Characteristics of ulcerated and non‐ulcerated necrobiosis lipoidica

Abstract

Background Necrobiosis lipoidica (NL) is complicated by ulceration in up to 35% of cases. Methods Retrospective study of patients with NL seen at our institution between January 1, 1992, and May 25, 2021, was conducted. Ulcerated NL (UNL, n = 83) and non‐ulcerated NL (NUNL, n = 233) groups were compared. Results Twenty‐six percent (83/316) of patients with NL experienced ulceration. UNL was significantly more likely to be painful (52% vs. 36%, P = 0.01), was more likely to have a lesion‐associated cutaneous malignancy (7% vs. 0%, P < 0.001), and had a larger median size (7 vs. 5 cm, P = 0.004) compared to NUNL. Vascular studies were performed on a subset of patients and revealed transcutaneous oxygen pressure (TcPO2) < 40 mm Hg in 53% and venous insufficiency in 62% with no significant differences between UNL and NUNL groups. In patients with unilateral ulceration, mean TcPO2 values (39.7 vs. 46.6 mm Hg), regional perfusion index <0.6 (29% vs. 14%), and TcPO2 < 40 mm Hg (43% vs. 14%) were worse in the ulcerated leg compared to the non‐ulcerated leg, but these differences were not statistically significant. Conclusions UNL was more likely to be painful, develop lesion‐associated malignancy, and be larger in size compared to NUNL. There were no statistically significant differences in venous insufficiency, arterial Doppler/ankle brachial index, or TcPO2 values between UNL and NUNL patients, however, a significant portion of the cohort demonstrated abnormal vascular studies, particularly on TcPO2 and venous insufficiency testing.

Cutaneous Manifestations Associated with Diabetes Mellitus—A Retrospective Study

“…The prevalence of skin involvement does not appear to differ between patients with type 1 and type 2 diabetes. However, it has been found that patients with type 2 diabetes develop skin lesions associated with infections more frequently, whereas patients with type 1 diabetes often have autoimmune skin lesions [ 1 , 4 , 11 ].…”

“…Cutaneous manifestations in diabetes mellitus are varied in nature, appearance and location, but are not always conditioned, as in other metabolic disorders, by elevated blood glucose levels. Sometimes it is even possible to speak of hyperglycemia (cutaneous diabetes) dissociated from hyperglycemia [ 1 , 4 , 11 ].…”

“…In case of superinfection, antibiotics should be administered and special hydrogel dressings, topical growth factors or grafts for epithelization. In ischemic ulcers, surgical revascularization should be used [ 10 , 11 ].…”

“…Other therapeutic options are calcineurin inhibitors, TNF-alpha inhibitors, pentoxifylline, synthetic antimalarials, PUVA. For ulcerated and bacterially superinfected lesions, local antibiotics, emollients, compressive bandaging are used [ 4 , 11 , 12 ].…”