Contents:
- Medical Video: What Causes NLD (Necrobiosis Lipoidica Diabeticorum) in Diabetics?
- What is lipoidic necrobiosis?
- Who might experience lipoidic necrobiosis?
- What are the symptoms of lipoidic necrobiosis?
- How do you manage this condition?
Medical Video: What Causes NLD (Necrobiosis Lipoidica Diabeticorum) in Diabetics?
Necrobiosis lipoidica diabeticorum is a degenerative disease of connective tissue in the skin. This disease usually appears at the bottom of the foot. The lesions may be small or elongated in a large area. The shape is usually protruding, yellow and looks waxy, and often has a purple fringe.
What is lipoidic necrobiosis?
Lipoidic necrobiosis is a skin swelling disease characterized by callous lesions of irregular shape, reddish-brown pigmentation, and central atrophy.
In lipoidic necrobiosis, collagen degenerates with a granulomatous response, associated with thickened blood vessels and accumulated fat.
Necrobiosis of lipoidica diabeticorum is a rare condition that occurs. Adult women are the group most likely to experience it. As long as the wound doesn't open, you don't need to take care of it. However, if you experience open wounds, see your doctor for treatment.
Who might experience lipoidic necrobiosis?
Lipoidic necrobiosis is a rare skin condition. Although there is a high prevalence of diabetes mellitus in patients with lipoidic necrobiosis (⅓ cases having diabetes, and ⅔ having abnormal glucose tolerance), the prevalence of reported lipoidic necrobiosis in patients with diabetes is 1-2%.
It most often appears in the 30s, but can occur at any age, including infants. This tends to appear earlier in diabetics than others: in one study, about 2% of young people with diabetes (aged up to 22 years) had lipoidic necrobiosis lesions compared to those with no control subjects.
This is 3 times more common in women than in men. Familial non-diabetic groupings of lipoidic necrobiosis do occur, but very rarely.
What are the symptoms of lipoidic necrobiosis?
Necrobiosis of lipoidica diabeticorum causes spots similar to diabetic dermopathy, but the numbers are fewer, larger and deeper.
Necrobiosis of lipoidica diabeticorum often starts with a dull red bump area. After a while, it will look like a shiny scar with violet-colored edges. Blood vessels under the skin can be seen more easily. Sometimes necrobiosis of lipoidica diabeticorum feels itchy and painful. Sometimes the spots break open.
The most common part is the pretibial area, but they can occur on the face, scalp, legs and upper arms where they tend to be less diagnosed correctly. Often there is no pain, but it can also be very painful.
Diabetics with lipoidic necrobiosis appear more frequently in smokers, compared to non-smokers, although the presence of lipoidic necrobiosis does not correlate with diabetes control.
How do you manage this condition?
Until now there was no truly effective treatment. You must avoid the trauma. Treatment of wounds for boils is the same as for other diabetic ulcers. First-line treatment is usually a topical steroid that works. This can reduce inflammation but does not affect burning lesions and can worsen atrophy, so careful monitoring is needed in this case. Intralesional steroid injections also sometimes help, but the risk of ulceration can increase. The doctor may prescribe the following immunomodulatory drugs, with varying degrees of success, to treat lipoidic necrobiosis:
- Cyclosporine
- Topical Tacrolimus
- Anti-tumor necrosis factor alpha therapy (anti-TNF-α)
Studies show, spontaneous healing of lipoidic necrobiosis after pancreatic and kidney transplantation, and immunosuppressive regimes have played an important role in this regard.
In addition, the doctor may give aspirin and dipyridamole. Pentoxifylline decreases blood viscosity and increases fibrinolysis and erythrocyte deformity that might help.
Excision and grafting are sometimes used, but are difficult to heal and often recur.
Treatment may be photodynamic therapy, because it has topical topical and psoralens retinoids with ultraviolet A (PUVA).
Laser treatments have been used to stabilize lesions and reduce erythema and telangiectasias.
