Twenty-five-year follow-up of necrobiosis lipoidica diabeticorum

Abstract

Necrobiosis lipoidica diabeticorum (NL) is a degenerative collagen disorder seen usually on the shins of the legs and rarely on the hands, forearms or face. It is seen more often in women than men, and usually presents in adolescence. Although most commonly observed in people with type 1 diabetes, up to 30% of cases may occur in non-diabetic individuals who may have a family history of diabetes or who have impaired glucose tolerance (IGT). A detailed review of NL is published earlier in this issue. 1 This short report describes a case of NL followed-up for 25 years to illustrate the natural history of this inflammatory disorder, associated with diabetes mellitus, for which the underlying cause is unknown and for which there is, as yet, no treatment defined. Case report A 15-year-old type 1 diabetic female, diagnosed at 13 years of age, controlled on twice-daily soluble and isophane insulins, presented with a bilateral skin eruption on both shins. This increased in size over the next seven years at which time there were reddish brown plaques with overlying superficial telangiectasia, typical of NL (figure 1). At this stage intra-lesion steroid injections were given with triamcinolone to the inflamed edge of the necrobiotic plaques. This therapy produced no benefit. Over the next five years, the patient intermittently applied local topical steroid creams, which again gave no benefit. Eventually, professional camouflage treatment was given by a beautician with appropriate make-up being applied in an attempt to ‘mask’ the lesions and improve the cosmetic appearance. After a total period of review of 25 years, the NL lesions have faded and are now simply represented by slightly sclerotic plaques with atrophic surfaces and small superficial veins (figure 2). Discussion Over a period of 25 years of follow-up this diabetic female developed no microvascular complications of diabetes i.e. no retinopathy, nephropathy or neuropathy. Likewise, no clinically overt macrovascular problems arose. NL is unassociated with