September 2021 - Case of the Month
A 24-year-old woman presented with a several year history of evolving 'lumps' especially on the central chest. The lady had mild facial acne and was otherwise well.
A 34-year-old woman was referred to clinic with a nine month history of a slowly expanding, asymptomatic rash on her left shin. There was no history of trauma. The rash had not responded to emollients, eumovate cream or anti-fungal preparations. Skin swabs were negative.
There was no other personal of family history of skin conditions.
The patient was known to have insulin-dependent diabetes.
She was a non-smoker and drank limited alcohol. The lady was a housewife. There was no recent foreign travel.
Examination revealed a red-yellow coloured patch with an atrophic centre and prominent telangiectasia.
What is the diagnosis?
Diagnosis - necrobiosis lipoidica
Necrobiosis lipoidica is an uncommon skin condition characterised by sharply demarcated, atrophic yellowish patches or plaques on the shins. It was first described in patients with insulin-dependent diabetes but it can affect non-diabetics as well.
The aetiology is unknown.
Necrobiosis lipoidica typically affect both shins, although it is sometimes unilateral and other sites can be affected. Lesions are typically yellowish patches / plaques. Lesions grow with an erythematous edge, and a centre that becomes shiny and atrophic with prominent telangiectasia. Ulceration can occur. Slow expansion over many years is usual, although lesions may go through periods of being more, and less, active.
Necrobiosis lipoidica can be recalcitrant to treatment and as such, uncomplicated cases may be managed conservatively and left untreated. On occasions potent topical steroids may be beneficial. Several other treatments have been tried.
For more information on necrobiosis lipoidica and its management please click on the link.
A 24-year-old woman presented with a several year history of evolving 'lumps' especially on the central chest. The lady had mild facial acne and was otherwise well.
A 52 year old man presented with a one year history of skin lesions predominantly on his hands, ears and scalp. He was also complaining of painful swollen fingers associated with morning stiffness. There was no family history of skin or joint problem...
A 72 year old man was referred with a rash, predominantly on the legs. The patient was systemically well and the lesions were only mildly symptomatic. The lesions presented as one to several at a time lasting several weeks. They had not res...
Welcome back to the new look PCDS website, and our first case. This lady was referred as a 2-week wait with a changing lesion on the right temple.
A 15 year old lady was referred for a diagnostic opinion for skin changes presenting in birth, affecting the right upper back, shoulder, antecubital fossa and dorsal wrist. The patient was asymptomatic and otherwise well.
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