Necrobiosis lipoidica in an adolescent with type 1 diabetes mellitus: case report

Clara Joana F. Dinis Gomes, Gabriela Laranjo, Joana Campos, Paulo Morais

Abstract


AIMS: To report a case of necrobiosis lipoidica, a rare chronic granulomatous dermatosis.

CASE DESCRIPTION: We present the case of a 17-year-old male adolescent, with type 1 diabetes mellitus from the age of four, followed in the Pediatric-Diabetology clinics of a level II hospital, under intensive regimen with multiple insulin administrations and poor metabolic control. At the age of 15, he noticed the appearance of an asymptomatic, erythematous, infiltrated, oval-shaped plaque, with a waxy whitish center, well-defined borders, 5 cm in diameter and progressive growth, located on the left forearm. The histological examination confirmed the diagnosis of necrobiosis lipoidica. He was treated with topical corticosteroid and emollient, thus stabilizing and reducing lesion infiltration.

CONCLUSIONS: The authors highlight a rare dermatosis, non-pathognomonic of diabetes mellitus but related to this diagnosis in most cases. Its challenging recognition, especially in the presence of recent onset lesions, with atypical clinical presentation or in unusual sites, is fundamental in order to avoid erroneous or late treatments and its progression to ulceration.


Keywords


adolescent; skin diseases; diabetes mellitus; necrobiosis lipoidica.

References


Hammer E, Lilienthal E, Hofer S, Schulz S, Bollow E, Holl R. Risk factors for necrobiosis lipoidica in Type 1 diabetes mellitus. Diabet Med. 2017;34:86-92. https://doi.org/10.1111/dme.13138

Erfurt-Berge C, Seitz A, 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;22:770-5.

Murphy-Chutorian B, Han G, Cohen SR. Dermatologic manifestations of diabetes mellitus: a review. Endocrinol Metab Clin N Am. 2013;42:869-98. https://doi.org/10.1016/j.ecl.2013.07.004

Sunil K, Sruti J. Necrobiosis lipoidica diabeticorun: A case-based review of literature. Indian J Endocrinol Metab. 2012;16(4):614-20. https://doi.org/10.4103/2230- 8210.98023

Pavlovic M, MilenKovic T, Dinic M, Misovic M. The prevalence of cutaneous manifestations in young patients with type 1 diabetes. Diabetes Care. 2007;30:1964-7. https://doi.org/10.2337/dc07-0267

Dissemond J. Images in clinical medicine. Necrobiosis lipoidica diabeticorum. N Engl J Med. 2012;366:2502. https://doi.org/10.1056/NEJMicm1109700

Mitre V, Wang C, Hunt R. Necrobiosis Lipoidica. J Pediatr. 2016;179:272-272.e1. https://doi.org/10.1016/j.jpeds.2016.08.080

Sibbald C, Reid S, Alavi A. Necrobiosis lipoidica. Dermatol Clin. 2015;33:343-60. https://doi.org/10.1016/j.det.2015.03.003

Marchetti 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;23:247-50. https://doi.org/10.1111/j.1525-1470.2006.00227.x

Uva L, Freitas J, Soares de Almeida L, Vasques H, Moura C, Miguel D, Filipe P. Squamous cell carcinoma arising in ulcerated necrobiosis lipoidica diabeticorum. Int Wound J. 2015;12:741-3. https://doi.org/10.1111/iwj.12206

Bonura C, Frontino G, Rigamonti A, Battaglino R, Favalli V, Ferro G, Rubino C, Del Barba P, Pesapane F, Nazzaro G, Gianotti R, Bonfanti R, Meschi F, Chiumell G. Necrobiosis Lipoidica Diabeticorum: a pediatric case report. Dermatoendocrinol. 2014;6:e983683. https://doi.org/10.4161/derm.27790

Yosipovitch G, Hodak E, Vardi P. The prevalence of cutaneous manifestations in IDDM patients and their association with diabetes risk factors and microvascular complications. Diabetes Care. 1998;21:506-9. https://doi.org/10.2337/diacare.21.4.506

Mendes AL, Miot HA, Haddad V Junior. Diabetes mellitus and the skin. An Bras Dermatol. 2017;92(1):8-20. https://doi.org/10.1590/abd1806-4841.20175514

Reid SD, Ladizinski B, Lee K, Baibergenova A, Alavi A. Update on necrobiosis lipoidica: a review of etiology, diagnosis, and treatment options. J Am Acad Dermatol. 2013;69:783-91. https://doi.org/10.1016/j.jaad.2013.05.034

Binamer Y, Sowerby L, El-Helou T. Treatment of ulcerative necrobiosis lipoidica with topical calcineurin inhibitor: case report and literature review. J Cutan Med Surg. 2012;16:458-61. https://doi.org/10.1177/120347541201600621

Tidman M, Duncan C. The treatment of necrobiosis lipoidica. Br J Diabetes Vasc Dis. 2005;5:37-41. https://doi.org/10.1177/14746514050050010701

Eberle F, Ghoreschi K. Severe ulcerative necrobiosis lipoidica: a case report and evaluation of current therapies. Acta Derm Venereol. 2010;90:104-6. https://doi.org/10.2340/00015555-0757




DOI: http://dx.doi.org/10.15448/1980-6108.2017.4.27149

 

********************************************************************************************************************

From 2011 (year in which it was indexed in Scopus) Scientia Medica counts on the Scimago Journal & Country Rank (SJR) impact factor:

SCImago Journal & Country Rank



This journal is a member of COPE (Committee on Publication Ethics) and follow the principles recommended by this international reference organization on integrity and ethics in scientific publication: http://www.publicationethics.org


Licença Creative Commons
Except where otherwise noted, the material published in this journal is licensed under a Creative Commons Attribution 4.0 International license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original publication is properly cited.
Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.


 

 

Editorial policies of Brazilian scientific journals. Availability for deposit: BLUE

 

  

Member of OASPA


    http://www.wame.org


Copyright: © 2006-2018 EDIPUCRS