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June 8, 2002

Complications

Question from Cardiff, United Kingdom:

Are there any new thoughts on the treatment of necrobiosis lipoidica diabeticorum?

Answer:

Information on this topic is rather sparse in textbooks. A literature search reveals trials with small numbers of patients. It appears that the prevalence of necrobiosis lipoidica diabeticorum, a plaque-like skin lesion on the lower extremities, occurs in only 0.3% of patients with diabetes. It tends to be more common in females and is more common with poor blood sugar control. The usual therapy is to observe unless they become large or ulcerate.

Minor trauma makes the lesion worse so avoidance of trauma to the area is important. In addition, good glucose control is probably helpful since it is more common when control is poor.

When therapy is administered, local injectable steroids are usually used, but the response is less than optimal. That is why you see other trials testing other alternative therapies. These range from “PUVA” (Psoralen and ultraviolet A light) to hyperbaric oxygen, to granulocyte stimulating factor, to retinoids. Once you get past steroids, I am not sure what the best alternative strategy might be. It would be important to have the input of a dermatologist with interest in the area.

JTL