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From California, USA:

I am a thirty-one year old type 1 diabetic of 5 years. I am somewhat in control now that I am on the new Humalog, and recently quit smoking. I have NLD on my left leg, and wonder if the herbal treatments for circulation have helped anyone. It seems to have gotten worse since quitting smoking. I did have an ulceration of it six months ago, which was treated with a unna boot, and luckily healed. Will walking more, or Gingko Biloba help? It is seriously ugly, and while it is a vanity thing, I also worry because it does seem to ache at night now. The area it covers is large, perhaps six inches linear, by two inches wide, bright purple and now it seems some of the lesions are yellowing in clusters inside each spot. I live in an area where the doctors are afraid to even prescribe insulin, let alone give ideas for further help, especially if it is not medicinal. The doctors here are the reason why is opened up into a large wound, they suggested to put hydrocortisone cream on and wrap it in saran wrap, this made a gaping wound that took two months to grow new skin. Hopefully you have some info.


Necrobiosis Lipoidica Diabeticorum (NLD) is usually just a cosmetic problem; but as you yourself have experienced it sometimes ulcerates so may interfere with control as well as being painful. Its underlying cause is not understood and treatment is often disappointing, a fact that is reflected in the variety of approaches that have been used. Some of the procedures on this list include pentoxifylline, hydrocortisone injections around the periphery of the lesions and hyperbaric oxygen. With chronic ulceration, surgical excision with skin grafting has had some success. One approach which we have used and which somewhat to our surprise was successful in a number of cases was the use of high doses of nicotinamide orally. This was first described in a paper from Bristol in England by Handfield-Jones and others in the British Journal of Dermatology, vo1 118 page 693, 1988. The dose we used was 500 mg a day of a slow release preparation and treatment was continued for two months or so. Your doctor should be able to get the reference from his local medical library or you might be able to get it for him. I would add that nicotinamide is a normal vitamin, I don't believe that any herbal remedies would be helpful though I see no harm in trying them.

I hope this helps. There are no ill effects of using nicotinamide and it might be a considerable help; but don't expect an overnight change.


Original posting 8 Nov 97


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