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- 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.
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.
- 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)