Necrobiosis lipoidica is a granulomatous condition presenting as indolent atrophic plaques, often on the lower extremities. There is a multitude of case reports suggesting possible associations and documenting different therapeutic alternatives with varied success. Important complications include ulceration and the development of squamous cell carcinoma. The disease course is often indolent and recurrent despite treatment. This article reviews the etiopathogenesis, clinical presentations, and evidence for treatment alternatives of this condition.
Key points
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Necrobiosis lipoidica (NL) typically presents as well-demarcated yellow-brown plaques with violaceous borders with central waxy atrophic appearance and telangiectasias on the lower extremities.
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The pathogenesis likely involves vascular and immunologic mechanisms with impaired neutrophil migration, collagen abnormalities, and granuloma formation.
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Investigations should include screening of underlying disease, especially diabetes and vascular studies when indicated. Biopsies are recommended when alternative diagnoses are considered.
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The disease course is often indolent, and treatment is based on patients’ concerns. The most common therapies include topical corticosteroids and calcineurin inhibitors.
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NL lesions should be monitored for transformation to malignancy.
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