Quiz
Mixed diagnoses – 10 cases (7 of 11)

For each of the ten cases, study the image(s) and then answer the questions. You can click on the image to view a larger version if required.

Each case should take approximately five minutes to complete. There is a list of suggested further reading material at the end of the quiz.

When you finish the quiz, you can download a certificate.

Case 5

A 16-year-old female presents with an area of relatively painless ulceration on her shin, which has arisen following a mild injury several months earlier.

What is the name of this skin condition?

This is necrobiosis lipoidica, an uncommon skin disorder more common in females, characterised by reddish brown plaques usually located on the shins. Older lesions become yellow, atrophic and telangiectatic. Minor trauma may result in ulceration in longstanding lesions.

What underlying systemic disease does she have?

The young woman illustrated developed insulin-dependent diabetes mellitus several years earlier.
Necrobiosis lipoidica arises in less than 1% of insulin-dependent diabetics. Although it is highly associated with diabetes, only about half the patients presenting with necrobiosis lipoidica have clinical or biochemical glucose intolerance. The pathogenesis is unknown.

Suggest management.

Necrobiotic plaques are relatively anaesthetic and should be protected from injury
Topical steroids under occlusion for several weeks or intralesional steroids into the edge of the plaques can help newer lesions
Pentoxifylline may prove beneficial but takes 6 to 12 months to show effect
Metabolic control of underlying diabetes should be optimised

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Quiz Mixed diagnoses – 10 cases (7 of 11)

Case 5

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Quiz
Mixed diagnoses – 10 cases (7 of 11)