Necrobiosis Lipoidica
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Diana S. Swett
A woman with type 2 diabetes mellitus (glycated hemoglobin, 8%) presented with a skin plaque on her right foot. Examination revealed a single waxy, yellow, atrophic, ill-defined plaque overlaid with telangiectatic vessels (pictured). Necrobiosis lipoidica (NL) was diagnosed. The patient's lesion continues to be monitored, and detailed integument examinations are performed on a regular basis. No additional lesions have been found; the existing lesion is clinically stable and does not cause any discomfort.
An uncommon chronic granulomatous dermatitis, NL has a strong association with diabetes mellitus.1 Early lesions typically appear as slowly enlarging reddish-brown to yellow sclerodermiform plaques with telangiectatic vessels overlying the surface; however, ulceration may occur in as many as 25% to 35% of cases.2 Although NL is found in less than 1% of patients with diabetes, 75% of individuals with NL have or will develop diabetes mellitus.3 There is no proven treatment, but topical or intradermal corticosteroids, topical 0.005% psoralen with ultraviolet-A irradiation, topical 0.1% tacrolimus, and subcutaneous tumor necrosis factor inhibitors have shown promise in selected cases.1,2 Although the presence of NL does not correlate with blood glucose levels, it should prompt further evaluation for diabetes mellitus.3
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Financial Disclosures: None reported.
References
1 Roy S Shayaan M . Unsightly rash on shin: necrobiosis lipoidica diabeticorum. J Fam Pract.2012;61(4):215-217.Search in Google Scholar
2 Suárez-Amor O Pérez-Bustillo A Ruiz-González I Rodriguez-Prieto MA . Necrobiosis lipoidica therapy with biologicals: an ulcerated case responding to etanercept and a review of the literature. Dermatology. 2010;221(2):117-121. doi:10.1159/000314694.10.1159/000314694Search in Google Scholar PubMed
3 O’Reilly K Chu J Meehan S Heller P Ashinoff R Gruson L . Necrobiosis lipoidica. Dermatol Online J.2011;17(10):18.10.5070/D304C8T43BSearch in Google Scholar
© 2013 The American Osteopathic Association
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Articles in the same Issue
- Editorial
- A Rising Tide of Older Patients: Preparing Future DOs
- Letters to the Editor
- Bibliometric Measures and National Institutes of Health Funding at COMs, 2006-2010
- Impact Indices Shed False Light
- Osteopathic Training of MDs
- Corrections
- Corrections
- Medical Education
- Developing Osteopathic Competencies in Geriatrics for Medical Students
- Ohio Osteopathic Residency Directors' Self-Reported Administrative Knowledge and Skills Before and After Participation in an Administrative Training Program
- New Colleges of Osteopathic Medicine: Steps in Achieving Accreditation—An Update
- Osteopathic Graduate Medical Education 2013
- Osteopathic Postdoctoral Training Institutions and Academic Sponsorship
- AOA Continuing Medical Education
- AOA Specialty Board Certification
- Special Communication
- Appendix 1: Colleges of Osteopathic Medicine in the United States
- Appendix 2: Figures and Tables Reprinted From Trends in Osteopathic Medical School Applicants, Enrollment and Graduates From the American Association of Colleges of Osteopathic Medicine (AACOM)
- The Somatic Connection
- Yoga vs Usual Care for Chronic Low Back Pain
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