Answer |

^*Mukul Prasoon,

^*Post-graduate Resident, Department Of Medicine ,LHMC New Delhi

A provisional diagnosis of diabetic dermopathy – Necrobiosis Lipodica Diabeticorum was made on basis of visual inspection and clinical examination. Skin Biopsy taken at this stage revealed alternating layers of necrobiotic collagen with inflammatory cell infiltrate of lymphocytes, histiocytes, multinucleated giant cells and plasma cells, with marked proliferation of blood vessels involving the full thickness of the dermis. It confirmed the diagnosis of NLD. The patient was prescribed subcutaneous long acting insulin once daily and occlusive dressing. The rash improved after glycaemic control on follow-up after 4 weeks.

DISCUSSION

Necrobiosis Lipoidica Diabeticorum is a relatively uncommon condition associated with DM. A It’s an inflammatory skin disorder characterized by irregularly shaped, callous lesions with reddish-brown pigmentation and central atrophy.

In necrobiosis lipoidica diabeticorum, the shins, ankles, and feet are typically affected, but 15% of patients may have lesions elsewhere. The disorder is more common among women than men and is more common among persons with diabetes than those without.

Microscopic studies have shown that it is a disorder of collagen degeneration characterized by a granulomatous response, thickening of the walls of blood vessels, and fat deposition. In our patients these classical features were present in our patient. The appearance and typical site aided to the diagnosis; this prompted a skin biopsy which clinched the diagnosis of NL.

REFERENCE

Joshi A, Rathi S K, Khanna N. Necrobiosis lipoidica mimicking cellulitis. Indian J Dermatol Venereol Leprol 1997; 63:191-192