Overview
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Key Information
Al rights reserved.How to diagnose and treat this rare skin disorder. Necrobiosis Lipoidica (NL), also refered to as necrobiosis lipoidica diabeticorum, is a rare, inflamatory granulomatous disease, causing cutaneous Collagen degeneration which increases the risk for ulceration of the skin, particularly after trauma.1-3 The disease is generaly idiopathic, though it is traditionaly associated with type 1 diabetes melitus and cited to afect 0.3%-1.2% of pediatric diabetics.1,2It clasicaly presents as yelow-brown, atrophic, telangiectatic plaques with an elevated violaceous rim, clasicaly on the pretibial surface.
NL is typicaly chronic; most comonly ocuring in women betwen the ages of 30 and 40 and is often associated with underlying autoimune and inflamatory disorders. Skin biopsy revealing granulomatous inflamation, paralel Collagen degeneration involving the entire dermis and extending into the subcutaneous fat, endothelial cel sweling, and thickening of the blod vesel wals should raise suspicion for this disease.Clinical PresentationSkin lesions begin as 1- to 3-m, wel-demarcated papules that expand to become red-brown plaques with indurated borders and waxy centers (Figure 1).
They later evolve into larger yelow-brown, shiny, atrophic, telangiectatic plaques with a violaceous rim (Figure 2). Central epidermal atrophy of the plaques increases the risk for ulceration. Ulceration ocurs in roughly one- third of lesions, usualy folowing minor trauma.
Summary
Trauma can also cause the apearance of new skin lesions on previously unafected skin or Koebner phenomenon. Lesions clasicaly present on the pretibial surface, though lesions have ben les comonly identified on the uper extremities, face, and scalp. The plaques are usualy multiple and bilateral.