Necrobiosis lipoidica

Necrobiosis lipoidica
Classification and external resources
ICD-10	L92.1
ICD-9	709.3
DiseasesDB	5414
eMedicine	derm/283
MeSH	D009335

Necrobiosis lipoidica is a necrotising skin condition that usually occurs in patients with diabetes but can also be associated with Rheumatoid Arthritis.^[1] In the former case it may be called necrobiosis lipoidica diabeticorum (NLD). NLD occurs in approximately 0.3% of the diabetic population, with the majority of sufferers being women (approximately 3:1 females to males affected).

Necrobiosis lipoidica commonly occurs simultaneously with granuloma annulare and with sarcoidosis. The severity or control of diabetes in an individual does not affect who will or will not get NLD.^[2] Better maintenance of diabetes after being diagnosed with NLD will not change how quickly the NLD will resolve.

Clinical appearance

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 asymptomatic 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 infected area usually has a yellowish tint while the area surrounding it is a dark pink. It is possible for the infected 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.

Pathophysiology

Although the exact cause of this condition is not known, it is an inflammatory disorder characterised by collagen degeneration, combined with a granulomatous response. It always involves the dermis diffusely, and sometimes also involves the deeper fat layer. Commonly, dermal blood vessels are thickened (microangiopathy).^[2]

It can be precipitated by local trauma, though it often occurs without any injury.^[3]

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.

There is no clearly defined cure for necrobiosis^[4]. Although there are some techniques that can be used to diminish the signs of necrobiosis such as a steroid cream or injection into the affected area, this process may be effective for only a small amount of those treated. Steroid cream has been known to cause thinning of the skin, so if used, it is best to wrap the area with some form of plastic wrap or cloth. Even then, this process can take long periods of time.

See also

• Diabetic dermadromes
• List of cutaneous conditions

References

1. ^ James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0. 
2. ^ ^{a b} Klaus J. Busam (15 January 2009). Dermatopathology. Elsevier Health Sciences. p. 54. ISBN 978-0-443-06654-2. http://books.google.com/books?id=7Wqf7falwdcC&pg=PA54. Retrieved 22 August 2011. 
3. ^ Michael I. Greenberg (2005). Greenberg's text-atlas of emergency medicine. Lippincott Williams & Wilkins. p. 416. ISBN 978-0-7817-4586-4. http://books.google.com/books?id=tjZttRRH8H8C&pg=PA416. Retrieved 22 August 2011. 
4. ^ AOCD Website

External links

• Information and image at NIH
• Image AOCD

This cutaneous condition article is a stub. You can help Wikipedia by expanding it.v · Categories: Skin conditions resulting from errors in metabolism Diabetes Cutaneous condition stubs Wikimedia Foundation. 2010. Игры ⚽ Нужен реферат? Lyceum Alpinum Zuoz Tramain Jones Look at other dictionaries: necrobiosis lipoídica — Enfermedad de la piel caracterizada por placas delgadas y brillantes de color amarillo o rojo, en las espinillas y los antebrazos. Sobre estas placas pueden producirse telangiectasias, costras y úlceras. Diccionario Mosby Medicina, Enfermería y… …   Diccionario médico Necrobiosis lipoidica — Klassifikation nach ICD 10 E10–E14 Diabetes mellitus .6 Mit sonstigen näher bezeichneten Komplikationen L92.1 …   Deutsch Wikipedia necrobiosis lipoidica — noun skin disease marked by thin shiny patches (especially on the legs); often associated with diabetes mellitus • Syn: ↑necrobiosis lipoidica diabeticorum • Hypernyms: ↑skin disease, ↑disease of the skin, ↑skin disorder …   Useful english dictionary necrobiosis lipoidica diabeticorum — necrobiosis lipoidica dia·bet·i·co·rum .dī ə .bet i kȯr əm n NECROBIOSIS LIPOIDICA * * * necrobiosis lipoidica in diabetics …   Medical dictionary necrobiosis lipoidica — necrobiosis li·poid·i·ca li pȯid i kə n a disease of the skin that is characterized by the formation of multiple necrobiotic lesions esp. on the legs and that is often associated with diabetes mellitus * * * a degenerative disease of dermal… …   Medical dictionary necrobiosis lipoidica diabeticorum — noun skin disease marked by thin shiny patches (especially on the legs); often associated with diabetes mellitus • Syn: ↑necrobiosis lipoidica • Hypernyms: ↑skin disease, ↑disease of the skin, ↑skin disorder …   Useful english dictionary Necrobiosis — Classification and external resources ICD 9 799.89 MeSH D017441 Necrobiosis is defined as t …   Wikipedia lipoidica — see NECROBIOSIS LIPOIDICA, NECROBIOSIS LIPOIDICA DIABETICORUM …   Medical dictionary necrobiosis — 1. Physiologic or normal death of cells or tissues as a result of changes associated with development, aging, or use. 2. Necrosis of a small area of tissue. [necro + G. bios, life] n. lipoidica, n. lipoidica diabeticorum a condition, in many… …   Medical dictionary necrobiosis — n. a gradual process by which cells lose their function and die. Necrobiosis lipoidica is a disease in which degeneration of collagen produces sharply demarcated yellowish brown plaques, especially on the shins of women. It is often, but not… …   The new mediacal dictionary 18+ © Academic, 2000-2024 Contact us: Technical Support, Advertising Dictionaries export, created on PHP, Joomla, Drupal, WordPress, MODx. Mark and share Search through all dictionaries Translate… Search Internet Share the article and excerpts Direct link … Do a right-click on the link above and select “Copy Link”