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• W4247934710 abstract "A 12-year-old girl with type 1 diabetes mellitus (T1DM)complained of asymptomatic, enlarging red skin lesions on her shins for 6 months. The firm plaques lacked hair and demonstrated erythematous borders surrounding yellow-hued telangiectatic centers (Figure). Skin biopsy showed layers of granulomatous inflammation and necrobiotic collagen, confirming the diagnosis of necrobiosis lipoidica. Clobetasol propionate 0.05% ointment applied twice daily resulted in moderate reduction of erythema after 2 weeks. She was diagnosed with T1DM at 5 years of age and required hospitalization 3 times for diabetic ketoacidosis. To date, she has no nephropathy or retinopathy. Over the last 6 months, her hemoglobin A1C ranged from 9.2% to 10.4%. She also is obese (body mass index 26.5, 95.5% for age) and has isolated hypertriglyceridemia. Necrobiosis lipoidica characteristically manifests as enlarging, annular plaques on the shins with red-brown edges and atrophic, yellow-brown, telangiectatic centers.1Sibbald C. Reid S. Alavi A. Necrobiosis lipoidica.Dermatol Clin. 2015; 33: 343-360Abstract Full Text Full Text PDF PubMed Scopus (53) Google Scholar, 2Marchetti F. Gerarduzzi T. Longo F. Faleschini E. Ventura A. Tonini G. Maturity-onset diabetes of the young with necrobiosis lipoidica and granuloma annulare.Pediatr Dermatol. 2006; 23: 247-250Crossref PubMed Scopus (21) Google Scholar, 3Uva L. Freitas J. Soares de Almeida L. Vasques H. Moura C. Miguel D. et al.Squamous cell carcinoma arising in ulcerated necrobiosis lipoidica diabeticorum.Int Wound J. 2015; 12: 741-743Crossref PubMed Scopus (18) Google Scholar, 4Muller S.A. Winkelmann R.K. Necrobiosis lipoidica diabeticorum: a clinical and pathological investigation of 171 cases.Arch Dermatol. 1966; 93: 272-281Crossref PubMed Scopus (239) Google Scholar Although commonly asymptomatic, affected skin may be fragile and painful ulcerations develop in 25%-33% of cases.5Erfurt-Berge C. Seitz A.-T. Rehse C. Wollina U. Schwede K. Renner R. Update on clinical and laboratory features in necrobiosis lipoidica: a retrospective multicentre study of 52 patients.Eur J Dermatol. 2012; 22: 770-775Crossref PubMed Scopus (42) Google Scholar, 6Bonura C. Frontino G. Rigamonti A. Battaglino R. Favalli V. Ferro G. et al.Necrobiosis Lipoidica Diabeticorum: a pediatric case report.Dermatoendocrinol. 2014; 6: e983683Crossref Scopus (16) Google Scholar Rarely, squamous cell carcinomas have developed within longstanding necrobiosis lipoidica lesions (after 6-40 years).3Uva L. Freitas J. Soares de Almeida L. Vasques H. Moura C. Miguel D. et al.Squamous cell carcinoma arising in ulcerated necrobiosis lipoidica diabeticorum.Int Wound J. 2015; 12: 741-743Crossref PubMed Scopus (18) Google Scholar Among children with T1DM, necrobiosis lipoidica prevalence is estimated to be only 0.06%, yet 11%-65% of patients with necrobiosis lipoidica have diabetes mellitus (usually T1DM) at time of skin lesion presentation.4Muller S.A. Winkelmann R.K. Necrobiosis lipoidica diabeticorum: a clinical and pathological investigation of 171 cases.Arch Dermatol. 1966; 93: 272-281Crossref PubMed Scopus (239) Google Scholar, 7Pavlovic M.D. Milenkovic T. Dinic M. Misovic M. Dakovic D. Todorovic S. et al.The prevalence of cutaneous manifestations in young patients with type 1 diabetes.Diabetes Care. 2007; 30: 1964-1967Crossref PubMed Scopus (74) Google Scholar, 8De Silva B.D. Schofield O.M. Walker J.D. The prevalence of necrobiosis lipoidica diabeticorum in children with type 1 diabetes.Br J Dermatol. 1999; 141: 593-594Crossref PubMed Scopus (27) Google Scholar Glycemic control does not appear to influence the progression of necrobiosis lipoidica; however, patients with necrobiosis lipoidica have greater rates of diabetes-related complications.9Kelly W.F. Nicholas J. Adams J. Mahmood R. Necrobiosis lipoidica diabeticorum: association with background retinopathy, smoking, and proteinuria. A case controlled study.Diabet Med. 1993; 10: 725-728Crossref PubMed Scopus (44) Google Scholar, 10Verrotti A. Chiarelli F. Amerio P. Morgese G. Necrobiosis lipoidica diabeticorum in children and adolescents: a clue for underlying renal and retinal disease.Pediatr Dermatol. 1995; 12: 220-223Crossref PubMed Scopus (51) Google Scholar In one study of adults, necrobiosis lipoidica also was associated with hypertension (9.2%), obesity (4.6%), and dyslipidemia (2.3%).11Jockenhöfer F. Kröger K. Klode J. Renner R. Erfurt-Berge C. Dissemond J. Cofactors and comorbidities of necrobiosis lipoidica: analysis of the German DRG data from 2012.J Dtsch Dermatol Ges. 2016; 14: 277-284PubMed Google Scholar Topical and intralesional corticosteroids are considered first-line treatment for necrobiosis lipoidica, but responses vary.6Bonura C. Frontino G. Rigamonti A. Battaglino R. Favalli V. Ferro G. et al.Necrobiosis Lipoidica Diabeticorum: a pediatric case report.Dermatoendocrinol. 2014; 6: e983683Crossref Scopus (16) Google Scholar Approximately 17% of cases spontaneously remit after 8-12 years.4Muller S.A. Winkelmann R.K. Necrobiosis lipoidica diabeticorum: a clinical and pathological investigation of 171 cases.Arch Dermatol. 1966; 93: 272-281Crossref PubMed Scopus (239) Google Scholar, 6Bonura C. Frontino G. Rigamonti A. Battaglino R. Favalli V. Ferro G. et al.Necrobiosis Lipoidica Diabeticorum: a pediatric case report.Dermatoendocrinol. 2014; 6: e983683Crossref Scopus (16) Google Scholar Tight glucose control is recommended.12Cohen O. Yaniv R. Karasik A. Trau H. Necrobiosis lipoidica and diabetic control revisited.Med Hypotheses. 1996; 46: 348-350Abstract Full Text PDF PubMed Scopus (36) Google Scholar Avoidance of trauma is central to preventing ulcers.3Uva L. Freitas J. Soares de Almeida L. Vasques H. Moura C. Miguel D. et al.Squamous cell carcinoma arising in ulcerated necrobiosis lipoidica diabeticorum.Int Wound J. 2015; 12: 741-743Crossref PubMed Scopus (18) Google Scholar Nodules or ulcerations within necrobiosis lipoidica lesions warrant prompt evaluation. Otherwise, yearly detailed clinical examinations are recommended for patients with necrobiosis lipoidica, including lipid screening and diabetes screening in nondiabetic patients.13Wanat K. Rosenbach M. Necrobiosis Lipoidica.https://www.uptodate.com/contents/necrobiosis-lipoidicaGoogle Scholar" @default.
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