A 40-year-old woman with a history of diabetes presents with red plaques on her shins (Figures 95-1 and 95-2). They are asymptomatic, though continue to increase in size. A biopsy was previously taken and revealed necrobiosis lipoidica. She had been working closely with her primary care physician to better control her glucose, but the lesions continued to progress. She has been applying topical corticosteroids with minimal improvement. This story demonstrates a typical case of necrobiosis lipoidica refractory to treatment in spite of well-controlled diabetes.
Large shiny, red-brown, well-demarcated plaque characteristic of necrobiosis lipoidica. A few satellite papules exist as well. (Photograph courtesy of Dr. Matthew Zirwas.)
Close up of the previous photograph. A waxy appearance to the plaque is evident. (Photograph courtesy of Dr. Matthew Zirwas.)
Strongly associated with diabetes mellitus (usually type 1), though rarely may occur in patients who are not diabetic.1
Percentage of patients with diabetes at the time of presentation ranges from 11% to 65%.1
Patients without diabetes on presentation may have impaired glucose tolerance, develop diabetes at a later date, or have positive family histories of diabetes.1
May occur at any age, though tends to develop at an earlier age in patients with pre-existing diabetes.2
Women are affected three times as often as men.1
Most common cutaneous finding in patients with diabetes mellitus, occurring in 9% to 55% of diabetics.3
Incidence increased in diabetics with other microangiopathic complications of diabetes (retinal, neuropathic, and/or nephrogenic).3
Occurs in both insulin-dependent and noninsulin-dependent diabetics.2
Incidence increases with age, typically seen in patients older than 50 years.3
Men are affected more often than women.4
ETIOLOGY AND PATHOPHYSIOLOGY
Disorder of collagen degeneration with granuloma formation and fat deposition.1
Etiology remains unknown; however, it may be related to immunologically mediated vascular disease, diabetic microangiopathy, or defective collagen.1
Etiology largely unknown; however, trauma may be a causative factor.3
Previously thought to be related to ischemia, though lesions are now recognized to have more blood flow than surrounding skin.5
Necrobiosis lipoidica—A biopsy is typically performed for diagnosis. No further laboratory workup is helpful in making a diagnosis.1
Diabetic dermopathy—This is a clinical diagnosis with no laboratory workup or biopsy necessary.3
Necrobiosis lipoidica—characterized by asymptomatic shiny, red-brown, telangiectatic papules, patches, plaques, or nodules (Figures ...
Log In to View More
If you don't have a subscription, please view our individual subscription options below to find out how you can gain access to this content.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.
AccessCardiology Full Site: One-Year Subscription
Connect to the full suite of AccessCardiology content and resources including textbooks such as Hurst's the Heart and Cardiology Clinical Questions, a unique library of multimedia, including heart imaging, an integrated drug database, and more.
Pay Per View: Timed Access to all of AccessCardiology
24 Hour Subscription $34.95
48 Hour Subscription $54.95
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.