The dermatologic words necrobiosis lipoidica are almost always followed by the word diabeticorum, since the disorder is seen predominantly in diabetics. Readers are encouraged to view photos of necrobiosis lipoidica diabeticorum (NLD) online. Although NLD is regarded as rare, in my experience it is one of the most commonly misdiagnosed cutaneous disorders in diabetics. NLD most commonly presents as symmetrical red-to-brown discolored irregular plaque-like deposits on the lower legs. Because the etiology — aside from its association with diabetes — is unclear, it should not be surprising that treatment regimens for NLD remain under study.
There are several evidence-based treatments for NLD. Immune modulation may be a key factor, since corticosteroids (topical, intralesional, or systemic) as well as other immunomodulator (e.g., infliximab, etanercept) steroids have each had some success. The treatment with the highest rate of NLD resolution is psoralen plus ultraviolet A; unfortunately, the treatment regimen intensity (average 47 sessions) is well beyond that of many patients, and the method is not within the typical boundaries of primary care practice. Variable results have been seen among diverse categories of intervention (e.g., cyclosporine, tacrolimus, pioglitazone, hyperbaric oxygen). Refractory cases of NLD may merit consideration of dermatologic referral. Because outcomes are often less than optimal, patients should be informed that NLD is frequently a refractory dermatologic problem.
Source: Reid SD, et al. Update on necrobiosis lipoidica: A review of etiology, diagnosis, and treatment options. J Am Acad Dermatol 2013;69:783-791.
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