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NLD appears as sharply defined plaques with a shiny atrophic surface and erythematous borders, most often on the lower extremities. Treatment of NLD is challenging and first-line therapy often includes topical or intralesional corticosteroids. Physicians should claim only the credit commensurate with the extent of their participation in the activity. History: A young adult slightly overweight man presented with mildly hyperpigmented, velvety-like thickening of the skin with many skin tags of both axillae. Swamy, MDMedical Director and Program Co-director, Chicago Children’s Diabetes Center at La Rabida Children’s Hospital; Attending Physician, Endocrinology, Ann & Robert H. This is more common in females with an average age at presentation of approximately 30 years.


This is controversial, as it seems that tight glycemic control might prevent NLD or even improve skin lesions when present. Other therapy reported includes aspirin, dipyridamole, pentoxifylline, systemic corticosteroids, chloroquine, topical tretinoin, hyperbaric oxygen and topical psoralen plus ultraviolet A therapy (PUVA ). Necrobiosis lipoidica diabeticorum in children and adolescents: a clue for underlying renal and retinal disease. He has no history of diabetes mellitus and family history of similar condition was negative. The pathogenesis may include an immunologic reaction to an unknown stimulus, such as an exaggerated response to trauma and inflammation in tissue with diffuse capillary disease. Although the skin lesions are usually asymptomatic, they can ulcerate and pose a challenge to heal.


Avoidance of trauma is warranted due to ulceration risk, and some patients use cosmetic cover-ups to mask the appearance. In keeping with the microangiopathy seen in type 1 DM, NLD may be associated with the presence or future development of microvascular complications of diabetes, such as retinopathy, nephropathy, and neuropathy.



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