Perforating disseminated necrobiosis lipoidica diabeticorum

Abstract

Perforating necrobiosis lipoidica is a very rare clinical variant which consists of degeneration and transepidermal elimination of the collagen with few cases reported in the literature. In two-thirds of the patients it associates with diabetes, with no relation with the glucose control. We present a 42-year-old female patient with a 7-year history of diabetes on insulin therapy, referred to our clinic with a 3-year history of multiple asymptomatic firm plaques disseminated on the upper and lower extremities. The clinical and histological findings proved the diagnosis of perforating necrobiosis lipoidica.

Figure 1

Infiltrated circinate plaques, erythematous border, and comedo-like papules in the center on the lower extremities of a 42-year-old diabetic patient.

Figure 2

Close view of an irregularly shaped brown-yellow plaque with comedo-like papules.

Figure 3

Histological examination demonstrated degenerated collagen and fibrosis with a peripheral lymphohistiocytic infiltrate in dermis (haematoxylin and eosin, original magnification ×200).

Figure 4

Histology demonstrates transepidermal elimination of necrotic material (haematoxylin and eosin, original magnification ×100).