necrobiosis lipoidica diabeticorum

糖尿病性リポイド類壊死症

WordNet

1. (physiology) the normal degeneration and death of living cells (as in various epithelial cells) (同)cell_death

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/02/18 00:09:26」(JST)

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Necrobiosis lipoidica
Classification and external resources
ICD-10	L92.1
ICD-9	709.3
DiseasesDB	5414
eMedicine	derm/283
MeSH	D009335

Necrobiosis lipoidica is a necrotising skin condition that usually occurs in patients with diabetes but can also be associated with Rheumatoid Arthritis. In the former case it may be called necrobiosis lipoidica diabeticorum (NLD). NLD occurs in approximately 0.3% of the diabetic population, with the majority of sufferers being women (approximately 3:1 females to males affected).

The severity or control of diabetes in an individual does not affect who will or will not get NLD. Better maintenance of diabetes after being diagnosed with NLD will not change how quickly the NLD will resolve.

Clinical appearance

NL/NLD most frequently appears on the patient's shins, often on both legs, although it may also occur on forearms, hands, trunk, and, rarely, nipple, penis, and surgical sites. The lesions are often asymptomatic but may become tender and ulcerate when injured. The first symptom of NL is often a "bruised" appearance (erythema) that is not necessarily associated with a known injury. The extent to which NL is inherited is unknown.

NLD appears as a hardened, raised area of the skin. The center of the affected area usually has a yellowish tint while the area surrounding it is a dark pink. It is possible for the affected area to spread or turn into an open sore. When this happens the patient is at greater risk of developing ulcers. If an injury to the skin occurs on the affected area, it may not heal properly or it will leave a dark scar.

Pathophysiology

Although the exact cause of this condition is not known, it is an inflammatory disorder characterised by collagen degeneration, combined with a granulomatous response. It always involves the dermis diffusely, and sometimes also involves the deeper fat layer. Commonly, dermal blood vessels are thickened (microangiopathy).

It can be precipitated by local trauma, though it often occurs without any injury.

Diagnosis

NL is diagnosed by a skin biopsy, demonstrating superficial and deep perivascular and interstitial mixed inflammatory cell infiltrate (including lymphocytes, plasma cells, mononucleated and multinucleated histiocytes, and eosinophils) in the dermis and subcutis, as well as necrotising vasculitis with adjacent necrobiosis and necrosis of adnexal structures. Areas of necrobiosis are often more extensive and less well defined than in granuloma annulare. Presence of lipid in necrobiotic areas may be demonstrated by Sudan stains. Cholesterol clefts, fibrin, and mucin may also be present in areas of necrobiosis. Depending on the severity of the necrobiosis, certain cell types may be more predominant. When a lesion is in its early stages, neutrophils may be present, whereas in later stages of development lymphocytes and histiocytes may be more predominant.

There is no clearly defined cure for necrobiosis. Although there are some techniques that can be used to diminish the signs of necrobiosis such as a steroid cream or injection into the affected area, this process may be effective for only a small amount of those treated. Steroid cream has been known to cause thinning of the skin, so if used, it is best to wrap the area with some form of plastic wrap or cloth. Even then, this process can take long periods of time.

See also

• Diabetic dermadromes
• List of cutaneous conditions

References

External links

• Information and image at NIH
• Image AOCD

UpToDate Contents

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• 1. リポイド類壊死症 necrobiosis lipoidica
• 2. サルコイドーシスの皮膚症状 cutaneous manifestations of sarcoidosis
• 3. 環状肉芽腫 granuloma annulare
• 4. 自己免疫性甲状腺疾患における前脛骨部粘液水腫（甲状腺皮膚症） pretibial myxedema thyroid dermopathy in autoimmune thyroid disease
• 5. 壊疽性膿皮症：病因、臨床症状、および診断 pyoderma gangrenosum pathogenesis clinical features and diagnosis

English Journal

• Resolution of long-standing necrobiosis lipoidica diabeticorum (NLD) lesion after restoration of euglycemia following successful pancreas after kidney (PAK) transplantation: a case report.

• Mazur MJ, Lowney AC, Prigoff J, Heilman RL, Chakkera H, Moss A, Mulligan D, Reddy K, Hamawi K.SourceDepartment of Nephrology, Cork University Hospital, Wilton, Cork, Ireland. marek.mazur@hse.ie
• Transplantation proceedings.Transplant Proc.2011 Nov;43(9):3296-8.
• Necrobiosis lipoidica diabeticorum (NLD) is an inflammatory skin disorder of unknown cause which can be seen in patients with diabetes mellitus. Various treatments, including immunosuppressive agents have been tried, without consistent efficacy. NLD is generally thought not to correlate well with ti
• PMID 22099781

Japanese Journal

• 糖尿病専門医のための皮膚病変講座(第5回)糖尿病性脂肪類壊死症(necrobiosis lipoidica diabeticorum;NLD),前脛骨部色素斑

• 宇谷 厚志
• 糖尿病 1(7), 125-127, 2009-12
• NAID 40017342440

Related Links

• Necrobiosis Lipoidica Diabeticorum - the American Osteopathic ...

Necrobiosis lipoidica diabeticorum is a rash that occurs on the lower legs. It is more common in women, and there are usually several spots. They are slightly raised shiny red-brown patches, with yellowish centers.

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リンク元	「糖尿病性リポイド類壊死症」「糖尿病性脂肪類壊死症」
関連記事	「necrobiosis」

「糖尿病性リポイド類壊死症」

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necrobiosis lipoidica diabeticorum

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糖尿病性脂肪類壊死症

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類脂質性壊死症

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糖尿病性リポイド類壊死症 : 約 2,330 件
糖尿病性脂肪類壊死症 : 63 件

「糖尿病性脂肪類壊死症」

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necrobiosis lipoidica diabeticorum

「necrobiosis」

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• 類壊死

関

bionecrosis、necrobiotic disorder