title: Specific features of a rare form of disseminated necrobiosis lipoidica granuloma annulare type: a case report.
abstract: Necrobiosis lipoidica (NL) is a rare dermatosis that has been shown to precede the onset of diabetes mellitus in 15% of patients. It is more common in women; the average age of the onset is 30 years. Skin lesions of classic NL begin as a small papule, typically on the bilateral pretibial area. Progressively, these papules become indurated plaques with an atrophic, yellow center and multiple telangiectatic vessels, and brown-violaceous borders. We present the case of a 57-year-old male with type II diabetes mellitus from 2004, class II obesity, hepatosteatosis and metabolic disturbances who presents a disseminated eruption from 2010, formed by indurated plaques with flattened centers and a tendency of atrophy and raised, sharply demarcated, red-violaceous borders, having a variable diameter between 1.5 and 5 cm. The laboratory findings revealed elevated glucose levels between 250 and 300 mg%, high levels of transaminases and lipids. Diagnosis of disseminated necrobiosis lipoidica granuloma annulare-type was histopathologically confirmed. For the treatment, we have used topical corticosteroids and Tacrolimus 0.1% and systemic vasodilators. We consider this rare case interesting because has some peculiarities, as: disseminated lesions extend over the characteristic areas for necrobiosis lipoidica, the characteristic features of lesions similar to granuloma annulare, gender (male) and the onset of the disease over fifth decade.
authors.affiliation: Department of Surgery, University of Medicine and Pharmacy of Craiova, Romania; gianosi@hotmail.com.
authors.forename: Simona Laura
authors.initials: SL
authors.lastname: Ianoşi
authors.forename: Cristina
authors.initials: C
authors.lastname: Tutunaru
authors.forename: Claudia Valentina
authors.initials: CV
authors.lastname: Georgescu
authors.forename: Nicolae Gabriel
authors.initials: NG
authors.lastname: Ianoşi
authors.forename: Diana Monica
authors.initials: DM
authors.lastname: Georgescu
authors.forename: Suzana
authors.initials: S
authors.lastname: Dănoiu
authors.forename: Elena Carmen
authors.initials: EC
authors.lastname: Niculescu
authors.forename: Carmen Daniela
authors.initials: CD
authors.lastname: Neagoe
mesh_terms: D004817:Epidermis / Q000473:pathology; D015622:Epithelioid Cells / Q000473:pathology; D016460:Granuloma Annulare / Q000473:pathology*; D006801:Humans; D007249:Inflammation / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009335:Necrobiosis Lipoidica / Q000473:pathology*