May 15, 2003
Complications
Question from Whitby, Ontario, Canada:
In the last year, my six and a half year son, who has had type 1 diabetes for three and a half years, has developed necrobiosis. it started on his tummy above the belly button, now it is on his ankle and arm, and we think it might be on his cheek. The ankle seems to be the biggest spot roughly the size of our dollar coin, and we have been told to use a good over the counter cream so we are using Aveeno. It seems to help keep the area (above the ankle) moist — not dry and itchy, but but our concern is what about the if the necrobiosis gets bigger at the arm and now the face — what do we do? It seems this necrobiosis is spreading, and we are getting worried and scared that it will keep populating our little boy’s body. Any help, advice, or suggestions would be great.
We do know that necrobiosis is very rare in children and in males also. We have taken him to the Children’s Hospital on the advice of a dermatologist and they were puzzled — the head dermatologists even took pictures of the areas because the other doctors had never seen it.
Answer:
Necrobiosis lipoidica diabeticorum (sometimes just called necrobiosis lipoidica) is indeed a strange and interesting finding. A minority of cases are not associated with diabetes at all. The cause is unknown but actually does not seem to be related to the degree of glucose control. Perhaps there is an autoimmune process, similar to that which causes type 1 diabetes and other conditions (lupus, thyroiditis, rheumatoid arthritis, celiac disease, adrenalitis and others).
My understanding is that there are no tried and true effective treatment methods. Certainly, this forum cannot diagnose a skin lesion for you, but it seems that you are seeking appropriate consultations. Some folks have used injected steroids successfully. There may be other, newer, research issues; I think you keep your dialogue going with the dermatologist (they’d probably know the “latest”), but keep your good common sense: keep the area clean and dry and do keep those glucose levels in good control.
DS
