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October 2, 2018

Other Illnesses

Question from Helotes, Texas, USA:

My older teen, who was diagnosed with type 1 at the age of three, developed large spots on her shins about eight years ago. They range from pink and shiny, to red and peeling. Our endocrinologist confirmed that it was necrobiosis lipoidica diabeticorum. We tried cortisone shots, which proved too painful and not terribly effective. So, I have a few questions: Is this fairly uncommon? I've never seen another T1 child with it, nor any adults that I know. Is it related to blood sugars at all? That is, does it worsen with poorer control and get better with a lower A1c? Are there any new therapies that can improve or eradicate it? Is it something to worry about in the long term? Does it get worse or ulcerate the longer one has it?

Answer:

Necrobiosis lipoidica diabeticorum has been known for decades but without any obvious real explanation. It is rather rare but was somewhat more commonly seen with the older, less purified insulin preparations compared to today’s better insulin choices. The risk is for skin breakdown, ulceration and infection so good skin hygiene is important. It does not seem related to glucose control directly but we really do not have a good understanding of who is at risk, why it occurs, so treatment, unfortunately, remains mostly local support for the site, sometimes cortisone or other steroid creams or injections and antibacterial medications if there is secondary infection.

SB