Necrobiosis lipoidica (NL) is a chronic noninfectious granulomatous skin disease of both the dermis and subcutaneous tissue.1 NL classically occurs in people with diabetes; other associated conditions include sarcoidosis, connective tissue disorders, and irritable bowel disease.1 In patients with diabetes, NL arises at a younger age and has a female predilection.2,3 NL initially presents as red-brown telangiectatic lesions. The lesions characteristically affect the anterior tibial surface but may uncommonly involve the thighs, popliteal regions, and dorsum of the feet and arms. As the disease progresses, lesions may develop into atrophied, depressed and sclerotic plaques. Untoward sequelae include ulceration and infection.

Diagnosis is usually based on history and clinical appearance. Histopathology of NL will demonstrate epidermal atrophy, zones of dermal sclerosis, and superficial dermal telangiectasia.2 In addition, there is presence of alternating horizontal layers of basophilic degeneration of collagen and palisades consisting of histocytes, lymphocytes, and plasma cells.

Currently, there are no definitive treatment guidelines for the management of NL. When associated with diabetes, disease activityis not correlated with glycemic control. Topical or intralesional corticosteroids are first-line therapies.Other treatment modalities include topical calcineurin inhibitors, retinoids, tumor necrosis factor inhibitors, and hyperbaric oxygen. 4

References

1. Ciazynska M, Bednarski I, Narbutt J, Woźniacka A, Lesiak A. Necrobiosis lipoidica – an old but challenging dermatosis. Przegl Dermatol. 2016;103:45-48.

2. Reddy V, Gattuso P, David O, Spitz D, Haber M. Differential Diagnosis in Surgical Pathology. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2015:63-64.

3. Hashemi DA, Brown-Joel ZO, Tkachenko E, et al. Clinical features and comorbidities of patients with necrobiosis lipoidica with or without diabetes. JAMA Dermatol. 2019;155(4): 455-459.

4. Tong LX, Penn L, Meehan SA, Kim RH. Necrobiosis lipoidica. Dermatol Online J. 2018;24(12):8.