TITLE:
Necrobiosis Lipoidica in the Absence of Diabetes Mellitus: A Case Report and an Analysis of 116 Japanese Cases
AUTHORS:
Ayumi Korekawaka, Koji Nakajima, Hajime Nakano, Daisuke Sawamura
KEYWORDS:
Peripheral Circulatory Disturbance, Ulceration, Trauma, Lower Leg
JOURNAL NAME:
Case Reports in Clinical Medicine,
Vol.3 No.12,
December
24,
2014
ABSTRACT: A 60-year-old Japanese woman was referred to our hospital for yellow-brown plaques accompanied by ulceration on her left lower leg. Her medical history included neither diabetes mellitus nor minor trauma. A histopathological examination of the plaques showed necrobiotic changes within the dermal collagen surrounded by granulomas that comprised lymphocytes, histiocytes, and giant cells. The lower dermis revealed fibrotic changes that extended into the subcutaneous tissue. The patient’s blood glucose and glycated hemoglobin levels were within the normal ranges. We considered a diagnosis of necrobiosis lipoidica (NL) in the absence of diabetes mellitus. We reviewed 116 cases of NL that were reported in the Japanese medical literature between 1986 and 2014 and found that NL onset was most common in individuals of both sexes ≥ 60 years of age. Previous reports that reviewed NL cases in the Japanese medical literature that were published during the1900s indicated that NL occurs in people ≥ 40 years of age. We suggest that the aging population and increasingly longer life spans have increased the average age of NL onset in Japan. With regard to treatments, there were no effective treatments, but skin grafts were curative. NL treatment is very difficult, especially when ulcers are present; hence, we suggest that further research is needed to determine effective NL treatments.