Necrobiosis lipoidica (NL) is a cutaneous disorder often, but not always, associated with diabetes mellitus. The lesions are distinctive, sharply circumscribed, multicolored plaques occurring on the anterior and lateral surfaces of the lower legs.
It is more common in women, and there are usually several spots. They are slightly raised shiny red-brown patches. The centers are often yellowish and may develop open sores that are slow to heal.
Causes of Necrobiosis Lipoidica
The arteriolar changes in the areas of necrobiosis of the collagen have been thought by some to be precipitated by aggregation of platelets. The granulomatous inflammatory reaction is believed to be due to alterations in the collagen. The severity of NL is not related to the severity of the diabetes mellitus. Furthermore, control of the diabetes has no effect on the course of NL.
Symptoms of Necrobiosis Lipoidica
Usually there are none. The main problem lies in the rather ugly appearance of the discoloured areas. In addition, the skin there is easily broken and heals poorly, so that even minor knocks can lead to painful ulcers.
Diagnosis
The lesions are so distinctive that biopsy confirmation is not necessary; biopsy may be required in early stages to rule out granuloma annulare.
Treatment
Glucocorticoids
Topical The application of potent glucocorticoids under occlusion is helpful in some cases, however, ulcerations may occur when NL is occluded.
lntralesional Intralesional triamcinolone,5 mg/mL into active lesions or lesion margins usually arrests extension of plaques of NL. This is the best treatment, with 3 to 5 mg/ml triamcinolone suspension.
Ulceration Most ulcerations within NL lesions heal with local wound care; if not, excision of entire lesion with grafting may be required.
Simple pain killing tablets will help with pain from ulcers.
Ultraviolet light treatment has been found to control this condition when it is flaring.
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