Necrobiosis lipoidica (NL) is a rare chronic inflammatory granulomatous skin disease, often associated with diabetes mellitus. We present the case of a 52-year-old Filipino female with a history of hypertension and well-controlled diabetes, who developed an ulcerated lesion on her right leg following an insect bite. Despite various self-medications and multiple treatments from different physicians, the ulcer persisted and progressed, leading to her referral for further evaluation. Histopathologic examination confirmed necrobiosis lipoidica. Initial treatment with topical corticosteroids and tacrolimus showed minimal improvement, prompting the use of punch grafting and platelet-rich plasma (PRP) injections. After six PRP sessions, the patient exhibited significant wound healing and a notable reduction in pain, leading to an improved quality of life. This case highlights the effectiveness of punch grafting and PRP injections in managing ulcerated NL, providing a novel therapeutic approach for a challenging condition.

Human ; Female ; Middle Aged: 45-64 Yrs Old ; Necrobiosis Lipoidica ; Ulcer

Necrobiosis lipoidica is a chronic granulomatous disease that has a well-known association with diabetes mellitus. It usually affects the bilateral lower legs of middle-aged women. Over time, the clinical features vary from red-brown papules to sharply demarcated yellow-brown plaque with atrophic center. Some of the lesions may become ulcerated, especially in diabetic patients. A 61-year-old Korean female with a history of diabetes, ischemic heart disease, and pancreatic cancer was referred to our clinic for evaluation of the painful papulovesicles on her left lower leg. Under the assumptive diagnosis of herpes zoster, we immediately started an antiviral agent. However, her skin lesions rapidly increased in size and in number, and progressed to the multiple ulcerations in 9 days. Histopathologic examination showed several poorly circumscribed necrobiotic granulomas in the deep dermis and subcutis levels of the skin. In addition, prominent vascular ectasia and vasculitis were observed. We diagnosed the patient as having necrobiotic lipoidica, and treated her with oral dapsone, colchicine, phentoxifylline and antiplatelets. Her leg ulcerations healed after four weeks of treatment.
Colchicine ; Dapsone ; Dermis ; Diabetes Mellitus ; Dilatation, Pathologic ; Female ; Granuloma ; Granulomatous Disease, Chronic ; Herpes Zoster ; Humans ; Leg ; Leg Ulcer ; Myocardial Ischemia ; Necrobiosis Lipoidica ; Necrobiotic Disorders ; Pancreatic Neoplasms ; Skin ; Ulcer ; Vasculitis

Necrobiosis lipoidica (NL) is a chronic granulomatous skin disease typified by indurated plaques on the shin. Although this condition is strongly associated with diabetes mellitus, its etiology and pathogenesis remains unknown. Localization of NL to the lower extremities suggests that local injury may be a contributing factor to the disease. A healthy 38-year-old man presented with localized erythematous to yellowish plaques on his right thigh that developed over several years. The lesion developed in the scar where suture had been done for laceration repair 25 years ago. A biopsy specimen showed degenerated collagen with surrounding palisading granulomas. Numerous lymphocytes and multinucleated giant cells were infiltrated throughout the reticular dermis. Plasma cells aggregation was found at the dermal subcutaneous junction.
Biopsy ; Cicatrix ; Collagen ; Dermis ; Diabetes Mellitus ; Giant Cells ; Granuloma ; Humans ; Lacerations ; Lower Extremity ; Lymphocytes ; Necrobiosis Lipoidica ; Necrobiotic Disorders ; Plasma Cells ; Skin Diseases ; Sutures ; Thigh

Necrobiosis lipoidica (NL) is a dermatologic disorder characterized by sharply demarcated yellow-brown plaques or indurated plaques with violaceous, irregular borders usually located on the pretibial region. Lesions may flatten and develop a central yellow or orange area as it becomes atrophic, often accompanied by the appearance of telangiectasias, giving it the characteristic "glazed¬porcelain" sheen. Typical histologic findings are seen at the edge of the lesions and include: variable amount of dermal fibrosis, particularly in its lower two-thirds of the dermis; and a superficial and deep perivascular inflammatory reaction. The dermal changes extend to the underlying subcutaneous septa. Although these histologic findings were first described in diabetic patients, not all patients with NL have concurrent diabetes. Treatment of NL involves the use of potent topical steroids and the prevention of the development of ulcers. This is a case of a 29-year-old female who presented with few erythematous plaques on the left anterolateral portion of the left lower extremity, histologically confirmed as NL with normal fasting blood sugar levels.

Human ; Female ; Adult ; Atrophy ; Blood Glucose ; Citrus Sinensis ; Connective Tissue Diseases ; Dermis ; Diabetes Mellitus ; Necrobiosis Lipoidica ; Skin Diseases ; Telangiectasis ; Ulcer

No abstract available.
Cyclosporine ; Necrobiosis Lipoidica ; Necrobiotic Disorders

Necrobiosis lipoidica (NL) is a chronic granulomatous skin disease of unknown etiology, which can be seen in patients with diabetes mellitus. Typical lesions of NL appear on the pretibial skin as painful yellow-brown inflammatory plaques with raised borders and atrophic centers. Ulceration occurs in approximately 35% of cases, leading to increased risk of secondary bacterial infection and scarring. Although there have been many proposed therapies for ulcerative NL, the response to treatment is often met with limited success. Here, we report a case of a 19-year-old girl with ulcerative NL, which showed improvements with oral hydroxychloroquine, an antimalarial agent.
Bacterial Infections ; Cicatrix ; Diabetes Mellitus ; Humans ; Hydroxychloroquine ; Necrobiosis Lipoidica ; Necrobiotic Disorders ; Skin ; Skin Diseases ; Ulcer ; Young Adult

A 70-year-old woman with an 8-year history of systemic sarcoidosis developed round, red-brown eruptions, with central atrophic lesions on her lower legs. The features of the biopsy specimen resembled those of necrobiosis lipoidica (NL), but although necrobiosis was present there were well-formed non-necrotizing granulomas in the dermis. The histological diagnosis was cutaneous sarcoidosis. Systemic sarcoidosis presenting with NL has rarely been reported. The histological features of cutaneous sarcoidosis sometimes mimic those of other granulomatous diseases, including NL and granuloma annulare, which are difficult to distinguish. We discuss the novel association between sarcoidosis and other granulomatous diseases.
Aged ; Biopsy ; Dermis ; Female ; Granuloma ; Granuloma Annulare ; Humans ; Hydrazines ; Leg ; Necrobiosis Lipoidica ; Necrobiotic Disorders ; Sarcoidosis

Necrobiosis lipoidica diabeticorum is a rare disease and possibly confused with another conditions such as sarcoid disease, rheumatic pimple … In its histopathological study, it must consider the histochemical methods in detecting the damage of connective fiber tissues as well as clinical signs of the disease. The gender ratio is 1/3 (male/female), the mean age of onset is 30 years old. The necrotic lipoid tissue can occur in various areas – thigh, leg, foot, hand and head skin, most commonly in the right face of the leg
diagnosis ; Necrobiosis Lipoidica ; Therapeutics

Transepidermal elimination is a mechanism whereby foreign or altered constituents can be removed from the dermis. The phenomenon of transepidermal elimination may occur as a primary process characterizing disorders such as elastosis perforans serpiginosa, reactive perforating collagenosis and chondrodermatitis nodularis chronica helicis; as well as a secondary process characterizing disorders such as granuloma annulare, necrobiosis lipoidica diabeticorum, calcinosis cutis, pseudoxanthoma elasticum, spitz nevi, pimented nevi, porokeratosis plantaris discreta and metastatic tumors. A 17-year-old man presented with a 2X2 cm sized well-circumscribed slightly erythematous plaque with some black colored papules on the left dorsum of his hand. The histopathology of the lesion indicated angiokeratoma circumscriptum with transepidermal elimination.
Adolescent ; Angiokeratoma* ; Calcinosis ; Dermis ; Granuloma Annulare ; Hand ; Humans ; Necrobiosis Lipoidica ; Nevus ; Porokeratosis ; Pseudoxanthoma Elasticum

The isomorphic response of Koebner is a well-known phenomenon commonly associated with psoriasis, but it has been also described in conjuction with a host of other disorders. However it has seldom been associated with necrobiosis lipoidica diabeticorum, a rare skin manifestation of diabetes mellicuts. In this report, we describe a 59-year-old woman who developed necrobiosis lipoidica diabeticorum on the left shin where a mosquito had bitten her 2 months ago. Four months ago, she was diagnosed as necrobiosis lipoidica diabeticorum on the right forearm and shin by biopsy and the lesions were improved with corticosteroids intralesional injection. The lesions were asymptomatic and had grown slowly. Histopathological findings showed a large palisading granulomas composed of histiocytes, epithelioid cells and areas of necrobiosis of collagen with multinucleated giant cells. Van Gieson stain showed decreased and fragmented elastic fibers and there were no deposits of mucin in the necrobiotic areas. The lesions were improved with triamcinolone acetonide intralesional injection and there was no recurrence during 4 months.
Adrenal Cortex Hormones ; Biopsy ; Collagen ; Culicidae ; Elastic Tissue ; Epithelioid Cells ; Female ; Forearm ; Giant Cells ; Granuloma ; Histiocytes ; Humans ; Injections, Intralesional ; Middle Aged ; Mucins ; Necrobiosis Lipoidica* ; Necrobiotic Disorders* ; Psoriasis ; Recurrence ; Skin Manifestations ; Triamcinolone Acetonide