Cutaneous Manifestations of Nutritional Excess: Pathophysiologic Effects of Hyperglycemia and Hyperinsulinemia on the Skin

Steven A. Svoboda, BS; Bridget E. Shields, MD


Cutis. 2021;107(2):74-78. 

In This Article

Necrobiosis Lipoidica

Necrobiosis lipoidica (NL) is a chronic granulomatous skin condition of unknown origin that presents with well-demarcated, yellow-brown, atrophic patches and plaques often found exclusively on the shins. There is a strong association with type 1 diabetes mellitus, with reported rates ranging from 11% to 65% in patients with NL.[58,59,60] In a recent retrospective study of 236 patients with NL, 58.5% of patients had diabetes.[61] Nevertheless, NL is a rare entity that affects less than 1% of the diabetic population.[60] Given its correlation with diabetes, it has been postulated that the pathogenesis of NL is due to microvascular ischemic changes resulting from prolonged hyperglycemia.[60] However, studies revealing an increase in blood flow to NL lesions suggest that the condition may instead be attributed to an inflammatory process.[62] Despite the disfiguring appearance, the lesions of NL often are asymptomatic. Pain or pruritus may develop secondary to ulceration, which occurs in approximately one-third of patients. Although many treatment options have been attempted—including topical and intralesional corticosteroids, immunomodulators, platelet inhibitors, and phototherapy is limited.[60]