Necrobiosis lipoidica diabeticorum

What is Necrobiosis Lipoidica Diabeticorum?

Necrobiosis lipoidica diabeticorum (NLD) is a rare skin condition that affects people with diabetes. It is characterized by firm, yellowish-brown patches of discolored skin usually located on the lower legs. The patches are small and firm at first, but can become larger and raised with time. They may be itchy or painful, and there is often a red, scaly outer border.

NLD is caused by an accumulation of fat in the small vessels near the surface of the skin. The exact cause of NLD is unknown, but genetics, hormones, or other factors associated with diabetes may play a role. Treatment for NLD is largely supportive and may involve avoiding trauma to the affected area, using soft dressings to keep the skin hydrated, taking oral steroids to suppress inflammation, or using topical corticosteroids to reduce itching and inflammation.

Signs & Symptoms of Necrobiosis Lipoidica Diabeticorum

NLD typically appears as plaques or patches of yellowish-brown discoloration on the lower legs. The patches may be firm or raised, and some may feel slightly itchy or painful. They often have scaly or crusty outer edges. Other signs and symptoms may include:

  • Little bumps or ulcers
  • Inflammation or swelling near the patch
  • Dry or scaly skin on the patch
  • Hyperpigmentation (darkening of the skin)
  • Hypertrophy (thickening of the skin)

Diagnosing and Treating Necrobiosis Lipoidica Diabeticorum

NLD is typically diagnosed through a biopsy, but in some cases, a physical exam may be enough to diagnose the condition. Treatment is largely supportive, but may include:

  • Avoiding trauma to the affected area
  • Keeping the skin moisturized with special dressings
  • Taking oral steroids to suppress inflammation
  • Using topical corticosteroids to reduce itching and inflammation

In some cases, laser therapy or cryotherapy may be used to treat the lesions. In very rare cases, surgery may be used to reduce the size of lesions.