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Necrobiosis Lipoidica Diabeticorum

Necrobiosis Lipoidica Diabeticorum

Necrobiosis lipoidica diabeticorum ("NLD") is a rash usually found on the lower part of the legs. Lesions can be small or extend over a large area. They are often raised, red-brown with a yellowish center (though they may also appear yellow with a purple border), and waxy in appearance. There are usually several spots, which may develop into open sores that are slow to heal. The exact cause of NLD in not known and often a biopsy is needed for proper diagnosis.

NLD occurs more often in people with diabetes or those with a family history of diabetes, but this condition can also occur in individuals without diabetes. It is more commonly seen in women.

Treatment of NLD is difficult. Sometimes it responds to topical cortisone creams, especially if covered ("occluded") with an airtight dressing. Cortisone injections can also be used to treat NLD. These are more effective than cortisone creams.

NLD usually goes through stages of activity and inactivity, so prediction of flare-ups is difficult. Ultraviolet light treatment has been found to control this condition when it is flaring. A baby aspirin each day, in people over 21 years of age, and other medications that thin the blood, may help NLD. Other medications, including prednisone pills (steroids) are used in difficult or severe cases. However, this medication can have a detrimental effect on blood sugar levels.

For people with diabetes, steroids and cortisones can raise blood glucose levels and should be used with great caution and only under the supervision of a medical doctor.

A similar condition that is often confused with NLD is granuloma annulare. Similar to the association of NLD and diabetes, it appears that a high percentage of people with disseminated granuloma annulare have diabetes. The individual spots typically consist of a circular array of reddish to brown and slightly translucent bumps.


SOURCE:
American Osteopathic College of Dermatology. Necrobiosis Lipoidica Diabeticorum . (Accessed 09/19/08.)

Reviewed by Francine Kaufman, MD. 01/09