Specific skin lesions

Necrobiosis lipoidica

Between 40% and 60% of patients with this condition may develop diabetes, but it is not very common in diabetic patients (0-3%). As the name indicates, there is necrosis of the connective tissue with lymphocytic and granulomatous infiltrate. There is replacement of degenerating collagen fibres with lipid material. It usually occurs over the shin but may appear at any site.

Granuloma annulare

This usually presents with localised papular lesions on the hands and feet but may occur elsewhere. The lesions may be partly or wholly annular and may be single or multiple. There is some degree of necrobiosis, with histiocytes forming "palisades" as well as giant cells and lymphocytes. It is seen more commonly in women, usually those aged under 30. There is an association with insulin dependent diabetes. In itself it is a harmless and self limiting condition that slowly clears but may recur.

Diabetic ulcer

Necrobiosis lipoidica

Diabetic ulcer

Necrobiosis lipoidica

Granuloma annulare

Porphyria

Granuloma annulare

Porphyria

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