Necrobiosis lipoidica

Abstract

Necrobiosis lipoidica and granuloma annulare are granulomatous skin conditions that have been traditionally associated with diabetes mellitus, although recently the strength of association has been questioned. In the first section of this two-part article, we describe the suggested aetiology, clinical features, histology and treatment of necrobiosis lipoidica. It is found in 0.3% of patients with diabetes, but has also been reported with other systemic conditions. Clinically it appears as a waxy, atrophic, yellowish plaque with overlying telangiectasia and a brown border. Although usually asymptomatic, it may be extremely painful, especially if ulcerated. Squamous cell carcinoma has occasionally been reported with longstanding lesions. Treatment is often difficult: numerous topical and systemic agents have been employed, but evidence is limited to small case series and individual case reports. Br J Diabetes 2016;16:6-9

Atypical Ulcerative Necrobiosis Lipoidica Diabeticorum: A Case Study

“…7 It may be difficult to conduct a large study with a rare condition such as this. It has also been previously shown that many NLD patients have elevated HgbA1c at time of presentation, 13 as in this patient, which seems to suggest glucose control playing a role in NLD, but this finding may simply be a reactionary stress response over time to this skin condition. At this point, the relationship between the elevated HgbA1c at time of presentation and NLD remains elusive.…”

“…These treatments can include several mentioned above and others like doxycycline, hydroxychloroquine, and colchicine. 13 In this case, the patient had already been using a suggested treatment for NLD. The patient was taking pentoxifylline when the lesions developed and the wounds worsened while she was taking the medication, leading to the conclusion, that for this patient, the medication did not have a benefit.…”

“…Steroid use is common with nonulcerated lesions because they decrease the inflammation seen in NLD and can be combined with other treatments to promote healing of the lesions. 13 Steroids need to be used with caution near atrophic skin, since they can cause ulceration. Care also needs to be used when placing topical steroids under an occlusion dressing because this has also been shown to lead to ulceration.…”

“…14 Pentoxifylline, antitumor necrosis factor-α therapy, ultraviolet A1 phototherapy, aspirin, dipyridamole (antiplatelet therapy), topical tacrolimus, and fumaric acid esters are additional treatments that have been suggested. 6,13 Since steroid use can make ulcerated lesions worse, other treatments need to be considered when dealing with these types of lesions. These treatments can include several mentioned above and others like doxycycline, hydroxychloroquine, and colchicine.…”

“…These treatments can include several mentioned above and others like doxycycline, hydroxychloroquine, and colchicine. 13…”