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Necrobiosis Lipoidica Diabeticorum

Necrobiosis Lipoidica Diabeticorum

The atrophic patches on the lower legs of this 47-year-old woman who has had diabetes mellitus for over 20 years are those of necrobiosis lipoidica diabeticorum. These areas involve degeneration of collagen and elastic fibers in the lower dermis and changes in blood vessel walls. The lesions usually begin as single or multiple elevated reddish nodules, most commonly in the pretibial area. Over time, they expand and coalesce into distinctive brownish yellow patches. These areas may be somewhat tender, but as they spread, they frequently become painless--unless they ulcerate. Because the involved skin is fragile, ulcers can form after any minor trauma. Approximately half of patients with necrobiosis lipoidica diabeticorum have diabetes. (Case and photograph courtesy of Dr Mary C. Greist.)

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