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Necrobiosis - Diabetic Skin Disorder
The skin disorder, Necrobiosis Lipoidica Diabeticorum is usually known as necrobiosis and is often associated with diabetes, although not exclusively so.
What is the Cause of NLD?
Although necrobiosis is well known, it is a very uncommon condition and many healthcare professionals may never have seen it before. It may develop before or at the time of diagnosis of diabetes, but usually will appear some years after diagnosis. It occurs most commonly in young women treated with insulin. The cause is unknown and it can happen no matter how well the diabetes is controlled. NLD is a disorder of collagen degeneration with a granulomatous response, thickening of blood vessel walls, and fat deposition. The exact cause of NL is unknown, but the leading theory of NL has focused on diabetic microangiopathy. Other theories suggest trauma or inflammatory or metabolic changes. Still other theories suggest that an antibody-mediated vasculitis may cause the changes seen in NLD
What does it look like?
It usually appears as small oval dark red or browny yellow patches (lesions) with a thick shiny surface. The patches may be raised above the surrounding skin, which
develops a shiny porcelain-like appearance, and the edges are usually sharply defined. They are often itchy or painful. The plaques often turn a light color due to extracellular fat (the "lipoidica"). In a small percentage of cases, a part of the patch may break down and form ulcers. The patches may be single or multiple and are most commonly found on the legs, particularly over the shins. However, the arms, hands and body may also be affected. Typically the spots turn a brownish color, which fades slowly but is permanent.
How does it progress?
Necrobiosis usually progresses slowly and it may remain very slight but rarely will it clear up completely. There are no symptoms and it is not painful unless it ulcerates. It does not lead to gangrene.
How is it treated?
Treatment is disappointing. Creams, dressings or injections of steroids into the patches may be tried and can help in some cases. Some people have tried complementary therapies with varying degrees of success, including Chinese Medicine. The lesions may be camouflaged with cosmetics and water-based ones are available. Color matching and skilful application is important for camouflaging to be successful and professional help should be obtained. Remember also that although the patches may be unsightly, they will not lead to any serious harm. If the patches are on the shins, it is important to avoid knocking them as this can lead to ulceration. It might be helpful to wear a padded dressing over the lesion. Medical advice should be sought should ulcers develop. Whilst the severity of the lesions may by unaffected by control of diabetes, it is advisable to keep the blood sugar levels between 4 and 8 mmol/l to avoid any problems of secondary infection within the lesion.
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