Necrobiosis lipoidica diabeticorum: A pediatric case report

Clara Bonura, Giulio Frontino, Andrea Rigamonti, Roseila Battaglino, Valeria Favalli, Giusy Ferro, Chiara Rubino, Paolo Del Barba, Filippo Pesapane, Gianluca Nazzaro, Raffaele Gianotti, Riccardo Bonfanti, Franco Meschi, Giuseppe Chiumello

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Necrobiosis lipoidica (NL) is a rare chronic granulomatous dermatitis that usually appears in the lower extremities. It affects about 0.3-1.2% of diabetic patients, the majority of whom have type 1 diabetes. The etiology and pathogenesis of this disorder are still unclear. NL is characterized by skin rash that usually affects the shins. The average onset is 30 years, with females being affected more commonly. There are very few reported cases of necrobiosis lipoidica in children. Case report: We report a case of a 16 year old girl affected by type 1 diabetes mellitus (15 years disease duration) who developed an erythematous nodular rash on the lower extremities and interscapular area. In the suspect of necrobiosis lipoidica, a skin biopsy was performed (lower extremities and interscapular area). The microscopic evaluation of the pretibial lesions was suggestive of necrobiosis lipoidica. The smaller lesions in the interscapular area showed signs of perivascular dermatitis which could be consistent with early stages of necrobiosis lipoidica. Local treatment with tacrolimus determined a progressive improvement of the lesions. Conclusion: In patients with T1DM, diagnosis of NL of the lower legs is usually unequivocal. However, diagnosis may be more challenging in the presence of lesions with recent onset and/or atypical clinical presentation and unusual site. In these cases, NL must always be taken in consideration in order to avoid misdiagnosis, wrong/late treatment decisions and progression to ulceration.

Original languageEnglish
Article numbere27790
JournalDermato-Endocrinology
Volume6
Issue numberJAN
DOIs
Publication statusPublished - 2014

Keywords

  • Children
  • Diabetes
  • Granulomatous dermatitis
  • Necrobiosis lipoidica
  • Skin lesion
  • T1DM
  • Type 1 diabetes

ASJC Scopus subject areas

  • Dermatology
  • Endocrinology, Diabetes and Metabolism

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