Necrobiosis Lipoidica

From Anvita Health Wiki

Contents 1 Introduction 2 Etiology 3 Epidemiology 4 Clinical-manifestations 5 Laboratory 6 Differential-diagnosis 7 Management 8 More General Terms 9 Additional Terms 10 References

Introduction

• A cutaneous disorder generally associated with diabetes mellitus characterized by distinct, sharply circumscribed, multicolored (red, yellow, brown) plaques on the anterior & lateral surfaces of the lower extremities.

Etiology

• unknown

Epidemiology

• < 1.0% of diabetics
• > 66% of patients with NL have diabetes
• > 90% of remainder develop glucose intolerance with glucocorticoids

Clinical-manifestations

• well demarcated, multicolored plaques with serpinginous borders evolving slowly over a period of months
• ulceration commonly occur within plaques
• telangiectasias seen within plaque
• lesions persist for years
• burned out lesions appear as tan-brown scars
• lesions generally symmetric
• 80% of lesions pretibial, but may also appear on feet, arms, trunk, face, scalp or in a generalized distribution

Laboratory

• diabetic assessment

• serum glucose
• hemoglobin A1c
• glucose tolerance test a & b are normal

• biopsy

• immunofluorescence shows presence of immunoglobulins & complement C3
• granulomatous infiltration in lower dermis
• microangiopathy with endothelial thickening & focal deposits of PAS+ material

Differential-diagnosis

• sarcoidosis
• granuloma annulare (frequently coexists with NL)
• xanthoma

Management

• topical corticosteroids under occlusion
• intralesional triamcinolone 5mg/ mL generally arrests yellow lesions
• wet to dry dressings for ulcerations

More General Terms

• skin disease (dermatologic disorder, dermatopathy, dermatosis)

Additional Terms

• diabetes mellitus
• granuloma annulare (GA)

References

Color Atlas & Synopsis of Clinical Dermatology, Common & Serious Diseases, 3rd ed, Fitzpatrick et al, McGraw Hill, NY, 1997, pg 422-24

necrobiosis lipoidica diabeticorum [NL]