Lipoid necrobiosis is a very dangerous chronic skin disease. It is not inherited. The disease occurs when metabolic disorders in the body. This is a local lipoidosis in which lipids are deposited in the dermis, in which there is collagen necrobiosis or degeneration.
Features of lipoid necrobiosis
The disease proceeds in a chronic form for a long time. Quite often, after an apparent recovery, the disease develops again. 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, people 20-40 years old are affected by lipoid necrobiosis. Less commonly, the disease occurs in children and the elderly. Most often, women get sick.
Risk factors
Risk factors include metabolic disturbances. Mostly lipid, hormonal and carbohydrate metabolism. The risk factor increases in patients with wounds of diabetes mellitus, various injuries (insect bites, bruises, etc.).
Which specialist should I contact?
For any skin lesions, including those with lipoid necrobiosis, a dermatologist 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, pathological changes develop in the vessels and microcircular disorders begin. The disease can also occur in people who have no problems with glucose tolerance.
Due to impaired microcirculation, degenerative changes in skin cells and their necrobiosis begin (intracellular metabolism changes). And as a result - fatty cell degeneration.
Lipoid necrobiosis: symptoms of the disease
The first symptoms of lipoid necrobiosis are the appearance of small pink-red oval nodules on the skin. At the edges they are surrounded by a bluish border. In the center of the lesion, the plaques are yellowish-gray. At the same time, small red nodules under the skin may form. They look like capillary cystic expansion. Sores at this stage of the disease do not appear.
Nodules grow and after some time merge into dense plaques having a smooth surface with a specific sheen. 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 around the edges.
The lesions are symmetrical and are located immediately on several plaques nearby. Most often, the lower limbs are affected, mainly on the lower leg. Plaques can sometimes appear on the hips, trunk, forearms, and scalp.
If the disease proceeds without complications, then skin lesions do not cause any unpleasant and painful sensations. Otherwise, sores and other skin defects appear first. Then begins burning, tingling, itching and pain.
Lipoid necrobiosis is much more difficult if a person also has diabetes. In this case, small vessels suffer, and this only enhances skin damage. If the blood sugar is low, then the patient's condition is somewhat normal. Plaques partially or completely absorb. Their number is decreasing.
Microscopic examination reveals a decrease in the elasticity of cells, in them there is a pathology of improper fat metabolism. Most of all, connective tissue suffers. A specific type of lipoid necrobiosis is Misher's chronic disciform granulomatosis. 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 blood glucose, a special test is performed to detect carbohydrate metabolism disorders. 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 tolerance test is a stress test with glucose. The procedure includes several stages of blood sampling from capillaries. It is done on an empty stomach after taking seventy-five grams of glucose. It is previously dissolved in water. Normal glucose levels are 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.
Apart from dermatological and therapeutic, an endocrinological center is also involved in diagnostics. First, an external examination of the patient is carried out. Then a histological examination of the samples obtained by biopsy of the affected skin is prescribed. Specific lipid staining with Sudan is used to detect accumulations of fat grains.
In blood vessels, attention is paid to the proliferation of endothelium and wall fibrosis. Differential diagnosis is carried out with:
- plaque scleroderma;
- annular granuloma;
- inductive erythema Bazena;
- papulonecrotic vasculitis;
- panniculitis;
- sarcoidosis;
- dermatitis of the lower leg;
- erythema nodosum , etc.
Drug treatment
For the treatment of lipoid necrobiosis, you must contact the endocrinology center. It conducts a complete examination of the patient. A diet is prescribed to regulate blood glucose levels. For treatment, anti-inflammatory and microcirculation-improving drugs are used:
- "Hingamin."
- "Acetylsalicylic acid".
- "Xanthinol nicotinate."
- "Dipyridamole" and some others.
Antidiabetic drugs and ointments are also prescribed, which include hormones of the adrenal cortex. Applications of the Dimexidum solution (25-30 percent) well help. Treatment can be either outpatient or inpatient.
Additionally, medications containing vitamin E are prescribed. Physiotherapeutic procedures are prescribed using Bucca's rays and x-ray irradiation. In difficult cases, treatment is performed surgically. During the operation, pathological formations are excised. Next, you need to carry out skin plastic.
Such a diagnosis as lipoid necrobiosis should not scare anyone. Treatment with a progressive form of diabetes mellitus of the first degree: various types of insulin are used. Against the background of the second - sulfonylureas. Of the vitamins, Aevit, Ascorutin, Vitamin B and nicotinic acid are prescribed. With necrobiosis, bromides or herbal preparations are prescribed. And also improving microcirculation - Ethamsylate, Complamin, etc.
Lipotropic drugs are prescribed, and with the non-diabetic nature of the disease, Dipromonium is administered intramuscularly. With local therapy, phonophoresis with heparin or prednisolone ointments is used. On days free of phonophoresis, corticosteroid drugs applied under dressings are used.
Treatment with folk remedies
For the treatment of lipoid necrobiosis with folk remedies, a dermatologist consultation is necessary. Self-medication without the approval of a doctor is highly undesirable. Celery (500 g) and lemons (6 pieces) are successfully used as suitable folk remedies, which are boiled 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.
Well help in the treatment of aloe and cinnamon. Twenty grams of cinnamon powder is poured into a glass of boiling water. It is infused until it cools, and ten milligrams of aloe juice is added to this infusion. It is mixed, divided into two equal parts. The first is drunk in the morning on an empty stomach. The second - in the evening, just before bedtime.
For external use, compresses are made from steamed powder of pine or oak bark. What is the danger of lipoid necrobiosis? If treatment is not performed or started, then it can reach the development of gangrene.
Disease prevention
Prevention - regular examinations in the clinic to detect diabetes or other diseases associated with impaired metabolic processes in the body. It is advisable to visit the local doctor and undergo a physical examination every six months. This will help get rid of many problems and prevent the development of possible diseases. People who have had diabetes mellitus among their relatives need to constantly monitor their glucose levels. If diabetes is detected, its mandatory and timely treatment is also the prevention of lipoid necrobiosis.
In addition to all of the above, it is necessary to avoid any physical injuries, especially the legs (in particular the lower leg). It is necessary to exclude fatty foods and fried foods from the diet. Preference should be given to boiled food and steamed.