Summary about Disease
Necrobiosis lipoidica (NL) is a rare, chronic inflammatory condition that primarily affects the skin, most commonly on the shins. It's characterized by well-defined, waxy, reddish-brown or yellowish plaques. While often associated with diabetes, it can occur in people without diabetes as well. The condition is typically asymptomatic but can sometimes be painful or itchy. The exact cause is unknown.
Symptoms
Initial Lesions: Small, raised, reddish-brown papules or patches that appear on the skin, often on the shins.
Plaque Formation: These initial lesions gradually enlarge to form well-defined, waxy, reddish-brown or yellowish plaques.
Central Atrophy: The center of the plaques may become thin, shiny, and atrophic (scarred) with visible blood vessels.
Color Changes: The color of the plaques can vary from red-brown to yellow-brown and may become purple over time.
Ulceration: In some cases, the plaques may ulcerate (break down and form sores), which can be painful and prone to infection.
Sensory Changes: The affected area may be numb or less sensitive to touch.
Itching or Pain: Although often asymptomatic, some individuals may experience itching or pain in the affected areas.
Causes
The exact cause of necrobiosis lipoidica is unknown. Several factors are thought to play a role, including:
Diabetes: NL is more common in people with diabetes, particularly type 1 diabetes, but it can also occur in individuals without diabetes.
Abnormal Collagen: Alterations in collagen structure and function in the skin.
Blood Vessel Abnormalities: Problems with small blood vessels (microangiopathy) in the skin.
Inflammation: An inflammatory process involving the immune system.
Genetics: A possible genetic predisposition.
Medicine Used
Treatment for necrobiosis lipoidica aims to control inflammation and prevent ulceration. There is no definitive cure. Treatment options may include:
Topical Corticosteroids: Potent corticosteroids applied directly to the affected skin can help reduce inflammation.
Intralesional Corticosteroids: Corticosteroids injected directly into the plaques.
Topical Calcineurin Inhibitors: Such as tacrolimus or pimecrolimus, can help reduce inflammation.
Pentoxifylline: Improves blood flow and may reduce inflammation.
Phototherapy: Light therapy, such as PUVA (psoralen plus ultraviolet A) or narrow-band UVB, may be used to reduce inflammation.
Systemic Medications: In more severe cases, systemic medications such as corticosteroids, cyclosporine, or biologics (e.g., TNF inhibitors) may be considered.
Wound Care: If ulceration occurs, careful wound care is essential to prevent infection.
Is Communicable
Necrobiosis lipoidica is not communicable. It is not contagious and cannot be spread from person to person through any means.
Precautions
Protect Affected Areas: Protect the affected skin from injury, as trauma can worsen the condition and increase the risk of ulceration.
Moisturize Regularly: Keep the skin well-moisturized to prevent dryness and cracking.
Control Diabetes (if applicable): If you have diabetes, strict control of blood sugar levels may help to improve the condition.
Avoid Smoking: Smoking can worsen NL and impair wound healing.
Sun Protection: Protect the affected areas from sun exposure.
Monitor for Ulceration: Regularly check the plaques for any signs of ulceration and seek prompt medical attention if they occur.
Gentle Skin Care: Use gentle, non-irritating soaps and skin care products.
How long does an outbreak last?
Necrobiosis lipoidica is a chronic condition, meaning it can last for years or even a lifetime. There are not necessarily "outbreaks" in the traditional sense. The lesions tend to develop slowly and persist over time. Treatment can help to control the inflammation and prevent progression, but the condition may recur or persist despite treatment.
How is it diagnosed?
Physical Examination: A dermatologist can often diagnose necrobiosis lipoidica based on the characteristic appearance of the skin lesions.
Skin Biopsy: A skin biopsy is usually performed to confirm the diagnosis. A small sample of skin is removed and examined under a microscope. The biopsy can help rule out other conditions.
Medical History: The doctor will ask about your medical history, including any history of diabetes or other medical conditions.
Blood Tests: Blood tests may be performed to check for diabetes or other underlying conditions.
Timeline of Symptoms
The timeline of symptoms can vary from person to person:
Initial Stage: Small, raised, reddish-brown papules or patches appear.
Progression: These lesions gradually enlarge and become well-defined plaques over months to years.
Chronic Stage: The plaques persist, with potential for central atrophy, color changes, and occasional ulceration.
Remission/Exacerbation: The condition may have periods of relative stability or worsening (exacerbation).
Important Considerations
Psychological Impact: NL can have a significant psychological impact due to its visible nature and chronic course. Support groups or counseling may be helpful.
Association with Diabetes: While NL is often associated with diabetes, it can occur in people without diabetes. Regular screening for diabetes is recommended if you are diagnosed with NL.
Risk of Ulceration: Ulceration is a significant complication of NL. Prompt treatment and wound care are essential to prevent infection and promote healing.
Cosmetic Concerns: The appearance of NL can be distressing. Discuss cosmetic options with your dermatologist, such as camouflage makeup.
Long-Term Management: NL requires long-term management and monitoring. Regular follow-up with a dermatologist is important.