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Ulcerated necrobiosis lipoidica to a teenager with diabetes mellitus and obesity.
Rom J Morphol Embryol. 2014; 55(1):171-6.RJ

Abstract

Many skin lesions are associated with diabetes mellitus (DM) type 1 or 2, due to the use of antidiabetics or to metabolic and endocrine disorders caused by this disease. Necrobiosis lipoidica (NL) occurs more frequently in patients with DM. Painful ulcerations may occur on NL areas in about 20-25% of the cases and usually they are related to trauma. We present the case of a teenager, male, 17-year-old, having NL with multiple plaques, some of them spontaneously ulcerated after about 33 months of onset. He is known with type 1 DM from 2.5 years and the NL preceding the diagnosis of diabetes mellitus with about six months, presented erythematous-infiltrative skin plaques, some ulcerated for about three months, interesting both shins. Based on clinical, histopathological and paraclinical examinations, we established the following diagnoses: ulcerated NL, type 1 DM, moderate mixed dyslipidemia, class I obesity; commissural candidiasis, juvenile acne. Under treatment with Pentoxifyllinum, Sulodexidum, Ketotifenum and topical therapy with 0.2% Hyaluronic acid two months later, we have managed to heal two of the three ulcerated plaques and of the third has become superficial. We applied 0.5% Fluocortolonum on non-ulcerated plaques recording an improvement after two weeks of treatment. NL is a skin disease with a predilection for the shins, more frequent in patients with diabetes and is a part of palisading granulomatous dermatitis, which leads to skin atrophy. NL is found in the 0.3-1.2% of diabetic patients and is rare in children with diabetes (0.006%). It is more common in the patients with type 1 DM. The onset is in the third decade in diabetic patients and in the fourth decade in non-diabetics. There is no consensus concerning the treatment of NL, and the results are often modest. Antiplatelet agents, corticosteroids (local and general), immunomodulatory drugs, cyclins, wide synthetic antipaludics, heparin, Thalidomide are used. NL treatment is very difficult, especially in the ulcerated forms. Many of the drugs listed have proven efficacy only in isolated cases. Studies are necessary on large series of patients to determine the optimal therapy of NL.

Authors+Show Affiliations

Department of Dermatology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania; vm.patrascu@gmail.com.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

24715184

Citation

Pătraşcu, Virgil, et al. "Ulcerated Necrobiosis Lipoidica to a Teenager With Diabetes Mellitus and Obesity." Romanian Journal of Morphology and Embryology = Revue Roumaine De Morphologie Et Embryologie, vol. 55, no. 1, 2014, pp. 171-6.
Pătraşcu V, Giurcă C, Ciurea RN, et al. Ulcerated necrobiosis lipoidica to a teenager with diabetes mellitus and obesity. Rom J Morphol Embryol. 2014;55(1):171-6.
Pătraşcu, V., Giurcă, C., Ciurea, R. N., Georgescu, C. C., & Ciurea, M. E. (2014). Ulcerated necrobiosis lipoidica to a teenager with diabetes mellitus and obesity. Romanian Journal of Morphology and Embryology = Revue Roumaine De Morphologie Et Embryologie, 55(1), 171-6.
Pătraşcu V, et al. Ulcerated Necrobiosis Lipoidica to a Teenager With Diabetes Mellitus and Obesity. Rom J Morphol Embryol. 2014;55(1):171-6. PubMed PMID: 24715184.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ulcerated necrobiosis lipoidica to a teenager with diabetes mellitus and obesity. AU - Pătraşcu,Virgil, AU - Giurcă,Claudia, AU - Ciurea,Raluca Niculina, AU - Georgescu,Corneliu Cristian, AU - Ciurea,Marius Eugen, PY - 2014/4/10/entrez PY - 2014/4/10/pubmed PY - 2015/4/7/medline SP - 171 EP - 6 JF - Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie JO - Rom J Morphol Embryol VL - 55 IS - 1 N2 - Many skin lesions are associated with diabetes mellitus (DM) type 1 or 2, due to the use of antidiabetics or to metabolic and endocrine disorders caused by this disease. Necrobiosis lipoidica (NL) occurs more frequently in patients with DM. Painful ulcerations may occur on NL areas in about 20-25% of the cases and usually they are related to trauma. We present the case of a teenager, male, 17-year-old, having NL with multiple plaques, some of them spontaneously ulcerated after about 33 months of onset. He is known with type 1 DM from 2.5 years and the NL preceding the diagnosis of diabetes mellitus with about six months, presented erythematous-infiltrative skin plaques, some ulcerated for about three months, interesting both shins. Based on clinical, histopathological and paraclinical examinations, we established the following diagnoses: ulcerated NL, type 1 DM, moderate mixed dyslipidemia, class I obesity; commissural candidiasis, juvenile acne. Under treatment with Pentoxifyllinum, Sulodexidum, Ketotifenum and topical therapy with 0.2% Hyaluronic acid two months later, we have managed to heal two of the three ulcerated plaques and of the third has become superficial. We applied 0.5% Fluocortolonum on non-ulcerated plaques recording an improvement after two weeks of treatment. NL is a skin disease with a predilection for the shins, more frequent in patients with diabetes and is a part of palisading granulomatous dermatitis, which leads to skin atrophy. NL is found in the 0.3-1.2% of diabetic patients and is rare in children with diabetes (0.006%). It is more common in the patients with type 1 DM. The onset is in the third decade in diabetic patients and in the fourth decade in non-diabetics. There is no consensus concerning the treatment of NL, and the results are often modest. Antiplatelet agents, corticosteroids (local and general), immunomodulatory drugs, cyclins, wide synthetic antipaludics, heparin, Thalidomide are used. NL treatment is very difficult, especially in the ulcerated forms. Many of the drugs listed have proven efficacy only in isolated cases. Studies are necessary on large series of patients to determine the optimal therapy of NL. SN - 1220-0522 UR - https://www.unboundmedicine.com/medline/citation/24715184/Ulcerated_necrobiosis_lipoidica_to_a_teenager_with_diabetes_mellitus_and_obesity_ L2 - http://www.rjme.ro/RJME/resources/files/550114171176.pdf DB - PRIME DP - Unbound Medicine ER -