Skin Rash on leg with open wound

[Columbus Mom]

My Daughter is in College and over the pas 18months has developed a red skin rash.  The dermatologist has said this can occur in just 3% of the diabetic population.  She has now an open sore (small) it is not healing even after anibiotics.  Where to we go to get more assistance with this condition?

[Human Pin Cushion]

Well, I went through this exact same scenario when I was a sophomore in college.  This was back in the 70's, before meters and A1C's.  Not a rash, but I had small scars pop up after a spring break trip to Florida.  On my ankles, calves and shins.

I made the mistake (but was trying to be independent) of going to the campus doctor, who said they were probably just bug bites from the sand in Florida.  Later, they became larger and I went to a dermatologist and had a biopsy just in case.  But he knew exactly what they were.  Treated early with cortisone injections helped a lot.  I let some of them go later, (they really enlarged so gradually, you just sort of live with them) then had them treated in another city.  Mine have gone away, but I'm left with a little bit of scar tissue.

One other thing.  I an concerned your daughter is seeing an endocrinologist who didn't at least see a red flag on this.  They are well known in the diabetes world.  Many non-diabetics get them as well.  It's basically scar tissue that keeps growing on the third layer of skin, I believe.  But, your endocrinologist should have known they were a possibility.

Also, look for a very clinical dermatologist.  So many these days are doing the "beauty treatments", look for someone knowledgable in this area.  The earlier the better.  I think better control has eliminated this problem for me.  But, this is a sneaky disease.  Good luck!

[MLWTR]

This link provides some information about the condition and treatment modalities: http://www.faqs.org/faqs/diabetes/faq/part3/section-21.html

The following link is to an article about the condition written for doctors. It is more technical (I don't know the extent of your medical background), but you might find it of interest. There is some treatment information towards the bottom of the page. http://www.emedicine.com/derm/topic283.htm

Hope these are some help.

[Columbus Mom]

I am sorry I did not have the name earlier - It is Necrobiosis Lipoidica Diabeticorum.  Her current endcrinolgist did not know of it.  A dermotologist diagnosed it.  She seems to have the symptoms I read about on the internet.  I was hoping for some guidance on how to manage the condition.  She does ok with blood sugars for the most part.  This condition  has her worried an anxious that seems to aggravate it more.

[JDRF-Team-sgg]

It is difficult to give you a definite answer because you have not specifically identified what this rash is other than rash. I do not know where the rash is found or whether this is a fungal rash or an allergy rash. You see, rashes are usually not the CAUSE but the symptom. So perhaps you can best help your daughter by trying to find out what is causing the rash. Does she suffer from a fungal problem or a bacterial problem or an allergy? I would suggest that you insist that the cause of the rash be identified. The open sore may just be an escalation of the original rash.

The next suggestion is that you find out what her hemoglobin a1c is. Although most endocrinologists will not complain if her a1c is not above 7, many diabetics are comfortably able to keep an a1c in the low 6's nowadays with pumps or 24-hour insulins combined with the very quick-acting insulins. I don't know how good or bad her control is, but poor control is fairly typical of college students. Getting tight control over the diabetes will help her body heal. Poor glucose control may be the real root cause of the skin problem if the problem is not an allergic condition.

Another suggestion: you may want to have her see an allergy specialist to make sure that an allergy is not causing the rash, but even if it is, getting her gluocse levels under tight control may help her deal with skin allergies better.