NECROBIOSIS LIPOIDICA

Diagnosis: NECROBIOSIS LIPOIDICA

Case submitted by Dr.Azeem Alam Khan to the dermRounds community.

Clinical Presentation

Clinical photograph(s) submitted for peer review and discussion.

Clinical History

Submitted by Dr.Azeem Alam Khan. Originally posted June 10, 2009.

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, dr.azeem alam khan