Necrobiose Lipoidica

  • Usually adults, plaques with red-brown rims and yellow hue, atrophic, shins most common, possible ulceration
  • Association with diabetes
    • 0,3% diabetics have NL, no link to disease severity
    • 65% NL have diabetes, > with abnormal glucose
    • Used to be “NLD” → Necrobiosis Lipoidica Diabeticorum
  • Pathology
    • Definição de “necrobiose”
      • misnomer - deveria chamar-se “colagenólise”. O colagénio não é substancia viva e não entra em necrose
      • Alterações degenerativas do colagénio frequentemente acompanhadas de resposta granulomatosa
    • “Layered cake” full dermal palisading and interstitial granulomas parallel to epidermis, plasma cells, <mucin, necrobiosis
    • Paniculite septal linfocítica
      • Not exclusive to the fat → Will always involve the dermis to varying degrees (DDx with morphea/scleroderma - exclusive to the fat)
      • Dramatic thickening of septa with mixed infiltrate and granulomas
  • Treatment
    • Local steroids, wound care, diabetic care, observation
      • notion image