Necrobiosis lipoidica diabeticorum
Necrobiosis Lipoidica Diabeticorum
Necrobiosis lipoidica diabeticorum (NLD) is a skin condition that typically presents as a symmetrical atrophic, yellowish, flesh-colored or violaceous plaque with a fibrotic, shiny surface surrounded by normal-appearing skin. NLD primarily affects adults with diabetes mellitus, although there have been reported cases occurring in individuals without a history of diabetes. Although NLD can lead to minor discomfort and loss of skin texture, it is generally considered a benign recurring disorder.
What are the Causes and Risk Factors of Necrobiosis Lipoidica Diabeticorum?
The exact cause of NLD is unknown but scientists believe that the skin condition is caused by the destruction of the collagen in the skin, as well as the presence of certain inflammatory cells. NLD most commonly occurs in people with Type I or Type II diabetes, but non-diabetic patients can also be affected. The risk of developing NLD is higher in people who are of Caucasian descent; however, it can affect individuals of any race.
Types:
- Type I NLD – This is the most common type and it is characterized by well-defined yellow-brown plaques with shiny and atrophic skin. It usually affects the lower legs and ankles.
- Type II NLD – This is a less common form of the condition and it is characterized by multiple smaller and well-circumscribed papules. It usually affects the upper legs and thighs.
Signs and Symptoms of Necrobiosis Lipoidica Diabeticorum:
The primary signs of NLD are the presence of yellow-brown plaques which are usually associated with thinning of the skin. These can present as a single lesion on the lower leg, or multiple lesions on the upper legs and thighs. These lesions may eventually become red, scaly and indurated. Other common symptoms are pruritus, burning, and mild discomfort.
Diagnosis:
Necrobiosis lipoidica diabeticorum is generally diagnosed by complete skin examination. A biopsy of the lesion before treatment may be necessary to differentiate it from other dermatologic conditions, such as erythema nodosum, granuloma annulare, or xanthoma. The diagnosis is typically confirmed by observation of the lesion and a review of the patient's medical history.
Treatment:
In most cases, NLD can be managed successfully with topical therapies, such as corticosteroids and emollients. In addition, ultraviolet B phototherapy has been shown to be an effective treatment option. For more severe cases, systemic therapy with corticosteroids or immunosuppressants may be necessary. Surgery is rarely necessary and should be reserved for severe cases in which more conservative measures have been unsuccessful.
Why Treat Necrobiosis Lipoidica Diabeticorum?
NLD can cause skin discoloration and thinning, as well as itching, burning, and mild discomfort. If left untreated, it can lead to infection, ulceration, and scarring. As such, it is important to seek medical treatment to ensure proper management and control of the condition.
When to See a Doctor?
If you have any of the signs or symptoms associated with NLD, you should see a doctor. You should also see a doctor immediately if you experience any significant skin changes, such as blistering, ulceration, or discoloration.
Complications:
Left untreated, NLD can lead to skin thinning, discolouration, and mild discomfort. In rare cases, complications such as ulceration and infection can occur. It is important to seek medical care if you have any of the signs or symptoms associated with NLD.
Risk Factors:
- Diabetes Mellitus (Type 1 and Type 2)
- Caucasian Descent
- Chronic Inflammatory Conditions
- Hereditary Factors