Necrobiosis Lipoidica Diabeticorum
The skin disorder, Necrobiosis lipoidica diabeticorum is usually known as necrobiosis or NLD and is often associated with diabetes, although not exclusively so.
Although necrobiosis is well known, it is a very uncommon condition and many healthcare professionals may never have seen it before. It is thought to affect 0.3 per cent of all people with diabetes. It may develop before or at the time of diagnosis of diabetes, but usually will appear some years after diagnosis.
It can occur at any age, but most commonly starts between the ages of 30 and 40. It is three times more common in women as in men. The cause is unknown and it can happen no matter how well the diabetes is controlled.
Q. What does it look like?
A. Its appearance can differ from person to person, however, it usually appears as small oval dark red or browny yellow patches (lesions) with a thick shiny surface. The patches may be raised above the surrounding skin and the edges are usually sharply defined. In a small percentage of cases, a part of the patch may break down and form ulcers. The patches may be single or multiple and are most commonly found on the legs, particularly over the shins. However, the arms, hands, torso and face may also be affected.
Q. How does it progress?
A. Necrobiosis usually progresses slowly and it may remain very slight but rarely will it clear up completely. There are no symptoms and it is not painful unless it ulcerates, which can often be slow to heal.
Q. How is it treated?
A. Unfortunately treatment can be disappointing as results are unpredictable. Creams, dressings, ultra violet light treatment or injections of steroids into the patches may be tried and can help in some cases. Some people have tried complementary therapies with varying degrees of success, including Chinese Medicine.
Q. Is there a cure?
A. As the cause of NLD remains unknown, a cure seems to be some way off.
Q. Is it dangerous?
A. Although NLD is not life threatening, the emotional trauma of dealing with such an unsightly condition often has the most damaging effect on those with NLD, especially when they are young women. NLD is not infectious.
Q. How do people cope with the condition?
A. Many people with NLD (both men and women) find that camouflaging the condition, using specialized make up, is one way of living with it. Colour matching and skilful application is important for camouflaging to be successful and professional help should be obtained. Changing Faces run a skin camouflage service teaching individuals how to self-apply specialist cover creams. The camouflage cream is extremely effective, can last up to four days and is waterproof. The service is provided free of charge with a referral from your GP or consultant; the camouflage creams are available on prescription. For further information, contact Changing Faces on 0300 012 0276, who can arrange a consultation with a skin camouflage practitioner, or check the Changing Faces website. Remember also that although the patches may be unsightly, they will not lead to any serious harm. If the patches are on the shins, it is important to avoid knocking them as this can lead to ulceration. It might be helpful to wear a padded dressing over the lesion. Medical advice should be sought should ulcers develop.
Whilst the severity of the lesions may by unaffected by control of diabetes, it is advisable to pay attention to blood glucose levels, to avoid any problems of secondary infection within the lesion.
It is important that the blood glucose levels being aimed for are as near normal as possible (that is in the range of those of a person who does not have diabetes). These are:
- 3.5 - 5.5mmols/l before meals
- less than 8mmols/l, 2 hours after meals.
There are many different opinions about the ideal range to aim for. As this is so individual to each person, the target levels must be agreed between the person and their diabetes team. The target blood glucose ranges below are indicated as a guide:
Children with Type 1 Diabetes (NICE 2004)
- Before meals: 4-8mmols/L
- 2 hours after meals: less than 10mmols/L
Adults with Type 1 Diabetes (NICE 2004)
- Before meals: 4- 7mmols/L
- 2 hours after meals: less than 9mmols/L
Type 2 Diabetes (NICE 2008)
- Before meals: 4-7mmol/L
- 2 hours after meals: less than 8.5mmols/L