Necrobiosis Lipoidica Diabeticorum

Definition

Necrobiosis lipoidica diabeticorum is a rash that occurs on the lower legs. It is more common in women, and there are usually several spots. In 1929, Oppehhein first described necrobiosis lipoidica diabeticorum and called it dermatitis atrophicans lipoidica diabetica, but it was later renamed necrobiosis lipoidica diabeticorum by Urbach in 1932. NLD is much more common in diabetics, who account for perhaps 2/3 of all cases. Many of the remainder develops diabetes, and NLD should be considered a warning sign of diabetes. Reports vary widely on exactly who is most at risk. About 1% of diabetics have some degree of NLD ... plus or minus 1%, depending on which report you read. Some reports say NLD occurs more often in young women, but some textbooks disagree. It is disease of the dermal connective tissue characterized by the development of erythematous papules or nodules in the pretibial area. The papules form plaques covered with telangiectatic vessels.

Causes

1. The most important cause of Necrobiosis lipoidica diabeticorum is diabetes. Almost 70% of total cases are in those patients who have diabetes.
2. Necrobiosis lipoidica diabeticorum has another cause as sex. Women are mostly caused by this disease. It is 3 times more common in women than in men.
3. High glucose causes the body to lose fluid, allowing the skin to dry and crack. It also acts as a fuel for infections and helps infection spread to other parts of the body.
4. High blood pressure may worsen other diabetic risk factors.
5. Trauma and inflammatory and metabolic changes may be a possible etiology.

Symptoms

1. The average age of onset is 30 years, but it can occur at any age. The age of onset ranges from infancy to the eighth decade.
2. In this disease collagen degeneration with a granulomatous response, thickening of blood vessel walls, and fat deposition occur.
3. There may be severe pain in the area of influence of the disease.
4. In the starting the skin may appear reddened, bronzed, bruised, or purple. Later it may Progress to dusky, dark color.
5. There may be bleeding in the skin.
6. The other symptoms may be destruction of sebaceous glands, tiny glands in the skin that secrete oil.
7. The plaques spread slowly and may be to the size of several centimeters.

Treatment

1. Protection of the legs with elastic support stockings and leg rest may be helpful.
2. Necrobiosis lipoidica diabeticorum responds to topical cortisone preparations well sometimes and it can be used.
3. Ultraviolet light treatment has been found to control this condition when it is flaring. It is quite useful in the condition when the disease is in mid way. It is expensive and less available treatment.
4. Cortisone injections can also be used to treat necrobiosis lipoidica diabeticorum.
5. A baby aspirin each day and other medications that thin the blood such as Trental helps in reducing necrobiosis lipoidica diabeticorum to some extent.
6. Excision and grafting have been successful, but recurrence may occur secondary to the underlying vascular damage. Poor healing of the graft site is not uncommon.