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- Necrobiosis lipoidica (NL) is a granulomatous skin disease.
- Presents with red-brown papules that develop into plaques with violaceous or red-brown raised borders and atrophic, yellow-brown, telangiectatic centers
- Most commonly occurs on the pretibial area
- Ulceration is the most common complication.
- Historically associated with diabetes mellitus (DM), although this association is now questioned
- Management is difficult but includes medical and/or surgical treatment.
Etiology and Pathophysiology
- Exact etiology remains unknown.
- One theory suggests that NL results from microangiopathy which is also associated with DM (1).
- Other theories include immunoglobulin deposition, impaired neutrophil migration, collagen abnormalities, inflammatory processes such as antibody-mediated vasculitis and trauma (1,2).
- Pathophysiology demonstrates collagen degeneration evolving into granulomatous inflammation with dermal and subcutaneous inflammation.
- Fatty deposition and endothelial wall thickening occur later, secondary to inflammation.
There are no known data on prevention.
Commonly Associated Conditions
- Older studies have reported >60% prevalence of diabetes in NL patients, whereas newer studies have reported only 15%; therefore, what was previously thought to be a strong association is now being called into question; diabetics with NL may have a higher incidence of microvascular complications such as retinopathy, neuropathy, and nephropathy (1,3).
- NL may also be found with thyroid disorders, sarcoid, inflammatory bowel disease, and rheumatoid arthritis (1,3).