700. https:\/\/doi.org\/10.1111\/cup.14238.","DOI":"10.1111\/cup.14238"},{"key":"2026052012500624372_j_jom-2025-0057_ref_005","doi-asserted-by":"crossref","unstructured":"Hwang, AS, Kechter, JA, Li, X, Hughes, A, Severson, KJ, Boudreaux, B, et al.. Topical ruxolitinib in the treatment of necrobiosis lipoidica: a prospective, open-label study. J\u00a0Invest Dermatol 2024;144:1994\u20132001.e4. https:\/\/doi.org\/10.1016\/j.jid.2023.11.027.","DOI":"10.1016\/j.jid.2023.11.027"},{"key":"2026052012500624372_j_jom-2025-0057_ref_006","doi-asserted-by":"crossref","unstructured":"Damsky, W, Singh, K, Galan, A, King, B. Treatment of necrobiosis lipoidica with combination janus kinase inhibition and intralesional corticosteroid. JAAD Case Rep 2020;6:133\u20135. https:\/\/doi.org\/10.1016\/j.jdcr.2019.11.016.","DOI":"10.1016\/j.jdcr.2019.11.016"},{"key":"2026052012500624372_j_jom-2025-0057_ref_007","doi-asserted-by":"crossref","unstructured":"Lee, JJ, English, JC3rd. Improvement in ulcerative necrobiosis lipoidica after janus kinase-inhibitor therapy for polycythemia vera. JAMA Dermatol 2018;154:733\u20134. https:\/\/doi.org\/10.1001\/jamadermatol.2018.0756.","DOI":"10.1001\/jamadermatol.2018.0756"},{"key":"2026052012500624372_j_jom-2025-0057_ref_008","doi-asserted-by":"crossref","unstructured":"Barbet-Massin, MA, Rigalleau, V, Blanco, P, Mohammedi, K, Poupon, P, Belin, E, et al.. Remission of necrobiosis lipoidica diabeticorum with a JAK1\/2 inhibitor: a case report. 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Improvement of necrobiosis lipoidica with topical ruxolitinib cream after prior nonresponse to compounded topical tofacitinib cream. JAAD Case Rep 2022;29:25\u20136. https:\/\/doi.org\/10.1016\/j.jdcr.2022.08.028.","DOI":"10.1016\/j.jdcr.2022.08.028"},{"key":"2026052012500624372_j_jom-2025-0057_ref_012","doi-asserted-by":"crossref","unstructured":"Vural, E, Ramakrishnan, J, Cetin, N, Buckmiller, L, Suen, JY, Fan, CY, et al.. The expression of vascular endothelial growth factor and its receptors in port-wine stains. Otolaryngol Head Neck Surg 2008;139:560\u20134. https:\/\/doi.org\/10.1016\/j.otohns.2008.07.015.","DOI":"10.1016\/j.otohns.2008.07.015"},{"key":"2026052012500624372_j_jom-2025-0057_ref_013","doi-asserted-by":"crossref","unstructured":"Nguyen, V, Hochman, M, Mihm, MCJr, Nelson, JS, Tan, W. The pathogenesis of port wine stain and sturge weber syndrome: complex interactions between genetic alterations and aberrant MAPK and PI3K activation. 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