Necrobiosis lipoidica

Diagnosis: Necrobiosis lipoidica

Necrobiosis lipoidica

Clinical Presentation

Necrobiosis lipoidica

Clinical History

Submitted by Ellie Goulding MD. Originally posted January 23, 2017.

Treatment

See case discussion.

Differential Diagnosis

• Granuloma annulare • Morphea • Sarcoidosis • Stasis dermatitis • Diabetic dermopathy • Xanthoma • Pyoderma gangrenosum

Key Learnings

• Classic: well-defined, waxy, yellow-brown atrophic plaques on pretibial skin with telangiectasia • Associated with diabetes mellitus (~65%), but treatment of diabetes does not improve NL • Ulceration occurs in ~33% of lesions — a significant complication • Histology: palisading and interstitial granulomatous dermatitis with necrobiosis throughout dermis • Koebner phenomenon may occur • Does NOT resolve with glycemic control

Tags: necrobiosis, lipoidica, ellie goulding md