If you have diabetes, there is a chance that this picture may look familiar to you.  Over the years, I have seen many a patient with diabetes walk into my office with these spots on their shins, wondering what this ‘rash’ on their legs might be.

This is called necrobiosis lipoidica (let’s call it NL for short).  In people with diabetes, it’s called necrobiosis lipoidica diabeticorum (NLD for short).

NL occurs most commonly on the lower legs, usually the shins.  It is not known how NL develops.  It may be related to poor blood flow to the skin in this area, but many other hypotheses exist as well.  Most people with necrobiosis lipoidica have diabetes, but NL is also associated with other medical conditions like obesity, hypertension, and thyroid disease.  Some people with NL go on to develop diabetes years later, but it is also possible to have NL and never develop diabetes.

The estimated prevalence of NLD is about 1%, and occurs more commonly in women than in men.  NLD begins as painless yellow, pink or brown spots that are slightly elevated, but over time they flatten out. Redness or prominent blood vessels can be present around the edges.  They usually have no symptoms, though they can be itchy and occasionally painful.  NLD is at risk of ulceration, and if so, this can be painful.

Treatment of NLD (under the care of a dermatologist) is directed at management of symptoms, controlling inflammation, prevention of ulceration, and healing of ulcers if present.  Avoiding trauma to the area is important, as trauma can lead to ulceration.

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