Necrobiosis lipoidica

Diagnosis: Necrobiosis lipoidica

Necrobiosis lipoidica

Clinical Presentation

Necrobiosis lipoidica

Clinical History

Yellow-brown atrophic plaques on pretibial skin with prominent telangiectasia. Evaluate for diabetes mellitus. Assess for ulceration.

Treatment

Potent topical or intralesional corticosteroids. Calcineurin inhibitors. Phototherapy. Pentoxifylline. Wound care for ulcerated lesions. Biologic agents for refractory cases.

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: dermatologist, dermatology, kodachrome, Necrobiosis lipoidica