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Necrobiosis lipoidica
See also in: Cellulitis DDx
Other Resources UpToDate PubMed

Necrobiosis lipoidica

See also in: Cellulitis DDx
Contributors: Vivian Wong MD, PhD, Gil Weintraub MD, Belinda Tan MD, PhD, Susan Burgin MD
Other Resources UpToDate PubMed


Necrobiosis lipoidica (NL) is a rare, chronic granulomatous disease characterized by indolent atrophic plaques typically located on the lower extremities.

While the majority of NL cases are found in patients with diabetes (studies range from 11%-65% of cases), the incidence of NL in diabetic patients is low, only 0.3%-1.2%. NL is also associated with sarcoidosis, inflammatory bowel disease, autoimmune thyroiditis, monoclonal gammopathies, and it has even been described in otherwise healthy patients. Importantly, NL may be the first sign of diabetes in a patient with no previous diagnosis. NL typically presents in the third decade of life and later in patients without diabetes. There are documented cases of pediatric onset as well. It is 3 times more common in women than in men and has no known racial predilection.

The exact etiology of NL remains unclear, but microangiopathy due to glycoprotein deposition, immunoglobulin deposition, and abnormal collagen production have all been linked.

NL typically presents unilaterally or bilaterally on the pretibial surface of the lower extremities as well-demarcated yellow, red, or brown atrophic plaques with prominent telangiectasias and an elevated violaceous rim. Atypical cases of NL have been reported on the face, trunk, upper extremities, and penis. The lesions predictably enlarge slowly over the course of months to years without intervention. The lesions may begin as asymptomatic papules, but as they progress, patients often report pruritus, dysesthesia, or pain. NL may koebnerize, ulcerate, or be exacerbated by trauma.

Malignant transformation has rarely been reported, most commonly to cutaneous squamous cell carcinoma, but basal cell carcinoma and malignant melanoma have also been reported within NL.


E13.620 – Other specified diabetes mellitus with diabetic dermatitis

9418005 – Necrobiosis lipoidica

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Differential Diagnosis & Pitfalls

  • Majocchi granuloma
  • Pretibial myxedema
  • Granuloma annulare
  • Sarcoidosis
  • Xanthomas (eg, Tuberous xanthoma, Plane xanthomas)
  • Diabetic dermopathy
  • Chronic Stasis dermatitis
  • Necrobiotic xanthogranuloma
  • Pyoderma gangrenosum
  • Calciphylaxis
  • Vasculitis
  • Panniculitis, including Erythema nodosum
  • Morphea
  • Lichen sclerosus
  • Lipodermatosclerosis
  • Leprosy

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Last Reviewed:06/14/2022
Last Updated:06/26/2022
Copyright © 2024 VisualDx®. All rights reserved.
Necrobiosis lipoidica
See also in: Cellulitis DDx
A medical illustration showing key findings of Necrobiosis lipoidica : Erythema, Orange color, Skin ulcer, Smooth plaque, Yellow color, Anterior lower leg
Clinical image of Necrobiosis lipoidica - imageId=48123. Click to open in gallery.  caption: 'An erythematous, shiny plaque with central scarring and erosion on the shin.'
An erythematous, shiny plaque with central scarring and erosion on the shin.
Copyright © 2024 VisualDx®. All rights reserved.