Lipoid necrobiosis
Lipoid necrobiosis, or diabetic lipoid necrobiosis, is a chronic skin disease characterized by pathological localized deposition of adipose tissue on the skin. This process is often inherent in patients suffering from diabetes mellitus. As a result of pathological deposition of fats, specific nodular formations are formed on the patient’s skin, accompanied by necrobiotic and degenerative changes. Visually, lipoid necrobiosis is a plaque of dense consistency with a characteristic shiny surface. Women aged 20 to 40 years are more likely to suffer from this disease. Men, children and older people are less susceptible to this disease. The risk group also includes patients with obesity or overweight.
The content of the article:
Causes of lipid necrobiosis
Symptoms of lipid necrobiosis of the skin
Diagnosis of lipoid necrobiosis
Treatment of lipoid necrobiosis
Lipoid necrobiosis
Causes of lipid necrobiosis
It is considered that this pathological condition occurs more often against the background of diabetes mellitus or conditions close to it (violation of glucose tolerance). As a result of a significant increase in sugar indicators, as well as “jumps” in glucose levels, all metabolic processes in the patient’s body are disrupted.
First of all, it concerns fat and carbon metabolism. Metabolic disorders lead to insufficient nutrition of all organs and tissues of the human body, the skin is no exception. In patients suffering from diabetes mellitus, the microcirculation function of individual skin areas often fails, as a result of which its degenerative changes occur. They occur at the cellular level and lead to fatty degeneration of skin cells.
Summarizing, we can say that lipid necrobiosis of the skin is a consequence of metabolic disorders in the patient’s body, which leads to vascular pathologies, insufficient nutrition of skin cells and, accordingly, to their final death.
Symptoms of lipid necrobiosis of the skin
At the onset of the disease, the patient has rosy-red nodules of small size. These nodules have a yellowish-gray area of sinking in the middle, and a characteristic blue-purple border forms around them. Also, the patient may have cystic capillary dilation, which visually look like subcutaneous nodules of red color. Such formations do not bring the patient any discomfort, except cosmetic. These formations increase in size over time and change their color. Old focal lesions have a brown, rather dark color.
As the small lesions grow, they merge and form one solid plaque with a shiny surface. Such skin lesions are rarely isolated, they often cover the human body with a certain symmetry. The most common place of localization of the pathological process is the lower extremities of the patient, especially the lower legs. Less often, lipid necrobiosis occurs on the surface of the thighs, on the forearms and on the scalp of the patient.
The most threatening symptoms of this pathology are acquired in patients with diabetes mellitus and in patients in whom, due to a violation of the integrity of the skin, one or another pathological microflora is attached. In this case, poorly healing ulceration of the skin appears. This condition sometimes becomes life-threatening for the patient and requires immediate medical intervention.
Scientists have noted a direct dependence of the clinical course of the disease on the patient’s blood sugar level. When the sugar is greatly increased, necrobiotic lipoid formations begin to increase intensively in size, but as soon as the sugar level can be brought into line with the norm, this process goes backwards, up to the complete resorption of the nodes.
In most cases, this disease has a long course. In some periods, the patient may experience a certain regression, but in the course of treatment, the symptoms of the disease appear again.
Diagnosis of lipoid necrobiosis
At the initial examination, the diagnosis is not particularly difficult, so characteristic are the changes in the skin. However, differential diagnosis with vasculitis, sarcoidosis, scleroderma, tubercle syphilis, etc. is required.
The final diagnosis is made only on the basis of the results of histological examination. For this diagnostic purpose, a tissue sample from the affected area of the skin (biopsy) is taken from the patient and sent to a diagnostic laboratory to determine the nature of pathological changes. In the course of this study, foci of necrobiosis, pathological proliferation of blood vessel cells, fibrous tissues or accumulations of fat grains (lipids) can be detected.
Additionally, the patient is prescribed laboratory blood tests for sugar, as well as a glucose tolerance test. Such studies are of crucial importance in the diagnosis of lipid necrobiosis.
Treatment of lipoid necrobiosis
If a patient is diagnosed with lipid necrobiosis, treatment should be aimed primarily at stabilizing blood sugar levels. Patients with diabetes mellitus need systemic therapy of background pathology and observation by the attending endocrinologist with constant monitoring of sugar levels.
Local therapy includes the use of ointments based on glucocorticoid compounds. It provides for the introduction of glucocorticoid drugs directly into the lesion. Effective in this pathology are drugs that improve local metabolic processes and microcirculation.
In the treatment of the disease, physiotherapy is used: irradiation with X-rays or Bucca rays, as well as combined laser therapy, including exposure to both blood and the lesion. In exceptional cases, surgical excision of the affected areas of the skin is indicated.
Only complex treatment of diabetes mellitus and lipid necrobiosis can give a positive dynamics of the development of this pathological process. Self-medication is unacceptable and ineffective. The medical prognosis of the disease is conditionally favorable with timely access to specialists and strict implementation of all the recommendations of the attending physician.
