Lipoid necrobiosis: causes, symptoms, diagnosis and treatment

Lipoid necrobiosis is a very dangerous chronic skin disease. It is not inherited by inheritance. The disease occurs when there is a metabolic disorder in the body. This is a local lipoidosis, in which lipids are deposited in the dermis, in which there is collagen necrosis or degeneration.

Features of lipoid necrobiosis

The disease proceeds in chronic form for a long time. Quite often after apparent recovery, the disease develops anew. There are cases of spontaneous recovery. But this is quite a rarity.

Which group of people is affected?

Lipoid necrobiosis is a relatively rare disease. It refers to local lipoidosis of the skin. It is mainly manifested in patients with diabetes mellitus. Most often, lipoid necrobiosis affects people 20-40 years old. Less often, the disease occurs in children and the elderly. Most often, women fall ill.

Risk factors

Risk factors include metabolic disorders. Basically lipid, hormonal and carbohydrate metabolism. The risk factor is increased in patients with wounds of diabetes mellitus, various injuries (insect bites, bruises, etc.).

To what specialist to apply?

For any skin lesions, including those with lipoid necrobiosis, dermatologist's consultation is necessary. The doctor will diagnose and prescribe the necessary treatment.

Causes of the disease

Lipoid necrobiosis of the skin appears due to Metabolic disorders. In particular, due to a failure in the metabolism of fats and carbohydrates. Because of this, the vessels develop pathological changes and microcircular disorders begin. The disease can also appear in people who have no problems with glucose tolerance.

Because of the disturbed microcirculation degenerative changes of skin cells and their necrobiosis begin (the intracellular metabolism changes). And as a result - fat cell regeneration.

Lipoid necrobiosis: symptomatology of the disease

The first symptoms in lipoid necrobiosis - the appearance on the skin of small pink-red oval nodules. At the edges they are surrounded by a bluish border. In the center of lesions, the plaques are yellowish-gray. At the same time, small red nodules can form under the skin. They look like capillary cystic enlargements. Sores at this stage of the disease do not appear.

Nodules expand and after a while merge into dense plaques, having a smooth surface with a specific luster. To the touch they are dense and painless. In the middle, the skin is covered with a translucent film. A small bluish-red roller forms along the edges.

Foci of lesions are symmetrical and are located immediately over several plaques nearby. Most often the lower extremities are affected, mainly on the lower leg. Sometimes plaques can appear on the hips, trunk, forearms and scalp.

If the disease runs without complications, then skin lesions do not cause any unpleasant and painful sensations. Otherwise, first appear jaundice and other skin defects. Then begins burning, tingling, itching and pain.

Lipoid necrobiosis is much more difficult if the person has diabetes at the same time. In this case, small vessels suffer, and this only increases the damage to the skin. If the sugar in the blood is lowered, then the patient's condition is somewhat normalized. Plaques partially or completely dissolve. Their number decreases.

Microscopic examination reveals a decrease in the elasticity of cells, in them appears the pathology of abnormal fat metabolism. Most of all, the connective tissue suffers. A specific type of lipoid necrobiosis is the chronic disciform granulomatosis of Micher. In this case, skin plaques are much larger in size. They are denser, to the touch - like the surface of a board. Especially in the middle of the affected area.

Diagnostics

If there is an increase in the level of glucose in the blood, A special test is performed to detect disorders of carbohydrate metabolism. This is mainly done at the initial stage of diabetes. In addition to the test, blood and urine tests for the presence of sugar are required.

A glucose-tolerant test is a load test with glucose. The procedure includes several stages of blood sampling from the capillaries. It is done on an empty stomach after taking seventy-five grams of glucose. It dissolves in water beforehand. The normal level of glucose is less than 5.5 mmol per liter. Two hours after the test - no more than 7.8 mmol per liter. Deviations from the norm mean a violation of the functions of the insular apparatus. In this case, a deeper and more thorough examination is carried out. The test is not done if the glucose level is above 6.7 mmol per liter.

Diagnostics is engaged, besides dermatological and therapeutic, also endocrinological center. First, an external examination of the patient is carried out. Then a histological examination of the samples obtained with biopsy of the affected skin is prescribed. Specific staining of lipids by the Sudan is used to detect clusters of fatty grains.

In the blood vessels, attention is paid to the proliferation of the endothelium and the fibrosis of the walls. Differential diagnosis is carried out with:

• Plaque scleroderma;
• Annular granuloma;
• Bazin's inducible erythema;
• Papulonecrotic vasculitis;
• Panniculitis;
• Sarcoidosis;
• Dermatitis of the lower leg;
• Erythema nodosum , etc.

Medication

To treat lipoid necrobiosis, you need to contact the endocrinology center. It conducts a complete examination of the patient. A diet is prescribed to settle blood glucose levels. For treatment, anti-inflammatory and microcirculatory-improving drugs are used:

• "Hingamin".
• "Acetylsalicylic acid".
• "Xanthinal nicotinate."
• "Dipiridamol" and some others.

Also prescribed antidiabetic drugs and ointments, which include hormones of the adrenal cortex. The application of the Dimexide solution (25-30 percent) is good. Treatment can be both outpatient and inpatient.

In addition, prescribe drugs that have in their composition, vitamin E. Physiotherapeutic procedures are prescribed with the use of Bucca beams and X-ray irradiation. In difficult cases, treatment is performed surgically. During the operation pathologic formations are excised. Then it is necessary to carry out skin plastic.

It should not frighten anyone with a diagnosis such as lipoid necrobiosis. Treatment with a progressive form against a background of diabetes of the first degree: different variants of insulin are used. Against the background of the second - sulfonylureas. From vitamins are appointed "Aevit", "Ascorutinum", vitamin B and nicotinic acid. With necrobiosis, bromides or herbal preparations are prescribed. And also improving microcirculation - "Etamsilat", "Complamine", etc.

Lipotropic drugs are prescribed, and for the nondiabetic nature of the disease - Dipromonium, which is administered intramuscularly. With local therapy, phonophoresis with heparin or prednisolone ointment is used. In days free from phonophoresis, corticosteroid agents applied under the bandages are used.

Treatment with folk remedies

For the treatment of lipoid necrobiosis by folk remedies, consultation of a dermatologist is necessary. Self-medication without the approval of a doctor is highly undesirable. As suitable folk remedies, celery (500 grams) and lemons (6 pieces) are successfully used, which are cooked for two hours in a water bath, previously ground in a blender. The finished product is taken in the morning for one tablespoon. The mixture is stored in the refrigerator.

Good help with the treatment of aloe and cinnamon. Twenty grams of cinnamon powder is poured into a glass of boiling water. It is infused before cooling down, and ten milligrams of aloe juice is added to this infusion. Stirred, divided into two equal parts. The first is drunk in the morning on an empty stomach. The second - in the evening, just before the dream.

For external use, compresses are made from steamed pine powder or oak bark. What is dangerous lipoid necrobiosis? If treatment is not performed or started, it can go to the development of gangrene.

Prevention of disease

Prevention - regular check-ups in a polyclinic for the detection of diabetes or other diseases associated with the violation of metabolic processes in the body. It is advisable to visit a district doctor and take a medical examination every six months. This will help get rid of many problems and prevent the development of possible diseases. People who have had diabetic cases among their relatives need to constantly monitor their glucose levels. In case of detection of diabetes, its mandatory and timely treatment is also the prevention of lipoid necrobiosis.

In addition to all of the above, you should avoid any physical injuries, especially the legs (in particular the shin). It is necessary to exclude from the diet fatty foods and fried. Preference should be given to boiled food and cooked for a couple.