Necrobiosis Lipoidica Diabeticorum

Abstract

IN CLASSIC textbooks on dermatology, necrobiosis lipoidica diabeticorum is described as a cutaneous disease characterized by atrophic, yellowish, sclerotic plaques with violaceous borders occurring chiefly on the lower extremities of diabetic females. Ormsby and Montgomery¹stated that 80% of the patients were female and 90% diabetic. The first case was described by Oppenheim²in 1930, and he offered the diagnostic title of dermatitis atrophicans lipoides diabetica for this condition. Urbach³in 1932 recognized a second case and suggested the pathogenesis of the disease. He named the lesion necrobiosis lipoidica diabeticorum (NLD). The early lesion begins as a well-defined, round, firm, glistening papule. By peripheral enlargement characteristic plaques are formed. The central portion of the lesion is yellow to yellowish brown; and as the area becomes depressed and atrophic, superficial telangiectatic blood vessels traverse the surface. Later, the border hue changes from violet to redbrown, and occasionally, the