(Figure 3.15A, B) - Uncommon necrobiotic disease associated with diabetes mellitus (DM): 30–40% patients with NLD have DM, but only 0.03–3% of patients with DM manifest with NLD
- Presents with yellow to red-brown atrophic to indurated plaques typically over pretibial areas; prominent telangiectasias, ± ulceration
- Histology: normal to atrophic epidermis, histiocytes often encircling necrobiotic collagen in dermis in layered fashion (tier-like, parallel to epidermis), ± sclerosis, interstitial lymphocytes, plasma cells, histiocytes, and multinucleated giant cells (granulomatous inflammation)
| | | | | | Horizontal palisading sandwiches and plasma cells on histology (unlike GA) | | | | | |
|
- Treatment: high potency topical corticosteroid (1 st line) or IL injection into active border; aspirin + dipyridamole (to ↓ plt aggregation), niacinamide, and if severe refractory ulcerations consider excision with graft
| | Figure 3.15
A: Necrobiosis lipoidica
(Courtesy of Dr. Sophie M. Worobec)
B: Necrobiosis lipoidica
(Courtesy of Dr. Paul Getz)
C: Necrobiotic xanthogranuloma
(Reprint from Morgan MB, Smoller BR,
Somach SC. Deadly Dermatologic
Diseases . New York, NY: Springer; 2007) |
|
