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November 1960

The Pathogenesis of Necrobiosis LipoidicaNecrobiosis Lipoidica, a Form Fruste of Diabetes Mellitus

Author Affiliations

Brunswick, Ga.; Durham, N.C.

From the Veterans Administration Hospital, Coral Gables, Fla. and the Department of Dermatology, University of Miami School of Medicine, Miami, Fla.

Present addresses: 2001 Gloucester St., Brunswick (Dr. Engel); Division of Dermatology, Department of Medicine, Duke University Medical Center, Durham (Dr. Smith).

Arch Dermatol. 1960;82(5):791-797. doi:10.1001/archderm.1960.01580050133020

The specificity of the vascular lesions of the kidney, retina, and vasa nervosum in diabetes mellitus1,2,8-12,20,31 and the relationship of the protein-bound carbohydrate to their pathogenesis have been the subject of much recent research and speculation.4,5,13, 14,28 Elevation of the total protein-bound hexose and of the α2-glycoprotein in the serum, together with the presence of mucopolysaccharide in the affected vessels, have been demonstrated repeatedly in the presence of the specific vascular complications of diabetes.* Similar findings have been reported in patients with necrobiosis lipoidica without diabetes mellitus.6 It is the purpose of this paper to clarify the relationship between these diseases and to present immunologic evidence for the presence of an abnormal serum protein or proteins common to both.

One method of separating and identifying complicated mixtures of antigen and antibody is the diffusion-in-gel technique. When employing protein antigens, sharply defined zones of reaction are noted because

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