Necrobiosis Lipoidica Diabeticorum
The patient, a Caucasian 16-y-old girl, was born at term by non-consanguineous, healthy parents. Type 1 diabetes (T1DM) had been diagnosed at one year of age. Our patient’s medical history was otherwise unremarkable. Until the age of 12 she maintained an adequate glucose control with HbA1c < 34 mmol/mol. Thereafter her glucose control progressively worsened with a HbA1c of 86 mmol/mol. At the age of 16, during a routine diabetes follow-up visit, the patient presented with erythematous subcutaneous nodular lesions which had appeared 4 mo earlier, initially in the pretibial area and subsequently in the interscapular area. Her HbA1c was 64 mmol/mol and daily insulin requirements were 0.95 U/kg/day. In the suspect of necrobiosis lipoidica, a skin biopsy was performed (lower extremities and interscapular area) ( and ). The microscopic evaluation of the pretibial lesions was suggestive of necrobiosis lipoidica. The smaller lesions in the interscapular area showed signs of perivascular dermatitis which could be consistent with early stages of necrobiosis lipoidica (). Local treatment with tacrolimus determined a progressive improvement of the lesions. Diabetes self-management education was reinforced and her HbA1c showed a gradual reduction.