title: Necrobiosis Lipoidica Diabeticorum: A pediatric case report.
abstract: BACKGROUND
  Necrobiosis lipoidica (NL) is a rare chronic granulomatous dermatitis that usually appears in the lower extremities. It affects about 0.3-1.2% of diabetic patients, the majority of whom have type 1 diabetes. The etiology and pathogenesis of this disorder are still unclear. NL is characterized by skin rash that usually affects the shins. The average onset is 30 years, with females being affected more commonly. There are very few reported cases of necrobiosis lipoidica in children.
  
  
  METHODS
  We report a case of a 16 year old girl affected by type 1 diabetes mellitus (15 years disease duration) who developed an erythematous nodular rash on the lower extremities and interscapular area. In the suspect of necrobiosis lipoidica, a skin biopsy was performed (lower extremities and interscapular area). 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.
  
  
  CONCLUSIONS
  In patients with T1DM, diagnosis of NL of the lower legs is usually unequivocal. However, diagnosis may be more challenging in the presence of lesions with recent onset and/or atypical clinical presentation and unusual site. In these cases, NL must always be taken in consideration in order to avoid misdiagnosis, wrong/late treatment decisions and progression to ulceration.
authors.affiliation: Ospedale San Raffaele Scientific Institute; Department of Pediatrics; Milano, Italy.
authors.forename: Clara
authors.initials: C
authors.lastname: Bonura
authors.affiliation: Ospedale San Raffaele Scientific Institute; Department of Pediatrics; Milano, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Frontino
authors.affiliation: Ospedale San Raffaele Scientific Institute; Department of Pediatrics; Milano, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rigamonti
authors.affiliation: Ospedale San Raffaele Scientific Institute; Department of Pediatrics; Milano, Italy.
authors.forename: Roseila
authors.initials: R
authors.lastname: Battaglino
authors.affiliation: Ospedale San Raffaele Scientific Institute; Department of Pediatrics; Milano, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Favalli
authors.affiliation: Ospedale San Raffaele Scientific Institute; Department of Pediatrics; Milano, Italy.
authors.forename: Giusy
authors.initials: G
authors.lastname: Ferro
authors.affiliation: Ospedale San Raffaele Scientific Institute; Department of Pediatrics; Milano, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Rubino
authors.affiliation: Ospedale San Raffaele Scientific Institute; Department of Pediatrics; Milano, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Del Barba
authors.affiliation: Università degli Studi di Milano; Fondazione IRCCS Ca' Granda Osp. Maggiore Policlinico; Department of Pathophysiology and Transplantation; Milano, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Pesapane
authors.affiliation: Università degli Studi di Milano; Fondazione IRCCS Ca' Granda Osp. Maggiore Policlinico; Department of Pathophysiology and Transplantation; Milano, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Nazzaro
authors.affiliation: Università degli Studi di Milano; Fondazione IRCCS Ca' Granda Osp. Maggiore Policlinico; Department of Pathophysiology and Transplantation; Milano, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Gianotti
authors.affiliation: Ospedale San Raffaele Scientific Institute; Department of Pediatrics; Milano, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Bonfanti
authors.affiliation: Ospedale San Raffaele Scientific Institute; Department of Pediatrics; Milano, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Meschi
authors.affiliation: Ospedale San Raffaele Scientific Institute; Department of Pediatrics; Milano, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Chiumello
keywords: T1DM; children; diabetes; granulomatous dermatitis; necrobiosis lipoidica; skin lesion; type 1 diabetes