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NECROBIOSIS LIPOIDICA
NECROBIOSIS LIPOIDICAย ย ICD-10: E14.640
โข Necrobiosis lipoidica (NL) is a cutaneous disorder often, but not always, associated with diabetes mellitus.
โข Young adults, early middle age, but not uncommon in juvenile diabetics. Female to male ratio: 3:1.
โข Incidence: From 0.3% to 3% of diabetic individuals. One-third of patients have clinical diabetes, one-third have abnormal glucose tolerance only, and one-third have normal glucose tolerance.
โข The severity of NL is not related to the severity of diabetes. Control of the diabetes has no effect on the course of NL.
โข Lesion starts as brownish-red or skin-colored papule that slowly evolves into a well-demarcated waxy plaque of variable size (Fig. 15-4). The sharply defined and slightly elevated border retains a brownish-red color, whereas the center becomes depressed and acquires a yellow-orange hue. Multiple telangiectasias of variable size are noted. Larger lesions formed by centrifugal enlargement or merging of smaller lesions acquiring a serpiginous or polycyclic configuration. Ulceration may occur and healed ulcers result in depressed scars. Burned-out lesions are tan with telangiectasia.
โข Usually one to three lesions; >80% occur on the shin; at times symmetric. Less commonly on feet, arms, trunk, or face and scalp; rarely may be generalized.
โข Dermatopathology: Sclerosis, obliteration of the bundle pattern of collagen โ necrobiosis, surrounded by concomitant granulomatous infiltration in lower dermis. Microangiopathy.
โข Biopsy confirmation is usually not necessary; however, biopsy may be required in early stages to rule out granuloma annulare (which frequently coexists with NL), sarcoidosis, or xanthoma.
โข Glucocorticoids. Topical: Under occlusion is helpful; however, ulcerations may occur when NL is occluded. Intralesional: triamcinolone, 5 mg/mL, into active lesions or lesion margins usually arrests extension of plaques of NL. Ulceration: Most ulcerations within NL lesions heal with local wound care; if not, excision of the entire lesion with grafting may be required.
FIGURE 15-4 โข Necrobiosis lipoidica diabeticorumโA large, symmetric plaque with active tan-pink, yellow, well-demarcated, raised, firm border and a yellow center in the pretibial region of a 28-year-old diabetic female. The central parts of the lesion are depressed with atrophic changes of epidermal thinning and telangiectasia against a yellow background. (Used with permission of Dr. Kenneth Greer.)