Last updated: June 2024
What is necrobiosis lipoidica?
Necrobiosis lipoidica is a rare skin condition which typically affects the lower legs, but can affect other parts of the body. It is characterized by shiny red-yellow plaques which usually enlarge and persist for years.
Who gets necrobiosis lipoidica?
Necrobiosis is three times more common in women than in men. 1 It affects all races and can occur at any age, although most commonly occurring in young adults and those of middle age.
What causes necrobiosis lipoidica?
The cause of necrobiosis lipoidica is not yet completely understood. It is often seen in individuals diagnosed with diabetes mellitus.
Individuals that develop this skin condition who are not known to be diabetic at the time, often develop diabetes in the future. It is thought to occur due to damage to the skin as well as changes in the small blood vessels of the skin, caused by excess sugar.
What does necrobiosis lipoidica look like?
Necrobiosis lipoidica typically starts as small, red, raised areas on one or both lower legs. Similar spots may develop on other parts of the body.
These spots tend to grow slowly over several months and may join up to form large, flat and irregularly shaped lesions. These larger lesions usually have a well-defined red border with a shiny yellow centre. The skin in the centre is typically very thin with visible blood vessels. These plaques may persist for many years.
How is necrobiosis lipoidica diagnosed?
A skin biopsy may be needed to confirm the diagnosis. As the presence of necrobiosis lipoidica can usually indicate an underlying disease process, other tests looking for diseases such as diabetes or insulin resistance may also be performed.
How is necrobiosis lipoidica treated?
Treatment options will vary depending on the individual and their needs.
Necrobiosis lipoidica does not always require treatment, especially if the individual is not bothered by it cosmetically and it is not painful or ulcerated. However, if that is not the case, treatment is best started in the early stages of this condition before scarring has developed.
Topical or injected corticosteroids are often used as the first line of treatment. If this fails other therapies may include:
- Topical tacrolimus
- Pentoxyfylline
- Phototherapy
What is the likely outcome of necrobiosis lipoidica?
Necrobiosis lipoidica is typically a chronic condition with variable progression and scarring.
In rare cases, the lesion may heal on its own. However, the skin overlying the lesion will be thinner and have permanent pigmentary changes.
- Erfurt-Berge C, Seitz A-T, Rehse C, Wollina U, Schwede K, Renner R. Update on clinical and laboratory features in necrobiosis lipoidica: A retrospective multicentre study of 52 patients. Eur J Dermatol. 2012;22(6):770–5. doi:10.1684/ejd.2012.1839
- Peckruhn, M., Tittelbach, J. and Elsner, P. (2017), Update: Treatment of necrobiosis lipoidica. JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 15: 151-157. https://doi.org/10.1111/ddg.13186
| A/Prof Deshan Sebaratnam and Grace Li | June 2024 |
| A/Prof Deshan Sebaratnam and Dr Xin Lin Wong | December 2018 |