Necrobiosis lipoidica diabeticorum is a rare disease that causes painless skin lesions on the lower legs, commonly seen in patients with diabetes. The ulcers are typically not harmful but can be treated for cosmetic reasons. The cause is not clear, but it is thought to be related to blood vessel disease in diabetic patients. Treatment includes protecting the legs and using topical antibiotics, and surgery is rarely recommended.
Necrobiosis lipoidica diabeticorum, also called NLD, is a rare disease that produces large, usually painless skin lesions on the lower legs. As the name suggests, necrobiosis lipoidica diabeticorum is most commonly seen in patients with diabetes. Over the course of several months or years, small red or brown patches of skin develop into yellow, shiny sores on the shins. The ulcers themselves typically don’t cause health problems, but people often choose to get treatment to improve their appearance and reduce their risk of infection.
Doctors don’t have a clear understanding of why or even how necrobiosis lipoidica diabeticorum develops. Since diabetes is an underlying condition in nearly all cases, blood vessel disease common in diabetic patients is thought to be responsible for leg ulcers. Abnormally high levels of glucose in the blood cause the tiny blood vessels in the legs to thicken, swell, and rupture. Because the blood vessels in the legs are very close to the skin’s surface, inflammation and bleeding can cause ulcers.
In most cases, necrobiosis lipoidica diabeticorum develops very slowly. A person first notices a collection of slightly raised red bumps that gradually turn brown and appear to spread. As an ulcer grows, it turns yellow in the center and takes on a shiny, waxy appearance. The lesions are rarely itchy or painful, but a broken area of skin can become infected and lead to additional symptoms. The ulcers are confined to the shins in nearly all cases, although the condition can rarely appear on the hands, forearms, or face as well.
A doctor can diagnose necrobiosis lipoidica diabeticorum by carefully examining skin ulcers and asking about a patient’s medical history. A small sample of skin tissue may be collected for histological analysis. Medical laboratory scientists can inspect tissue to determine whether the appearance of blood and fat cells is consistent with the pathology of necrobiosis lipoidica diabeticorum. If a patient has not yet been diagnosed with diabetes, blood tests are usually done to confirm or rule out the condition.
Treatment measures depend on the size and severity of the ulcers. In most cases, doctors focus on limiting the risk of infections by suggesting that patients protect their legs and use topical antibiotics on open wounds. Topical and injected corticosteroids are occasionally used to reduce inflammation in developing lesions.
Surgery is not often recommended, but a person who is concerned about the cosmetic appearance of their legs may choose to have a procedure done. A plastic surgeon can excise lesions and graft skin tissue from other parts of the body onto the shins. It is possible, however, for necrobiosis lipoidica diabeticorum to return after surgery.
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