Necrobiosis Lipoidica Flashcards
M:F predominance of necrobiosis lipoidica:
F:M 3:1
What disease is necrobiosis lipoidica a/w?
Diabetes/glucose intolerance
What is the general pathogenesis of necrobiosis lipoidica?
microangiopathic changes (from diabetes for ex)—-> dermal ischemia—-> dermal collagen degeneration—–> secondary granulomatous inflammatory response
How does necrobiosis lipoidica present?
initially reddish papules that expand to atrophic plaques on bilateral shins a/w peripheral violaceous to erythematous rim and atrophic central yellow-brown discoloration w/ telangiecatsias
Trauma to lesion of necrobiosis lipoidica can lead to_______
ulceration
What can be lost within plaques of necrobiosis lipoidica?
adnexae and neural element loss leading to decreasded pinprick/fine touch sensation, hypohidrosis, and localized alopecia
Histopath of necrobiosis lipoidica:
square biopsy sign
- horizontally arranged palisaded granulomatous inflammation with layering (layer of granulomatous inflammation, followed by layer of sclerotic dermis, and so on)
- plasma cells and multinucleated giant cells are abundant
What types of cells will you see in histopath of necrobiosis lipoidica?
Histiocytes, plasma cells, multinucleated giant cells, lymphocytes
First line tx for necrobiosis lipoidica:
potent topical CS and or intralesional steroids
- or TCI’s
What is the prognosis/clinical course of necrobiosis lipoidica?
- difficult to treat
- rarely undergoes spontaneous remission
- SCC may arise in chronic ulcerated lesions
If you dx someone with necrobiosis lipoidica, what labs should you order?
HgA1c
Does blood glucose control/levels affect disease course of necrobiosis lipoidica?
It does not affect course of the lesions already present, but can possibly prevent new lesions from forming.
