Sean Klepper M.D.
Artur Zembowicz M.D....
Also known as necrobiosis lipoidica diabeticorum
- Approximately two thirds of cases are associated with diabetes mellitus.
- Women are affected three times more frequently than men.
- Patients present with indurated, waxy patches or plaques surrounded by an erythematous border, most frequently on the shins.
- The dermis and subtimes subcutis show zones of degenerated collagen ("necrobiosis") alternating with palisading granulomatous inflammation.
- The areas of necrobiosis and granulomatous inflammation characteristically alternate in horizontal rows, parallel to the epidermis.
- Mucin is absent, in contrast to granuloma annulare.
- The dermis is diffusely involved, in contrast to the focal involvement normally seen in granuloma annulare.
- The adjecent dermis is typically fibrotic, unlike in granuloma annulare, in which it is normal.
- A superficial and deep perivascular inflammatory infiltrate rich in plasma cells is typically present, and there may be vasculitis.