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Lesions Exhibiting Necrobiosis

Three dermatological conditions — granuloma annulare, necrobiosis lipoidica diabeticorum, and rheumatoid nodules — are classified by the presence of degenerative collagen (colloid milium), or necrobiosis. Though they are commonly differentiated on a clinical basis and while the clinical characteristics of these three lesions are distinctive, in some patients they may overlap.

Each of these chronic skin conditions requires care from an experienced dermatologist. Advanced Dermatology and Skin Cancer Center provides each patient with professional, individualized treatments that best meet their skin and health needs. We treat a wide range of skin conditions, including the following lesions that exhibit necrobiosis.

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Granuloma Annulare

Granuloma annulare is a skin condition that causes raised, reddish or skin-colored lesions which form in a ring pattern on the hands, feet, elbows, knees, ankles, or wrists. These lesions are common in both children and young adults, particularly in those with a significant family history of diabetes mellitus. The initial lesions can resemble a mosquito bite, and they do not itch or cause any symptoms. This skin granuloma gradually spreads over the skin in a circular pattern — due to its circular formation, it may be misdiagnosed for ringworm or tinea corporis.

In most cases, granuloma annulare only presents in 1-2 lesions, but dozens of lesions may develop in certain patients. In most cases, granuloma annulare treatment includes intralesional steroid therapy. However, in severe cases, systemic therapies, such as PUVA therapy, dapsone, methotrexate, and retinoid therapy — may be required. Depending on the variety, a patient may have one of the following types of granuloma annulare.

  • Localized. This is the most common type of granuloma annulare. With localized granuloma annulare, the lesion’s borders are circular or semicircular with a diameter of up to 2 inches. The skin-colored or red-colored bumps appear on the hands, feet, ankles, and wrists of young adults or children.
  • Generalized. Generalized granuloma annulare is less common than localized granuloma annulare, but it can affect adults. It causes itchy, reddish, or skin-colored bumps most commonly on the body, including the arms, legs, and trunk.
  • Subcutaneous. Under the skin, or subcutaneous granuloma annulare, is a type that affects young children. It produces small, firm lumps under the skin instead of a rash. These tiny lumps usually form under the skin on the hands, shins, and scalp.

Necrobiosis Lipoidica Diabeticorum

Necrobiosis lipoidica diabeticorum (NLD) is a rare granulomatous skin disorder that produces distinctive skin lesions that may occur anywhere on the body. Still, it most commonly appears on the shin area of the lower legs. Necrobiosis lipoidica is a diabetes-related skin condition that can appear before the onset of diabetes, either in its early stages or long after the initial diagnosis. It may also, however, occur in non-diabetic individuals as well.

It is more common in women than in men. The skin lesions present as slightly raised, red, or brown patches with yellow centers, and they may develop open sores that are slow to heal. As with any lesion or skin condition associated with diabetes, careful management of one’s blood glucose level is essential for dermatologists to provide and for patients to receive necrobiosis lipoidica treatment effectively. Distinct clinical characteristics of NLD include the following.

  • Tissue Loss. Growth of the lesions often result in the destruction of an individual’s hair follicles and sebaceous glands (oil-producing glands).
  • Skin Thinning. Small, bright red blood vessels (telangiectatic vessels) can become visible, particularly around a lesion’s periphery.
  • Lipid Deposits. At the central portion of the lesion, the skin may develop a yellow or orange-colored pigmentation, which may occur due to lipid (fat) deposits.

Rheumatoid Nodules

Rheumatoid nodules are firm lumps that develop under the skin. These well-demarcated, flesh-colored, subcutaneous lumps or masses are usually freely moveable, but attachment to the underlying tissues is possible. Nodules can vary in size from a small, pea-sized lesion up to masses the size of a lemon, and they are often round in shape, although they can also be linear. As suggested by this condition’s name, it is closely related to rheumatoid arthritis (RA). It is one of the most common dermatologic manifestations of rheumatoid arthritis — it occurs in approximately one-quarter of patients with RA and it is more common in women than in men.

Rheumatoid nodules are lesions that present no symptoms and are most often located over the extensor areas of joints in the hands, wrists, elbows, toes, ankles, and knees. Rarely, nodules may develop in the visceral organs, such as the lungs, heart, or sclera of the eye. These nodules typically appear at some point over the course of the disease and don’t usually respond to therapies for RA, such as systemic therapy. Patients or their physicians may observe and ignore the nodules, accepting them to be a common aspect of the underlying disease. However, treatment of rheumatoid nodules that are symptomatic, such as those infected, ulcerated, impinging on underlying nerves or causing dysfunction due to their location, require professional treatment.

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