Treatment: Treatment is typically initiated with the use of high-potency topical steroids. It may seem counterintuitive to treat an atrophic condition with topical corticosteroid creams, which can cause atrophy. In cases of necrobiosis lipoidica, however, the high-potency steroid agents do not lead to an increase in the atrophy. The steroid agents act to decrease and stop the inflammatory infiltrate from occurring and perpetuating itself. Intralesional injections of triamcinolone have also been successful. Many other agents have been anecdotally reported to be successful in treating this condition, although they have not been tried in standardized, placebo-controlled studies. Gaining control of the underlying diabetes does not seem to play a role in the outcome of the skin disease. Ulcerations should be treated with aggressive wound care, and compression garments should be worn if edema or venous insufficiency is present. Ulcers may take months to heal. Once the inflammation has been stopped, most people have residual atrophy that may be permanent or may improve slightly with time.
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