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Tuesday, December 2, 2014

Necrobiosis lipoidica in an obese diabetic woman


I'm back with some seriously unpleasant photos! Today's post is about an obese lady suffering from a skin disorder that made her legs look like something out of the X-Files. Thankfully, bariatric surgery turned out to be a good solution for her health problems.

Necrobiosis lipoidica is a nasty necrotising skin condition that usually occurs in patients with diabetes mellitus. It strikes approximately 0.3% of the diabetic population, with the majority of sufferers being women. It is an inflammatory disorder of unknown etiology, involving the skin and often also the deeper fat layer. Hardened, raised reddish brown lesions appear, usually on the legs (particularly the shins), but sometimes other body parts are affected as well. With time, these lesions often degenerate into open sores. Ulceration may result in pain, infections and unsightly scars.

Type II diabetes is often a complication of obesity; hence, quite a few diabetic people suffering from necrobiosis lipoidica have this problem because they are obese. (Note that untreated diabetes can have various other ugly effects on health - it can damage your eyesight, arteries, nerves and feet.)  While bariatric surgery is not without its risks, at least for some obese patients the surgeon's knife is the only way left to shed those hundreds of unwanted pounds and improve health. Studies show that bariatric surgery dramatically improves diabetes, often to a point where blood glucose levels return to normal and antidiabetic medications can be discontinued.

A 32-year-old Turkish woman with a BMI of 45.14 kg/m2 (the normal BMI range is 18.5 to 24.9) had had diabetes mellitus for 12 years and also suffered from necrobiosis lipoidica. Her lower legs were covered with ulcerated, oozing plaques that caused persistent pain. Steroids, psoralen, UV therapy, skin dressings and painkillers were all only partly effective. In April 2011 the patient underwent a laparoscopic minigastric bypass operation and began to lose weight. After only a month, the lesions on her left leg subsided, and after another two months, the lesions on the right leg healed too. A year after the surgery, the patient had a BMI of 22.23 kg//m2 with only non-ulcerated scars on her legs

Below, the photos on the left show the ulcerated, oozing plaques on the patient's legs before surgery. On the right are the non-ulcerated, non-oozing scars a year after the surgery.




Images from: Bozkurt et al. 2013


Literature:

Bozkurt S, Coskun H, Kadioglu H, Memmi N, Cipe G, Ersoy YE, Lebe B, Muslumanoglu M. (2013) Remission of Ulcerated Necrobiosis Lipoidica Diabeticorum after Bariatric Surgery. Case Rep Dermatol Med. 2013: 352579.

Wikipedia - Necrobiosis lipoidica 

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