Necrobiosis lipoidica diabeticorum (NLD) is a granulomatous skin disease found in diabetic patients. The prevalence of NLD is quite rare being found in less than 0.3% of all diabetics.(1) Fifty percent of all diabetic patients with NLD are insulin dependent.
What causes necrobiosis lipoidica diabeticorum?
The cause of NLD is not clearly defined and is considered to be caused by one or more of the following contributing factors:
- Microangiopathy is the primary cause of damage to the retina and kidney in diabetic patients. NLD shows similar microangiopathy changes. Microangiopathy of the retina, kidney and in NLD appear to be due to deposition of glycoprotein in the blood vessel wall. (2)
- Antibody mediated vasculitis plays a role in inflammatory changes found in NLD. Deposition of immunoglobulins and fibrinogen inhibit the permeability of the vessel wall resulting in platelet aggregation and tissue necrobiosis.(3)
- Increased collagen cross linking is found in NLD resulting in basement membrane thickening and early aging of the skin.(4)
- Other theories include inflammatory and metabolic changes along with direct trauma to the skin.
NLD does not correlate to any other complication of diabetes and appears with an onset that does not clearly correlate to onset of duration of diabetes. NLD is found primarily on the shin and lower leg.
Treatment of necrobiosis lipoidica diabeticorum
Treatment of NLD includes the following:
- Cutaneous blood flow enhancers – aspirin, pentoxyphylline, dipyridamole
- Corticosteroids – topical and intralesional
- Wound healing enhancers – topical collagen gel, hyperbaric oxygen
- Immunomodulation – cyclosporine, Infliximab and thalidomide
Necrobiosis lipoidica diabeticorum is a rare skin condition found in diabetic patients. The onset, cause and treatment require more research before we can fully understand this unique condition.
Jeffrey A. Oster, DPM
- Kota S, Jammula S, Kota S, Meher L, Modi K Necrobiosis lipoidica diabetacorum: a case-based review of the literature. Indian J Endocrinol Metab. 2012 Jul-Aug; 16(4): 614–620. doi: 10.4103/2230-8210.98023
- Boateng B, Hiller D, Albrecht HP, Hornstein OP. Cutaneous microcirculation in pretibial necrobiosis lipoidica. Comparative laser Doppler flowmetry and oxygen partial pressure determinations in patients and healthy probands. Hautarzt. 1993;44:581–6. [PubMed] [Google Scholar]
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- Tidman MJ, Duncan C. The treatment of necrobiosis lipoidica. Br J Diabetes Vasc Dis. 2005;5:37–41.