Question

A 52 year-old male with history of non-insulin-dependent diabetes, presents to your clinic with complaints of facial pain and discharge. Two days ago he noticed a rash developing anterior to his right ear that has now spread along his cheek. He states that this rash started as red and itchy, however is now blistered, leaking clear fluid, and is exquisitely tender. Upon examination, you note anterior to his ear has become increasingly reddened and draining yellow, honey colored discharge.

1. What is the primary diagnosis for this patient? Support your answer using the pathophysiology of the disease.

2. How do you explain the change in his rash along the initial eruption?

Answer 1

1.Necrobiosis lipoidica diabeticorum (NLD) refers to a skin rash that most commonly affects the shins and is seen more often in women. Mostly seen in extrimities but also seen in face .This is the most dramatic skin condition usually associated with diabetes.

pathophysiology :-Necrobiosis lipoidica is a disorder of collagen degeneration with a granulomatous response, thickening of blood vessel walls, and fat deposition. And in case of diabetes due to increased glucose There is increased chance of bacterial and fungal growth in the skin which is more favourable for the micro organisms to grow in our skin causing infection and pustules formation.The main complication of the disease is ulceration,When there is a poor blood supply and high glucose concentration which is more favourable for the bacterial organisms to grow into and causing infection.

2.The patient initially had facial pain and discharge and later on he have noticed that the rashes developing anterior to his right ear and have spread along his cheeks and as the patient is a known case of type two diabetes mellitus It was really favourable for the organism to grow .patient initially started with reddish change in his skin with itching and which further developed in blister formation later on the blisters rupture causing bleeding and can cause peeling of the skin.