DermNet NZ

Facts about the skin from DermNet New Zealand Trust. Topic index: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Necrobiosis lipoidica

What is necrobiosis lipoidica?

Necrobiosis lipoidica is a rare granulomatous skin disorder which can affect the shin of insulin dependent diabetics, although it may occur in non-diabetic subjects as well. The cause is unknown.

Clinical features of necrobiosis lipoidica

Typically in necrobiosis lipoidica, one or more tender yellowish brown patches develop slowly on the lower legs over several months. They may persist for years. They may be round, oval or an irregular shape. The centre of the patch becomes shiny, pale, thinned, with prominent blood vessels (telangiectasia). A minor injury to an established patch can cause it to ulcerate. This is often painless, but is at risk of secondary bacterial infection and delayed healing.

Necrobiosis lipoidica Necrobiosis lipoidica Necrobiosis lipoidica
Necrobiosis lipoidica

How is the diagnosis of necrobiosis lipoidica made?

The diagnosis of necrobiosis lipoidica may be made clinically. Skin biopsy may be performed to confirm the diagnosis. The histopathology is characteristic; it shows an granulomatous inflammatory reaction around destroyed collagen. This is known as necrobiosis or collagenolyis. It can however be difficult to distinguish from granuloma annulare and rheumatoid nodules.

What is the treatment for necrobiosis lipoidica?

Not all cases require treatment. The following are sometimes effective:

Ulcerating necrobiosis lipoidica may require aggressive treatment.

Related information

On DermNet NZ:

Other websites:

Books about skin diseases:

See the DermNet NZ bookstore

DermNet NZ does not provide an online consultation service.
If you have any concerns with your skin or its treatment, see a dermatologist for advice.