Necrobiosis Lipoidica

Necrobiosis Lipoidica is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Necrobiosis lipoidica (NL) is a granulomatous skin disease.
  • Presents with violaceous red–brown skin plaques with palpable borders and yellow–brown atrophic centers with telangiectasias
  • Most commonly occurs on the pretibial area
  • Ulceration is the most common complication.
  • Ulceration found in 1/3 of cases
  • Associated with type 2 diabetes mellitus (DM) in 46% of cases.
  • May persist for decades
  • Management includes medical and/or surgical treatment.

Epidemiology

  • 0.3–1.2% of DM patients have NL (1):
    • 11% of those with NL have DM diagnosis.
  • Female > male (3:1) (2)
  • Most prevalent in ages 20 to 40 years; may also occur in children (rare) and the elderly

Etiology and Pathophysiology

  • Exact etiology remains unknown.
  • Unclear whether a marker for diabetes severity
  • One theory suggests that NL results from systemic microangiopathy associated with DM.
  • Other theories include immunoglobulin deposition, tissue damage due to venous insufficiency and hypercholesterolemia, impaired neutrophil migration, collagen abnormalities, and trauma.
  • Pathophysiology demonstrates collagen degeneration evolving into granulomatous inflammation with dermal and subcutaneous inflammation.
  • Fatty deposition and endothelial wall thickening occur later, secondary to inflammation.

Risk Factors

  • DM
  • Hypertension
  • Obesity
  • Trauma

General Prevention

  • Smoking cessation
  • Blood glucose control
  • Avoidance of trauma
  • Compression stockings

Commonly Associated Conditions

  • Obesity, hyperlipidemia, hypertension, and diabetes complications, such as peripheral neuropathy, nephropathy, and retinopathy
  • Also may be found with thyroid disorders, sarcoid, inflammatory bowel disease, celiac disease, CHF, HLD, and rheumatoid arthritis (1)

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Citation

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TY - ELEC T1 - Necrobiosis Lipoidica ID - 816301 ED - Baldor,Robert A, ED - Domino,Frank J, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816301/all/Necrobiosis_Lipoidica PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -