Necrobiosis Lipoidica
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A 13-year-old girl with type 1 diabetes mellitus presented with diabetic ketoacidosis. She was on regular insulin thrice a day with poorly controlled blood sugars. On examination, the girl had a well-defined, circular, indurated red plaque, measuring 5×5 cm, over the left leg (Fig.1). The lesion started as painless, reddish papules that slowly enlarged to a plaque over a period of 3 years. Analysis of the biopsy specimen confirmed the diagnosis of necrobiosis lipoidica (NL) diabeticorum. Laboratory investigations revealed an elevated glycosylated hemoglobin (12.5%), normal thyroid function, normal complete blood count, unremarkable liver and renal functions, and normal serum cholesterol and triglycerides. She was able to achieve good glucose control and resume her normal life; however, the complication on skin persisted despite an intensive insulin treatment and topical steroids...

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