Perforating necrobiosis lipoidica in a girl with type 1 diabetes mellitus: A new case reported
Necrobiosis lipoidica is an idiopathic dermatological condition that is strongly associated with diabetes mellitus. It is more commonly seen in women than men. The average age of onset is 30-40 years. Necrobiosis Lipoidica diabeticorum is an extremely rare finding in childhood diabetes. We describe the case of a 13-year-old girl who has had type 1 diabetes mellitus since she was 8 years old. The patient presented with 2 well-defined, persistent plaques with a depressed central area and elevated purple peripheral ring, one on the right thigh and the other over the lateral left leg. Histopathologic evaluation of the patient's biopsy confirmed the diagnosis of necrobiosis lipoidica with transfollicular elimination. Our patient is the second pediatric case described with perforating necrobiosis lipoidica. We review the literature and discuss clinical features, several complications, and the most recent treatment options for necrobiosis lipoidica in diabetic children.
Available from: Lyubomir Dourmishev
- "The clinical expression is typical: primary perforating disorders appear as hyperkeratotic, eroded papules, while secondary ones consisted of smooth plaques with centered keratotic papules and peripherally comedonal plugs . The phenomenon of transfollicular and transepidermal elimination of degenerated collagen, elastic fibers, and necrotic tissue in necrobiosis lipoidica diabeticorum is rare, with few cases reported in the literature [8–12]. "
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ABSTRACT: Perforating necrobiosis lipoidica is a very rare clinical variant which consists of degeneration and transepidermal elimination of the collagen with few cases reported in the literature. In two-thirds of the patients it associates with diabetes, with no relation with the glucose control. We present a 42-year-old female patient with a 7-year history of diabetes on insulin therapy, referred to our clinic with a 3-year history of multiple asymptomatic firm plaques disseminated on the upper and lower extremities. The clinical and histological findings proved the diagnosis of perforating necrobiosis lipoidica.
Available from: Adriana Franzese
- "The reported prevalence in children varies from 0.06% to 10% (De Silva et al., 1999). The female/male ratio is 3:1(Hammami et al., 2008). The average age of onset is 30–40 years. "
Available from: Aikaterini Patsatsi
- "According to some reports, smoking cessation and blood glucose control is recommended [1, 2]. Other therapeutic options are antiplatelet agents , cyclosporine [1, 2, 3, 8], thalidomide [3, 8], clofazimine , anti-TNF agents [3, 8], fumaric acid esters [2, 8], PUVA [2, 3, 8], photodynamic therapy [8, 9], hydroxychloroquine  and tacrolimus [3, 11, 12, 13]. "
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ABSTRACT: We present a case of necrobiosis lipoidica (NL) with atypical early lesions and good response to topical tacrolimus. NL is a disease with clinical features that are seldom misinterpreted. Often histology just confirms the clinician's diagnosis. Only in rare cases, the clinical presentation and the involved body sites may be misleading. A 67-year-old diabetic woman was admitted to our department with a well-defined, persistent plaque on her left arm and on her right shin. Histologic examination of both lesions revealed features of NL despite the dissimilar clinical presentation. The patient was treated with 0.1% topical tacrolimus ointment twice daily for 8 weeks and once daily for 8 weeks. A significant improvement and no further lesions were observed after 1 year of follow-up. A high index of suspicion regarding NL lesions with atypical clinical presentation on different body sites is advised in order to avoid misdiagnosis, wrong treatment decisions and ulceration. Additionally, it appears that topical tacrolimus treatment is an effective therapeutic option in patients with recent, non-ulcerated NL lesions.
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