Necrobiosis lipoidica diabeticorum


A chronic granulomatous dermatitis, associated with diabetes.

A noninfectious granulomatous skin disorder seen 0.3% of patients with diabetes or impaired glucose tolerance.

These lesions may occur in patients without diabetes, and they may precede diagnosis of diabetes by several years.

Unknown cause.

Most often associated with diabetes mellitus, but can be seen without it.

25% of cases noted before the diagnosis of diabetes.

Yellow brown, telangiectatic plaques with central atrophy, and raised violaceous borders.

Has a classic appearance of sharply demarcated redish-brown plaque with central yellow deposits on the pretibial regions.

Most frequent site of involvement of the shins, or dorsa of the feet.

Lesions may develop ulcerations, telangiectasia, and then atrophic appearance.

30% of cases associated with ulcers.

Rarely squamous cell cancers may develop in older patients with ulcerations.

The characteristic appearance is such that is not always necessary to obtain biopsy confirmation to make diagnosis.

A biopsy may help distinguish such lesions from sarcoidosis and granuloma annulare.

Lesions or chronic and enlarge slowly opened many years.

Some lesions may resolve spontaneously and that may be related to improve glycemic control, however glycemic control does not correlate with disease activity.

Topical and intralesional steroids can slow the progression of active lesions.

Ulcerated necrobiosis lipoidica requires wound care to prevent the development of bacterial superinfection.

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