At a Glance - Necrobiosis lipoidica vs gravitational eczema

Necrobiosis lipoidica

Discriminatory features

  • Affects shin of insulin-dependent diabetics.
  • Can also occur in non-diabetic patients.
  • One or more tender yellowish brown patches develop over months.
  • May be round, oval or an irregular shape.
  • They may persist for years.
  • The centre of the patch becomes shiny, pale, thinned, with telangiectasia.
  • Painless ulcers can occur when patch is injured.

Management

  • Topical steroids if border is raised and mauve.
  • Cosmetic camouflage.
  • Ulcers that are difficult to heal may require protective dressing, systemic steroids or skin graft.

Gravitational eczema

Discriminatory features

  • Itchy rash on the lower legs.
  • Preceded by 'venous' or 'stasis' eczema.
  • Affected leg is swollen after standing and in hot weather.
  • Dermatitis can be discrete patches or circumferential.
  • Lower leg is red and scaly, and may ooze, crust and ulcerate.
  • Complications are cellulitis, lichenification, hyperpigmentation and lipodermatosclerosis.

Management

  • Avoid standing for long time.
  • Use moisturising cream.
  • Walk regularly.
  • When sitting elevate feet above hips.
  • Elevate foot end of bed when sleeping.
  • Compression stocking unless contraindicated by Doppler.
  • Dry up oozing patches with Condy's solution (potassium permanganate).
  • Topical steroid and coal tar ointment.
  • Antibiotics for secondary infection.

Text contributed by Dr Vasa Gnanapragasam, a GP in Sutton, Surrey.

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