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Author Note: Ysabel M. Bello, MD, and Tania J. Phillips, MD Dr Bello is wound healing fellow and Dr Phillips is professor of dermatology, Boston University School of Medicine. Robert T. Brodell, MD, coordinator of this series, is professor of internal medicine and clinical professor of dermatopathology in pathology, Northeastern Ohio Universities College of Medicine, Rootstown, and associate clinical professor of dermatology, Case Western Reserve University School of Medicine, Cleveland. Correspondence: Tania J. Phillips, MD, 609 Albany St, Boston, MA 02118.
A 37-year-old white woman with type 1 diabetes presented with a 15-year history of plaques over both shins. The patient was concerned about the cosmetic appearance of her lower legs and about the possibility of ulceration. She had noted the gradual development of fine blood vessels on her shins. The plaques had been treated 10 years before with intralesional corticosteroids. She had never had skin grafts, ulceration, deep venous thrombosis, cellulitis, surgical treatment, or trauma to the legs.
On examination, 10- to 15-cm, yellow, atrophic, centrally scarred plaques with multiple telangiectases around the borders were seen over both shins (figure 1). Swelling was more marked on the left shin than on the right. A diagnosis of necrobiosis lipoidica...