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necrobiosis lipoidica diabeticorum [NLD]
Etiology:
- diabetes mellity
- often occurs in association with diabetic nephropathy &/or diabetic retinopathy [2]
Epidemiology:
1) < 1.0% of diabetics
2) > 66% of patients with NL have diabetes
3) > 90% of remainder develop glucose intolerance with glucocorticoids
Clinical manifestations:
1) well demarcated, multicolored plaques (orange,red, yellow, brown) with serpinginous borders evolving slowly over a period of months
2) ulceration commonly occur within plaques
3) telangiectasias seen within plaque
4) lesions persist for years
5) burned out lesions appear as tan-brown scars
6) lesions generally symmetric
7) 80% of lesions pretibial, but may also appear on feet, arms, trunk, face, scalp or in a generalized distribution
* images [3,4]
Laboratory:
1) diabetic assessment
a) serum glucose
b) hemoglobin A1c
c) glucose tolerance test a & b are normal
2) biopsy
a) immunofluorescence shows presence of immunoglobulins & complement C3
b) granulomatous infiltration in lower dermis
c) microangiopathy with endothelial thickening & focal deposits of PAS+ material
Differential diagnosis:
1) sarcoidosis
2) granuloma annulare (frequently coexists with NL)
3) xanthoma
4) pretibial myxedema
- history of hyperthyroidism Graves disease)
- elephantiasis may develop in pretibial myxedema [2]
Management:
1) topical corticosteroids under occlusion
2) intralesional triamcinolone 5mg/mL generally arrests yellow lesions
3) wet to dry dressings for ulcerations
Related
diabetes mellitus
granuloma annulare (GA)
General
diabetes mellitus complication
necrobiosis lipoidica
References
- Color Atlas & Synopsis of Clinical Dermatology, Common
& Serious Diseases, 3rd ed, Fitzpatrick et al, McGraw Hill, NY,
1997, pg 422-24
- Medical Knowledge Self Assessment Program (MKSAP) 17,
American College of Physicians, Philadelphia 2015
- Barnes CJ, Griffing GT (images)
Medscape: Necrobiosis Lipoidica
http://emedicine.medscape.com/article/1103467-overview
- DermNet NZ. Necrobiosis lipoidica (images)
http://www.dermnetnz.org/dermal-infiltrative/necrobiosis-lipoidica.html