Necrobiosis lipoidica diabeticorum is an uncommon skin condition related to
Necrobiosis lipoidica; NLD; Diabetes - necrobiosis
The cause of necrobiosis lipoidica diabeticorum (NLD) is unknown. It is thought to be linked to blood vessel inflammation related to
People with type 1 diabetes are more likely to get NLD than those with type 2 diabetes. Women are more affected than men. Smoking increases the risk for NLD. Less than one half of one percent of those with diabetes suffer from this problem.
A skin lesion is an area of skin that is different from the skin around it. With NLD, lesions start as firm, smooth, red bumps (papules) on the shins and lower part of the legs. They usually appear in the same areas on opposite sides of the body. They are painless in the early stage.
As the papules become bigger, they flatten down. They develop a shiny yellow brown center with raised red to purplish edges. Veins are visible below the yellow part of the lesions. The lesions are irregularly round or oval with well-defined borders. They can spread and join together to give the appearance of a patch.
Lesions can also occur on the forearms. Rarely, they may occur on the stomach, face, scalp, palms, and soles of the feet.
Trauma may cause the lesions to develop
NLD is different from ulcers that can occur on the feet or ankles in people with diabetes.
Exams and Tests
Your health care provider can examine your skin to confirm the diagnosis.
If needed, your provider may do a
Your provider may do a
NLD can be difficult to treat. Control of blood glucose does not improve symptoms.
Treatment may include:
- Corticosteroid creams
- Injected corticosteroids
- Drugs that suppress the immune system
- Anti-inflammatory drugs
- Medicines that improve blood flow
Hyperbaric oxygen therapymay be used to increase the amount of oxygen in the blood to promote healing of ulcers
- Phototherapy, a medical procedure in which the skin is carefully exposed to ultraviolet light
- Laser therapy
In severe cases, the lesion may be removed by surgery, followed by moving (grafting) skin from other parts of body to the operated area.
During treatment, monitor your glucose level as instructed. Avoid injury to the area to prevent the lesions from turning into ulcers.
If you develop ulcers, follow steps on how to take care of the ulcers.
If you smoke, you will be advised to
NLD is a long-term disease. Lesions do not heal well and can recur. Ulcers are difficult to treat. The appearance of the skin may take a long time to become normal, even after treatment.
NLD can rarely result in skin cancer (
Those with NLD are at increased risk for:
Diabetic retinopathy Diabetic nephropathy
When to Contact a Medical Professional
Call your provider if you have diabetes and notice non-healing lesions on your body, especially on the lower part of legs.
Fitzpatrick JE, High WA, Kyle WL. Annular and targetoid lesions. In: Fitzpatrick JE, High WA, Kyle WL, eds. Urgent Care Dermatology: Symptom-Based Diagnosis. Philadelphia, PA: Elsevier; 2018:chap 16, 269-288.
James WD, Berger TG, Elston DM. Errors in metabolism. In: James WD, Berger TG, Elston DM, eds. Andrews' Diseases of the Skin. 12th ed. Philadelphia, PA: Elsevier; 2016:chap 26, 509-541.
Patterson JW. The granulomatous reaction pattern. In: Patterson JW, ed. Weedon's Skin Pathology. 4th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2016:chap 7, 189-218.
Rosenbach MA, Wanat KA, Reisenauer A, White KP, Korcheva V, White CR. Non-infectious granulomas. In: Bolognia JL, Schaffer JV, Cerroni L, eds. Dermatology. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 93, 1644-1663.
Review Date: 19/08/2018
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