What is necrobiosis lipoidica disease ?
NECROBIOSIS LIPOIDICA :
The severity or control of diabetes in an individual does not affect who will or will not get NLD. Better maintenance of diabetes after being diagnosed with NLD will not change how quickly the NLD will resolve.
What are the signs and symptoms of necrobiosis lipoidica ?
NL/NLD most frequently appears on the patient's shins, often on both legs, although it may also occur on forearms, hands, trunk, and, rarely, nipple, penis and surgical sites. The lesions are often as but may become tender and ulcerate when injured. The first symptom of NL is often a "bruised" appearance erythema that is not necessarily associated with a known injury. The extent to which NL is inherited is unknown.
NLD appears as a hardened, raised area of the skin. The center of the affected area usually has a yellowish tint while the area surrounding it is a dark pink. It is possible for the affected area to spread or turn into an open sore. When this happens the patient is at greater risk of developing ulcers. If an injury to the skin occurs on the affected area, it may not heal properly or it will leave a dark scar.
A skin lesion is an area of skin that is different from the skin around it. With NLD, lesions start as firm, smooth, red bumps (papules) on the shins and lower part of the legs. They usually appear in the same areas on opposite sides of the body. They are painless in the early stage.
As the papules become bigger, they flatten down. They develop a shiny yellow brown center with raised red to purplish edges. Veins are visible below the yellow part of the lesions. The lesions are irregularly round or oval with well-defined borders. They can spread and join together to give the appearance of a patch.
Lesions can also occur on the forearms. Rarely, they may occur on the stomach, face, scalp, palms, and soles of the feet. Trauma may cause the lesions to develop ulcers . Nodules also may develop. The area may become very itchy and painful. NLD is different from ulcers that can occur on the feet or ankles in people with diabetes.
How is necrobiosis lipoidica diagnosis ?
NL is diagnosed by a skin biopsy, demonstrating superficial and deep perivascular and interstitial mixed inflammatory cell infiltrate (including lymphocytes, plasma cells, mononucleated and multinucleated histiocytes, and eosinophils) in the dermis and subcutis, as well as necrotising vasculitis with adjacent necrobiosis and necrosis of adnexal structures. Areas of necrobiosis are often more extensive and less well defined than in granuloma annulare. Presence of lipid in necrobiotic areas may be demonstrated by Sudan stains. Cholesterol clefts, fibrin, and mucin may also be present in areas of necrobiosis. Depending on the severity of the necrobiosis, certain cell types may be more predominant. When a lesion is in its early stages, neutrophils may be present, whereas in later stages of development lymphocytes and histiocytes may be more predominant.
NL usually appears as patches, or lesions, on the lower legs or shins. It can also appear elsewhere on the body such as on the upper legs, hands, arms, torso, face, or scalp though this is rare.
People with NL may notice one or more shiny, raised, flushed patches of skin on the lower legs. These may also be itchy or painful. The centers of the patches can become pale with visible blood vessels. Ulceration can occur following minor trauma to the skin. Roughly a third of the lesions can become ulcerated.
What are the causes of necrobiosis lipoidica ?
Healthcare professionals do not know the cause of NL. However, some people may be more at risk of developing it than others. The cause of necrobiosis lipoidica diabeticorum (NLD) is unknown. It is thought to be linked to blood vessel inflammation related to autoimmune factors . This damages proteins in the skin (collagen). People with type 1 diabetes are more likely to get NLD than those with type 2 diabetes. Women are more affected than men. Smoking increases the risk for NLD. Less than one half of one percent of those with diabetes suffer from this problem.
NL can occur in both type 1 and 2 diabetes, affecting around of those with diabetes.
People who smoke are also more at risk of developing skin ulcers, as smoking slows down the body’s ability to heal wounds.
It also appears to be up to to affect females than males. However, according to one ulceration occurs in 58% of males and 15% of females.
According to a healthcare professionals associate the following conditions with an increased risk of developing NL:
- thyroid disease
- celiac disease
- hypertension
- obesity
- chronic heart failure
- elevated lipids in the blood (dyslipidemias)
Avoid sustaining injury or trauma to the affected area by using padded dressings, shin guards, or support stockings. They can also try to stop smoking. This can help reduce the risk of ulcers forming and improve the body’s ability to heal.
If there is an underlying health condition, such as diabetes, working with a doctor to keep blood sugar levels under control may help. Although this may not improve NL, it may help reduce the risk of infection. It is best to start treatment for NL at an early stage, to reduce the risk of ulcers developing and subsequent scarring.
However, if the condition is mild, simply monitoring it may be enough. According to a 2020 article, around 17% of lesions can resolve spontaneously.
NL is a chronic condition, which means that it can be lifelong. People may have permanent symptoms or symptoms that flare up from time to time.
To date, there is no particular successful treatment for NL. However, there are some options that may be effective.
A doctor may recommend one or a combination of the following treatments
- oral corticosteroids, such as prednisone
- corticosteroid injections into the inflamed areas of skin
- antimalarial drugs, such as hydroxychloroquine, to reduce inflammation
- UV light treatment, to help control flare-ups
- photodynamic therapy
- laser treatment, to improve the appearance of blood vessels
- immunomodulating drugs, such as cyclosporine, to help heal ulcers
- medications to thin the blood, such as aspirin
- surgical removal of the lesions and grafting to repair the skin
NLD can be difficult to treat. Control of blood glucose does not improve symptoms.
Treatment may include:
- Corticosteroid creams
- Injected corticosteroids
- Drugs that suppress the immune system
- Anti-inflammatory drugs
- Medicines that improve blood flow
- Hyperbaric oxygen therapy may be used to increase the amount of oxygen in the blood to promote healing of ulcers
- Phototherapy, a medical procedure in which the skin is carefully exposed to ultraviolet light
- Laser therapy
In severe cases, the lesion may be removed by surgery, followed by moving (grafting) skin from other parts of body to the operated area.
During treatment, monitor your glucose level as instructed. Avoid injury to the area to prevent the lesions from turning into ulcers.
If you develop ulcers, follow steps on how to take care of the ulcers.
If you smoke, you will be advised to quit. Smoking can slow healing of the lesions.
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