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Indian Pediatr 2016;53: 848

Necrobiosis Lipoidica

 

*Selim Dereci and Ozgur Pirgon

Süleyman Demirel University, Faculty of Medicine,  Department of Pediatrics, Isparta, Turkey.
Email: [email protected]
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A 13-year-old girl with type 1 diabetes mellitus presented with diabetic ketoacidosis. She was on regular insulin thrice a day with poorly controlled blood sugars. On examination, the girl had a well-defined, circular, indurated red plaque, measuring 5×5 cm, over the left leg (Fig.1). The lesion started as painless, reddish papules that slowly enlarged to a plaque over a period of 3 years. Analysis of the biopsy specimen confirmed the diagnosis of necrobiosis lipoidica (NL) diabeticorum. Laboratory investigations revealed an elevated glycosylated hemoglobin (12.5%), normal thyroid function, normal complete blood count, unremarkable liver and renal functions, and normal serum cholesterol and triglycerides. She was able to achieve good glucose control and resume her normal life; however, the complication on skin persisted despite an intensive insulin treatment and topical steroids.

Fig. 1 Necrobiosis lipoidica plaque with erythematous margins in the pretibial area.

NL is an extremely rare finding in childhood diabetes and typically presents at 30-40 years of age. The most commonly affected site is the leg; 85% of cases affect that site exclusively. Differential diagnoses include granuloma annulare (typically found on the dorsa of hands, fingers and feet), sarcoidosis, necrobiotic xanthogranuloma, lichen sclerosus, and erythema induratum. First-line therapy for NL includes non-steroidal inflammatory agents, cryotherapy and potent topical glucocorticoid agents for early lesions, and intralesional corticosteroids injected into the active borders of established lesions. Systemic glucocorticoid therapy may also be effective, but can be associated with adverse effects in patients with diabetes.

 

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