Journal of Community Hospital Internal Medicine Perspectives
ISSN: (Print) 2000-9666 (Online) Journal homepage: http://www.tandfonline.com/loi/zjch20
Necrobiosis lipoidica Ranjan Pathak MD, Paras Karmacharya MD, Madan Raj Aryal MD & Karen E Smith-Coleman MD, FACE To cite this article: Ranjan Pathak MD, Paras Karmacharya MD, Madan Raj Aryal MD & Karen E Smith-Coleman MD, FACE (2013) Necrobiosis lipoidica, Journal of Community Hospital Internal Medicine Perspectives, 3:3-4, 22627, DOI: 10.3402/jchimp.v3i3-4.22627 To link to this article: http://dx.doi.org/10.3402/jchimp.v3i3-4.22627
© 2013 Ranjan Pathak et al.
Published online: 17 Dec 2013.
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Date: 20 May 2017, At: 20:15
CLINICAL IMAGING æ
Necrobiosis lipoidica Ranjan Pathak, MD1*, Paras Karmacharya, MD1, Madan Raj Aryal, MD1 and Karen E. Smith-Coleman, MD, FACE2 1
Department of Internal Medicine, Reading Health System, West Reading, PA, USA; 2RPS Endocrinology Diabetes and Metabolism Center, Wyomissing, PA, USA *Correspondence to: Ranjan Pathak, Reading Hospital and Medical Center, 6th ave and Spruce St, West Reading, PA 19611, USA, Tel: 484 628 8255, Email: [email protected] Received: 15 August 2013; Accepted: 8 October 2013; Published: 17 December 2013
47-year-old woman reported an 18-month-old pretibial rash on her left shin during a routine office visit. She had a history of type 1 diabetes mellitus (DM) and has been on insulin therapy for the
A
past 13 years. She did not complain of any itching, pain, or bleeding from the rash. On examination, an 8 3 cm elongated indurated plaque with telangiectases, central atrophy, and yellow pigmentation was noted. Reddishbrown pigmentation was present peripherally along the margins. No ulcerations were present. Patient was diagnosed to have necrobiosis lipoidica on the basis of history and typical features on examination. Necrobiosis lipoidica is an inflammatory skin disorder of unknown cause, occurring three times more often in females than in males (1). It typically involves the shins, ankles, and feet. It occurs in less than 1% of all diabetic patients (2). It occurs at an earlier age in patients with type 1 DM than those with type 2 DM or non-diabetics (3). No clear correlation with glycemic control or other complications of DM has been established (4). Although there is no proven treatment for necrobiosis lipoidica, topical, and intra-lesional steroids can be tried for the initial management (5) (Fig. 1). Other agents like tacrolimus, antimalarials, cyclosporine, granulocyte-macrophage colony stimulating factor, hyperbaric oxygen, and systemic corticosteroids have been used with variable results.
References 1. Erfurt-Berge C, Seitz A-T, Rehse C, Wollina U, Schwede K, Renner R. Update on clinical and laboratory features in necrobiosis lipoidica: A retrospective multicentre study of 52 patients. Eur J Dermatol 2012; 22(6): 7705. 2. Muller SA, Winkelmann RK. Necrobiosis lipoidica diabeticorum. A clinical and pathological investigation of 171 cases. Arch Dermatol 1966; 93(3): 27281. 3. Van Hattem S, Bootsma AH, Thio HB. Skin manifestations of diabetes. Cleve Clin J Med 2008; 75(11): 772, 774, 776777 passim. 4. Kota SK, Jammula S, Kota SK, Meher LK, Modi KD. Necrobiosis lipoidica diabeticorum: A case-based review of literature. Indian J Endocrinol Metab 2012; 16(4): 61420. 5. Ferringer T, Miller F 3rd. Cutaneous manifestations of diabetes mellitus. Dermatol Clin 2002; 20(3): 48392.
Fig. 1. Necrobiosis lipoidica. Journal of Community Hospital Internal Medicine Perspectives 2013. # 2013 Ranjan Pathak et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/), permitting all noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Citation: Journal of Community Hospital Internal Medicine Perspectives 2013, 3: 22627 - http://dx.doi.org/10.3402/jchimp.v3i3-4.22627
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ISSN: (Print) 2000-9666 (Online) Journal homepage: http://www.tandfonline.com/loi/zjch20
Necrobiosis lipoidica Ranjan Pathak MD, Paras Karmacharya MD, Madan Raj Aryal MD & Karen E Smith-Coleman MD, FACE To cite this article: Ranjan Pathak MD, Paras Karmacharya MD, Madan Raj Aryal MD & Karen E Smith-Coleman MD, FACE (2013) Necrobiosis lipoidica, Journal of Community Hospital Internal Medicine Perspectives, 3:3-4, 22627, DOI: 10.3402/jchimp.v3i3-4.22627 To link to this article: http://dx.doi.org/10.3402/jchimp.v3i3-4.22627
© 2013 Ranjan Pathak et al.
Published online: 17 Dec 2013.
Submit your article to this journal
Article views: 1
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=zjch20 Download by: [80.82.77.83]
Date: 20 May 2017, At: 20:15
CLINICAL IMAGING æ
Necrobiosis lipoidica Ranjan Pathak, MD1*, Paras Karmacharya, MD1, Madan Raj Aryal, MD1 and Karen E. Smith-Coleman, MD, FACE2 1
Department of Internal Medicine, Reading Health System, West Reading, PA, USA; 2RPS Endocrinology Diabetes and Metabolism Center, Wyomissing, PA, USA *Correspondence to: Ranjan Pathak, Reading Hospital and Medical Center, 6th ave and Spruce St, West Reading, PA 19611, USA, Tel: 484 628 8255, Email: [email protected] Received: 15 August 2013; Accepted: 8 October 2013; Published: 17 December 2013
47-year-old woman reported an 18-month-old pretibial rash on her left shin during a routine office visit. She had a history of type 1 diabetes mellitus (DM) and has been on insulin therapy for the
A
past 13 years. She did not complain of any itching, pain, or bleeding from the rash. On examination, an 8 3 cm elongated indurated plaque with telangiectases, central atrophy, and yellow pigmentation was noted. Reddishbrown pigmentation was present peripherally along the margins. No ulcerations were present. Patient was diagnosed to have necrobiosis lipoidica on the basis of history and typical features on examination. Necrobiosis lipoidica is an inflammatory skin disorder of unknown cause, occurring three times more often in females than in males (1). It typically involves the shins, ankles, and feet. It occurs in less than 1% of all diabetic patients (2). It occurs at an earlier age in patients with type 1 DM than those with type 2 DM or non-diabetics (3). No clear correlation with glycemic control or other complications of DM has been established (4). Although there is no proven treatment for necrobiosis lipoidica, topical, and intra-lesional steroids can be tried for the initial management (5) (Fig. 1). Other agents like tacrolimus, antimalarials, cyclosporine, granulocyte-macrophage colony stimulating factor, hyperbaric oxygen, and systemic corticosteroids have been used with variable results.
References 1. Erfurt-Berge C, Seitz A-T, Rehse C, Wollina U, Schwede K, Renner R. Update on clinical and laboratory features in necrobiosis lipoidica: A retrospective multicentre study of 52 patients. Eur J Dermatol 2012; 22(6): 7705. 2. Muller SA, Winkelmann RK. Necrobiosis lipoidica diabeticorum. A clinical and pathological investigation of 171 cases. Arch Dermatol 1966; 93(3): 27281. 3. Van Hattem S, Bootsma AH, Thio HB. Skin manifestations of diabetes. Cleve Clin J Med 2008; 75(11): 772, 774, 776777 passim. 4. Kota SK, Jammula S, Kota SK, Meher LK, Modi KD. Necrobiosis lipoidica diabeticorum: A case-based review of literature. Indian J Endocrinol Metab 2012; 16(4): 61420. 5. Ferringer T, Miller F 3rd. Cutaneous manifestations of diabetes mellitus. Dermatol Clin 2002; 20(3): 48392.
Fig. 1. Necrobiosis lipoidica. Journal of Community Hospital Internal Medicine Perspectives 2013. # 2013 Ranjan Pathak et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/), permitting all noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Citation: Journal of Community Hospital Internal Medicine Perspectives 2013, 3: 22627 - http://dx.doi.org/10.3402/jchimp.v3i3-4.22627
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