Early-Onset Multiple Necrobiosis Lipoidica in a Child with Type 1 Diabetes Mellitus

Necrobiosis lipoidica is uncommon in childhood, and a multifocal presentation early in the course of type 1 diabetes mellitus appears to be infrequently reported.In our patient, multiple lesions developed within 3 years of diabetes diagnosis, despite the absence of overt microvascular complications.The persistence of lesions alongside recurrent episodes of ketoacidosis may suggest a potential association between suboptimal metabolic control and cutaneous microangiopathic changes; however, causality cannot be established on the basis of a single case.Early recognition of such lesions may be clinically relevant, as they may prompt careful metabolic evaluation and closer follow-up in affected children.What is already known on this topic?Necrobiosis lipoidica (NL) is a rare, chronic granulomatous skin disorder most commonly associated with type 1 diabetes mellitus and typically occurring in young or middle adulthood.In children and adolescents with diabetes, NL is exceedingly uncommon, with only a limited number of cases reported in the literature. What this study adds?This report describes an early-onset, multifocal presentation of NL in a child with type 1 diabetes mellitus, a pattern rarely reported in childhood.NL developed within the first 3 years following diabetes diagnosis, highlighting that poor metabolic control, rather than disease duration alone, may play an important role in the early development of cutaneous complications.Despite long-standing poor glycaemic control and extensive skin involvement, no microalbuminuria or retinopathy was detected, underscoring the heterogeneous nature of microvascular complications in paediatric diabetes.