Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Necrobiosis Lipoidica Linked with Diabetes, Obesity

JAMA Dermatology; ePub 2019 Feb 20; Hashemi, et al

A recent study of necrobiosis lipoidica (NL), a rare granulomatous condition, supports its associations with diabetes as well as obesity, hypertension, dyslipidemia, and thyroid disease. Younger age and female sex were observed more frequently in patients with diabetes. Otherwise, NL lesions in patients with or without diabetes shared many clinical features, suggesting that risk factors outside of elevated blood glucose may play an important role in the disease. This multicenter retrospective review included 236 patients aged 15 to 84 years who were evaluated and received a diagnosis of NL between 2000 and 2018. Researchers found:

  • Of total patients with NL, 200 were women and 36 were men, and 182 were white, with a median age at presentation of 50.0 years.
  • The diagnosis was biopsy proven in 156 patients (66.1%).
  • Of the 230 patients with location specified, 225 (97.8%) had NL on the lower legs.
  • A total of 138 patients with NL (58.5%) had diabetes.
  • The median hemoglobin A1c for patients with diabetes was 8.00%.
  • Patients with diabetes were significantly younger than patients without diabetes, and slightly less likely to be female, but lesion characteristics were otherwise comparable.

Hashemi DA, Brown-Joel ZO, Tkachenko E, et al. Clinical features and comorbidities of patients with necrobiosis lipoidica with or without diabetes. [Published online ahead of print February 20, 2019]. JAMA Dermatology. doi:10.1001/jamadermatol.2018.5635.