The Intersection of Dermatological Dilemmas and Endocrinological Complexities: Understanding Necrobiosis Lipoidica—A Comprehensive Review

Abstract

Background: Necrobiosis lipoidica (NL) is a rare granulomatous skin disorder with a predilection for females, often associated with diabetes mellitus (DM). This paper aims to comprehensively review the literature on NL, focusing on its association with DM, thyroid disorders, and the metabolic syndrome. Methods: A systematic search was conducted in English-language literature from inception to October 2023, utilizing PubMed. We identified 530 studies and selected 19 based on clinical significance, statistical support, and relevance to the paper’s goals. Results: The coexistence of NL and DM is prevalent, with rates ranging from 11% to 65.71%. NL may precede DM diagnosis and a correlation between NL and increased daily insulin requirements has been observed in such patients. NL is suggested as a potential prognostic marker for DM complications; however, recent studies question this association, highlighting the need for further research. Studies in the context of NL and Thyroid Disease indicate a correlation, especially with autoimmune thyroiditis. Regarding NL and Metabolic Syndrome, the prevalence of metabolic syndrome among NL patients is notably higher than in the general population. Additionally, DM patients with ulcerated NL commonly exhibit hypertension or obesity, raising questions about the potential influence of hypertension and obesity on NL ulcerations. Conclusion: Additional research is required to untangle the complex connections between NL and various comorbidities.

Shedding Light on Photodynamic Therapy in the Treatment of Necrobiosis Lipoidica: A Multicenter Real-Life Experience

“…In this regard, a recent multicenter retrospective study, examining the data of 52 patients with NL of the lower legs, found a prevalence of thyroid function disorders in 13%, compared to 5.5% in the general population, suggesting that NL could be associated with other conditions than DM alone [7]. It was observed that patients diagnosed with both NL and type 1 DM had a higher overall susceptibility to celiac disease in comparison to those with diabetes alone, with the prevalence of celiac disease being 3.4% among patients with both conditions, compared to 1% among patients with type 1 DM [8,9]. In addition to DM, NL patients have also been observed to suffer from dyslipidemia, obesity, hypertension, coronary heart disease, stroke, and reduced renal function, with hypertension being the most frequent secondary diagnosis associated with NL [10].…”