Is Necrobiosis Lipoidica Diabeticorum Treatable?

Necrobiosis Lipoidica Diabeticorum is a skin condition that is most common among patients with diabetes, though it can also occur in non-diabetic individuals. It most often presents on the legs, although there have also been cases where it presented on the face, scalp, trunk, and arms.

It generally begins as shiny, red-brown patches that are entirely asymptomatic. As the condition progresses, the patches grow in size and turn yellow. In some cases, painful ulcerations may occur, usually after some type of trauma is experienced to the site of the patches.

What causes this rash to develop?

Necrobiosis lipoidica diabeticorum usually occurs in patients with diabetes, which necessarily insinuates a connection between the two; however the exact cause of NLD is not known.

Some researchers believe that there is an underlying abnormality in the vascular system that can lead to the development of this condition. Still others point to defective collagen development as a potential cause.

Research into the exact cause of this condition is ongoing.

Can NLD be treated effectively?

Because the exact cause has not been pinpointed, treatment of necrobiosis lipoidica diabeticorum is difficult. Sometimes NLD responds to topical cortisone preparations or cortisone injections, but this usually only works in the early stages of the condition. Once the lesions have become atrophic, cortisone preparations will have little, if any, effect.

Various studies have been conducted to determine the efficacy of other types of treatment including nicotinamide, clofazimine and heparin, all with limited success. A baby aspirin each day may help control the condition by reducing inflammation and improving platelet formation. Another classification of drugs that target tumor necrosis have also show promise in treating this condition. These medications, including etanercept, adalimumab and infliximab have all had limited success in treating the ulcerated form of NLD.

Necrobiosis lipoidica diabeticorum usually goes through stages of activity and inactivity but doctors cannot predict when the condition will flare. Ultraviolet light treatment has been found to control this condition when it is flaring. This treatment is available in a dermatoligist’s office.

Other alternative treatments include surgical excision and laser therapy. Surgical excision of the lesions has been successful but poor healing and recurrence are common side effects. In general, laser therapy has had better results, with many patients showing both marked cosmetic improvement and stabilizing of the lesions after three treatment sessions.

Because a decrease of plasma cholesterol is one of the underlying triggers of this condition, taking a niacin, or vitamin B-3, supplement can help to control plasma cholesterol levels and thus lessen the symptoms of NLD. Retinoids, which are vitamin A based medications, have also proven helpful as they regulate cell growth, preventing the production of affected cells.

Since localized trauma can cause NLD lesions to ulcerate, wearing protective stockings over affected legs and resting the legs as much as possible are both highly recommended.