Necrobiosis Lipoidica Diabeticorum as a Sign of Diabetes

NLD is a type of skin eruptions that occur on the lower legs. The average age of onset is 30 to 40 years, but it could present at any age and tends to occur earlier in diabetics; it is three times more common in females than males. NLD develops as a slightly raised shiny red-brown patch with a yellowish center. Typically, multiple patches develop and might progress to open sores that take a long time to heal; it is usually surrounded by blood vessels that are easily visible under the skin (telangiectasia)2. Many etiological theories have been proposed, but the exact cause is unknown. Nevertheless, the most accepted theory is that it is due to a vascular disturbance involving immune complex deposition or microangiopathic changes resulting in collagen degeneration. NLD usually occurs in people with diabetes mellitus, family history of diabetes or those predisposed to diabetes. NLD could be confused with similar conditions, such as Granuloma Annulare, which appears as individual spots, usually consisting of a circular array of reddish to brown and slightly translucent bumps. Other similar conditions include lipodermatosclerosis, necrobiotic xanthogranuloma, and diabetic dermopathy. Skin