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keithroach

Dr. Keith Roach

Dear Dr. Roach: My girlfriend has necrobiosis lipoidica. She suffers from this on her shins, as did her mother. She is not diabetic. We cannot find good information on how to rid her of this. The information we find is not about cures, but treatments that mask the symptom, such as steroids. We cannot even find a doctor that specifically treats this condition. Can you help?

-- M.B.

A: Necrobiosis lipoidica is a rare skin disorder, usually but not always associated with diabetes. It occurs mostly in young adults (the average is 25 years old when associated with diabetes, 46 years if not), and is more common in women. It may also be associated with thyroid disorders and celiac disease. The cause is unknown.

The diagnosis is made by skin biopsy. The appearance is usually of a large, variably colored and elevated patch of skin, most commonly on the shins, as your girlfriend's is, but it can spread to other parts of the body, especially skin that has been scraped or damaged. Because necrobiosis lipoidica can occasionally transform to skin cancer, it needs careful surveillance.

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There is no cure for necrobiosis lipoidica. However, there are treatments that can reduce the inflammation. Steroids, either topical or injected, are the usual first choice. Topical steroids are more effective if they are given as ointment and covered with an air- and water-tight dressing. If topical steroids are not as effective, there are many other therapies that have been tried, including: the medication tacrolimus, which decreases the immune response; ultraviolet light A; antimalarial drugs (also used for autoimmune diseases); and others. The disease normally progresses slowly, then stabilizes, but it can spontaneously resolve in some people.

Necrobiosis lipoidica may also ulcerate, at which point a wound care specialist may be of tremendous value.

More good information is available at https://tinyurl.com/NLskin.

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Dr. Keith Roach writes for North America Syndicate. Send letters to 628 Virginia Dr., Orlando, FL 32803 or email ToYourGoodHealth@med.cornell.edu.

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