Photoclinic Diagnosis: Multiple Plaques of Necrobiosis Lipoidica Diabeticorum

A7-year-old male Caucasian-Iranian child with a 2 ½ year history of type I diabetes, continued use of human insulin (NPH, 10 IU/day in the first 1 ½ years and 15 IU/day in the last year), and a positive family history of diabetes mellitus (in several family members) presented with multiple persistently tender plaques which had persisted for at least a year before presentation. There were 4 plaques on the anterior lower legs, 3 on both thighs, and 4 on both forearms. On the right pretibial skin, there were two 12 x 7 cm and 9.5 x 4.3 cm plaques. On the left leg, two 11 x 9.5 cm and 6.8 x 4.6 cm white ovaloid plaques could be found with atrophic telangiectatic centers. They extended from just below the knees to the ankles. No one was ulcerated. The remaining plaques were small, between 3.4 x 2.4 cm and 4.6 x 4.3 cm.