Clinical Images  |   April 2013
Necrobiosis Lipoidica
Author Notes
  • From The University of Vermont College of Medicine in Burlington 
  • Address correspondence to Matthew P. Gilbert, DO, MPH, Division of Endocrinology and Diabetes, The University of Vermont College of Medicine, 62 Tilley Dr, South Burlington, VT 05403-4407. E-mail:  
Article Information
Endocrinology / Imaging / Diabetes / Clinical Images
Clinical Images   |   April 2013
Necrobiosis Lipoidica
The Journal of the American Osteopathic Association, April 2013, Vol. 113, 363. doi:
The Journal of the American Osteopathic Association, April 2013, Vol. 113, 363. doi:
A woman with type 2 diabetes mellitus (glycated hemoglobin, 8%) presented with a skin plaque on her right foot. Examination revealed a single waxy, yellow, atrophic, ill-defined plaque overlaid with telangiectatic vessels (pictured). Necrobiosis lipoidica (NL) was diagnosed. The patient's lesion continues to be monitored, and detailed integument examinations are performed on a regular basis. No additional lesions have been found; the existing lesion is clinically stable and does not cause any discomfort. 
An uncommon chronic granulomatous dermatitis, NL has a strong association with diabetes mellitus.1 Early lesions typically appear as slowly enlarging reddish-brown to yellow sclerodermiform plaques with telangiectatic vessels overlying the surface; however, ulceration may occur in as many as 25% to 35% of cases.2 Although NL is found in less than 1% of patients with diabetes, 75% of individuals with NL have or will develop diabetes mellitus.3 There is no proven treatment, but topical or intradermal corticosteroids, topical 0.005% psoralen with ultraviolet-A irradiation, topical 0.1% tacrolimus, and subcutaneous tumor necrosis factor inhibitors have shown promise in selected cases.1,2 Although the presence of NL does not correlate with blood glucose levels, it should prompt further evaluation for diabetes mellitus.3 
   Financial Disclosures: None reported.
Roy S, Shayaan M. Unsightly rash on shin: necrobiosis lipoidica diabeticorum. J Fam Pract. 2012;61(4):215-217. [PubMed]
Suárez-Amor O, Pérez-Bustillo A, Ruiz-González I, Rodriguez-Prieto MA. Necrobiosis lipoidica therapy with biologicals: an ulcerated case responding to etanercept and a review of the literature. Dermatology. 2010;221(2):117-121. doi:10.1159/000314694. [PubMed]
O'Reilly K, Chu J, Meehan S, Heller P, Ashinoff R, Gruson L. Necrobiosis lipoidica. Dermatol Online J. 2011;17(10):18. [PubMed]