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Necrobiosis lipoidica diabeticorum
ARTICLES
20 World Health Organisation. Severe falciparum malaria. Trans R Soc Trop Med Hyg, 2000; 94 (suppl 1). 21 World Health Organisation. Assessment of therapeutic efficacy of antimalarial drugs: WHO/MAL/96.1077. Geneva: WHO, 1996. 22 Nosten F, ter Kuile FO, Luxemburger C, et al. Cardiac effects of antimalarial treatment with halofantrine. Lancet 1993; 341: 1054–56. 23 Byrd SR, Gelber RH. Effect of dapsone on haemoglobin concentration in patients with leprosy. Lepr Rev 1991; 62: 171–78.
24 Mookherjee S, Howard V, Nzila-Mouanda A, Watkins W, Sibley CH. Identification and analysis of dihydrofolate reductase alleles from Plasmodium falciparum present at low frequency in polyclonal patient samples. Am J Trop Med Hyg 1999; 61: 131–40. 25 Brockman A, Price RN, van Vugt M, et al. Plasmodium falciparum antimalarial drug susceptibility on the north-western border of Thailand during five years of extensive use of artesunate-mefloquine. Trans R Soc Trop Med Hyg 2000; 94: 537–44.
Clinical picture Necrobiosis lipoidica diabeticorum Mark A Marinella A 38-year-old woman with poorly controlled type 1 diabetes mellitus complicated by diabetic nephropathy was admitted for coronary angiography following an abnormal thallium study. On physical examination she had welldemarcated, waxy erythematous plaques with prominent telangiectasias over both shins (figure). These lesions are characteristic of necrobiosis lipoidica diabeticorum, an uncommon granulomatous inflammatory dermopathy which affects less than 1% of patients with diabetes mellitus. Wright State University School of Medicine, Dayton, Ohio 45429, USA (M A Marinella MD)
THE LANCET • Vol 360 • October 12, 2002 • www.thelancet.com
1143
For personal use. Only reproduce with permission from The Lancet Publishing Group.
20 World Health Organisation. Severe falciparum malaria. Trans R Soc Trop Med Hyg, 2000; 94 (suppl 1). 21 World Health Organisation. Assessment of therapeutic efficacy of antimalarial drugs: WHO/MAL/96.1077. Geneva: WHO, 1996. 22 Nosten F, ter Kuile FO, Luxemburger C, et al. Cardiac effects of antimalarial treatment with halofantrine. Lancet 1993; 341: 1054–56. 23 Byrd SR, Gelber RH. Effect of dapsone on haemoglobin concentration in patients with leprosy. Lepr Rev 1991; 62: 171–78.
24 Mookherjee S, Howard V, Nzila-Mouanda A, Watkins W, Sibley CH. Identification and analysis of dihydrofolate reductase alleles from Plasmodium falciparum present at low frequency in polyclonal patient samples. Am J Trop Med Hyg 1999; 61: 131–40. 25 Brockman A, Price RN, van Vugt M, et al. Plasmodium falciparum antimalarial drug susceptibility on the north-western border of Thailand during five years of extensive use of artesunate-mefloquine. Trans R Soc Trop Med Hyg 2000; 94: 537–44.
Clinical picture Necrobiosis lipoidica diabeticorum Mark A Marinella A 38-year-old woman with poorly controlled type 1 diabetes mellitus complicated by diabetic nephropathy was admitted for coronary angiography following an abnormal thallium study. On physical examination she had welldemarcated, waxy erythematous plaques with prominent telangiectasias over both shins (figure). These lesions are characteristic of necrobiosis lipoidica diabeticorum, an uncommon granulomatous inflammatory dermopathy which affects less than 1% of patients with diabetes mellitus. Wright State University School of Medicine, Dayton, Ohio 45429, USA (M A Marinella MD)
THE LANCET • Vol 360 • October 12, 2002 • www.thelancet.com
1143
For personal use. Only reproduce with permission from The Lancet Publishing Group.