What are the other Names for this Condition? (Also known as/Synonyms)

• Necrobiosis Lipoidica Diabeticorum (NLD)
• NLD (Necrobiosis Lipoidica Diabeticorum)

What is Necrobiosis Lipoidica? (Definition/Background Information)

• Necrobiosis Lipoidica is a benign skin condition that occurs as multiple raised papules or plaques. This condition mostly occurs in individuals who have diabetes or prediabetes
• The most common location for the skin lesions includes the shin (lower leg). Necrobiosis Lipoidica mostly affects middle-aged adults and is rarely observed in children
• A thorough physical examination correlated with a complete medical history of diabetes, followed by a skin biopsy, may help in the diagnosis of Necrobiosis Lipoidica
• Untreated Necrobiosis Lipoidica may be associated with complications of diabetes such as diabetic retinopathy and diabetic nephropathy. The skin lesions can also ulcerate, bleed, and develop superimposed infections
• The treatment of Necrobiosis Lipoidica would essentially include treating diabetes, which may be ensured through proper diet, physical activity, and medications to keep the blood sugar levels under check
• The prognosis of Necrobiosis Lipoidica is generally excellent with proper treatment. In the majority of cases, the condition is chronic and persistent; in some individuals, though, it can disappear with time (spontaneous regression)

Who gets Necrobiosis Lipoidica? (Age and Sex Distribution)

• Necrobiosis Lipoidica develops in adults (average age 35 years). It may be occasionally seen in children
• It affects both males and females, but females are affected more than males in a 3:1 ratio
• There is no geographical distribution observed; the condition occurs worldwide in all races and ethnic groups

What are the Risk Factors for Necrobiosis Lipoidica? (Predisposing Factors)

The risk factors for Necrobiosis Lipoidica include:

• Individuals with diabetes, either type 1 or type 2, are at risk. The longer the individual has diabetes, the more likely the chance of developing Necrobiosis Lipoidica
• Individuals with prediabetes are also at risk

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Necrobiosis Lipoidica? (Etiology)

The causative factors of Necrobiosis Lipoidica development are not well known.

• It is linked to the presence of diabetes and prediabetes. Hence, the condition is also known as Necrobiosis Lipoidica Diabeticorum
• The biochemical and inflammatory steps to developing Necrobiosis Lipoidica are not delineated

What are the Signs and Symptoms of Necrobiosis Lipoidica?

The signs and symptoms of Necrobiosis Lipoidica may include:

• The presence of benign skin lesions that occur as multiple raised papules or nodules or plaques
• These papules become flat patches or plaques with time
• The most common location is the front of the lower leg (the shin); either one leg or both legs may be affected
• The skin lesions may ulcerate and bleed
• Additionally, the signs and symptoms of accompanying diabetes may be observed

It is important to note that the severity of Necrobiosis Lipoidica does not correlate with the control of diabetes. Hence, individuals with well-controlled diabetes may have more severe signs and symptoms than individuals with poorly-controlled diabetes.

How is Necrobiosis Lipoidica Diagnosed?

Necrobiosis Lipoidica is diagnosed using the following methods:

• A thorough physical examination correlated with a complete medical history of diabetes (or prediabetes)
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Blood glucose level tests
• Skin biopsy: A skin biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed), and microscope findings, the pathologist arrives at a definitive diagnosis
• Testing of the eyes for any signs of diabetic retinopathy
• Testing of the kidneys for any signs of diabetic nephropathy

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Necrobiosis Lipoidica?

Necrobiosis Lipoidica may result in the following complications:

• Individuals with Necrobiosis Lipoidica and those who are insulin-dependent have a higher chance of developing diabetic retinopathy, a complication of diabetes that can seriously affect one’s eyes and hamper vision
• Scratching or itching of the lesion may lead to bleeding and ulceration. This can cause secondary bacterial or fungal infections to develop
• The longstanding and persistent skin lesions can cause stress and anxiety in the affected individuals
• Other complications due to poorly-controlled diabetes

How is Necrobiosis Lipoidica Treated?

The treatment measures for Necrobiosis Lipoidica may include undertaking proper control of diabetes. This may be ensured by the following measures:

• Diet and exercise
• Regular check-ups to ensure that blood sugar levels are within control
• Medications may be prescribed to help lower blood sugar levels
• Weight-loss surgery may be considered if the individual is overweight or obese
• Reports of Photodynamic Therapy (PDT) effectively treating NLD have been published
• Surgical excision of the plaques with subsequent skin grafting have shown the risk of recurrence of the condition at the margins of the excisions 

The treatment for the skin lesions caused by Necrobiosis Lipoidica may include a complete surgical excision to remove the benign tumors. However, ensuring proper treatment of diabetes is more important.

How can Necrobiosis Lipoidica be Prevented?

Diabetes does not always lead to Necrobiosis Lipoidica, and not all individuals with longstanding diabetes may be affected by this benign skin condition. The preventive methods for diabetes could include:

• Eating healthy and incorporating physical activity (exercise) into one’s daily routine; ensure an active lifestyle
• Monitoring blood glucose levels consistently
• Regularly having hemoglobin A1C tests undertaken: This test reflects the average blood sugar level in one’s body for a 2-3 month period before the test
• Keep blood pressure and cholesterol levels in check
• Quitting smoking, as smoking increases the risk of developing diabetes-related complications

What is the Prognosis of Necrobiosis Lipoidica? (Outcomes/Resolutions)

• The prognosis of Necrobiosis Lipoidica is generally excellent with adequate treatment
• In some individuals, the condition is observed to regress and resolve on its own spontaneously

Additional and Relevant Useful Information for Necrobiosis Lipoidica:

• Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken to avoid strong soaps and chemicals that could potentially worsen the condition
• The presence of dirt on the body is not a causative factor for the condition. However, it helps to be clean and hygienic, which may help prevent the condition from getting worse