​Dermatology - Necrobiosis Lipoidica

​Dermatology - Necrobiosis Lipoidica
Necrobiosis lipoidica is a skin condition that frequently, although not always, occurs in individuals with diabetes mellitus. It typically affects young adults, but is also seen in juvenile diabetics. Women are afflicted with this condition at a rate three times higher than that of men. 33.3% of patients exhibit clinical diabetes, 33.3% display abnormal glucose tolerance only, and the remaining 33.3% have normal glucose tolerance.
The severity of diabetes is not correlated with the severity or management of the disease.


Necrobiosis lipoidica exhibits a gradual progression and increases in size over the course of several months, being present for a prolonged period of years.
The presence of cosmetic deformity and the development of ulcers in lesions can cause significant pain.

The lesion initially appears as a papule that is either brownish red or skin-colored. Over time, it gradually transforms into a well-defined waxy plaque of varying size. The border is distinct and slightly raised, maintaining a brownish-red tone, while the center becomes depressed and takes on a yellow-orange tint. Multiple telangiectasias of varying sizes can be observed through the glossy and atrophic epidermis. Centrifugal expansion leads to the formation of larger lesions. The combination of lesser lesions results in a serpiginous or polycyclic pattern. Ulceration can develop inside the plaques, and when these ulcers heal, they leave behind depressed scars. The burned-out lesions exhibit a tan coloration and are accompanied by telangiectasia.
The number of lesions typically ranges from 1 to 3, with over 80% appearing on the shin. Occasionally, the lesions may exhibit symmetry.
Occasionally, lesions can also appear on the feet, arms, trunk, or face and scalp; although it is rare, they may also be widespread.

Biopsy confirmation is not necessary due to the highly distinctive nature of the lesions. However, in the early stages, a biopsy may be needed to eliminate the possibility of granuloma annulare (which often occurs together), sarcoidosis, or xanthoma.

Topical glucocorticoids used in conjunction with occlusion can be beneficial. However, it is important to note that occlusion may lead to the development of ulcerations. Injecting 5 mg/mL of triamcinolone directly into active lesions or the edges of lesions typically stops the spread of plaques. The majority of ulcerations can be treated successfully with local wound care. However, if this approach is not effective, it may be necessary to surgically remove the entire lesion and perform a grafting procedure.