Table of ContentsView AllTable of ContentsNecrobiosis Lipoidica Diabeticorum RashNecrobiosis Lipoidica Without DiabetesHow to Manage Chronic Necrobiosis Lipoidica
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Table of Contents
Necrobiosis Lipoidica Diabeticorum Rash
Necrobiosis Lipoidica Without Diabetes
How to Manage Chronic Necrobiosis Lipoidica
Necrobiosis lipoidicais a rare skin ailment that often begins on the lower legs and shins. Though many of those affected havetype 1ortype 2 diabetes, the rash can also occur in people without diabetes. It is also linked with many other systemic (whole-body) diseases.
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Necrobiosis lipoidica diabeticorumrash occurs in people with type 1 or type 2 diabetes. Though this rash is linked to diabetes, it is unrelated to the control ofblood glucose.
Reason It Happens
The reason that necrobiosis lipoidica diabeticorum rash happens is not well understood. Theories center oninflammationand other changes that affect blood vessels associated withautoimmune diseases(conditions in which your body attacks its own cells) such as diabetes or antibody-mediatedvasculitis(inflamed blood vessels). These factors can deterioratecollagenproteins in your skin.
Your risk of developing necrobiosis lipoidica increases if you have any of the following characteristics:
The Effects of Diabetes on Skin
Identifying Symptoms
Symptoms of necrobiosis lipoidica diabeticorum rash can vary during the disease and among different people. They can include:
Diabetic Dermopathy: Pictures, Symptoms, Treatment
Necrobiosis Lipoidica Treatment and Effectiveness
Because necrobiosis lipoidica is rare and its causes are not fully understood, no conclusive treatment regimens exist for this condition. Treatment plans are individualized and can involve several modalities before results are achieved. The condition is a long-term disease that can heal and recur.
Treatment is individualized and may require modifications as the disease progresses. Common treatments for necrobiosis lipoidica include:
Corticosteroids
Corticosteroidsadministered as topical, intralesional, and sometimes systemic, are considered a first-line treatment for the rash. In one multicenter study, researchers reported that topical corticosteroids had a positive effect in 40% of cases treated.
However, topical corticosteroids can delay wound healing and aggravate some skin infections, especially atrophied lesions. Prolonged use can exacerbatehypertension(high blood pressure) andhyperglycemia(high blood sugar), which can complicate disease control in people with diabetes. Therefore, the use of systemic corticosteroids in people with diabetes and necrobiosis lipoidica is controversial.
There is a wide range of second-line treatments for necrobiosis lipoidica, but there is no definitive evidence that supports one therapy over others. In an analysis of 16 treatment regimens in 49 publications, researchers concluded that there is no clear recommendation for a specific second-line therapy when corticosteroids fail. Some notable treatment options include:
Calcineurin Inhibitors
Research indicates thatcalcineurininhibitors, specificallytacrolimusointment, are more effective than topical corticosteroids. Results of one study showed that tacrolimus was effective in 61.5% of cases, yielding better results than corticosteroids without the risk of skin atrophy inherent in corticosteroids. Tacrolimus is also effective in treatingulcersthat occur with the condition.
Fumaric Acid Esters
Results from a prospective, uncontrolled study of 18 people with necrobiosis lipoidica showed that the administration of fumaric acid esters over six months yielded significant clinical improvement. Though the results were notable, moderate side effects including gastrointestinal upset andflushingoccurred.
Photodynamic Therapy
Treatment withphotodynamic therapyhas been successful as a second-line treatment for necrobiosis lipoidica in some cases. Researchers have reported complete responses in up to 66% of people treated with photodynamic therapy, and partial responses in 39% to 90% of cases treated.
Other Drugs
Other drugs reported to have varying worthwhile impact on the disease include the following:
Newer Treatments
Risks/Complications of Necrobiois LipoidicaThe main risks and complications reported in necrobiosis lipoidica involve:Development ofmalignancy, typically in the form ofsquamous cell carcinoma, in the lesionSecondary infection or painful ulceration in the wound bed, often a result of trauma to the siteUnsightly scarring at the site, which can create a cosmetic disability
Risks/Complications of Necrobiois Lipoidica
The main risks and complications reported in necrobiosis lipoidica involve:Development ofmalignancy, typically in the form ofsquamous cell carcinoma, in the lesionSecondary infection or painful ulceration in the wound bed, often a result of trauma to the siteUnsightly scarring at the site, which can create a cosmetic disability
The main risks and complications reported in necrobiosis lipoidica involve:
The onset of necrobiosis lipoidica is not limited to people with diabetes. This skin condition has been linked with other diseases, though the absence of diabetes does not seem to have a significant impact on many aspects of the disease.
Reasons It Happens
Among people who have necrobiosis lipoidica, research indicates that the lesions in people with and without diabetes share many clinical features. This association suggests that factors other than elevated blood glucose may contribute to the disease’s onset.
Though necrobiosis lipoidica has been linked with diabetes, it is also associated with systemic conditions that include the following, though the reason for the link is unclear:
In a study comparing the experiences of people with diabetes and those without it, necrobiosis lipoidica occurred at a younger age and among more females in people with diabetes versus those without diabetes.
Research indicates that symptoms of necrobiosis lipoidica do not seem to have notable variation between people with or without diabetes. However, there is some evidence that ulceration, a risk that occurs in up to 35% of all cases of necrobiosis lipoidica, happens more often in affected people with diabetes.
Healing Time
Though treatments remain the same regardless of whether diabetes is present or not, people without diabetes do not have the burden of considering the impact on disease control. Because hyperglycemia is a side effect of systemic corticosteroids, people without diabetes may be able to continue this type of first-line treatment without controversy.
Necrobiosis lipoidica is a chronic, incurable disease in which lesions do not heal well. Plaque patches can take years to heal. Recurrence is possible. Even with prompt and appropriate treatment, scarring and discoloration are likely. When possible, the appearance of affected skin can take a long time to appear normal.
Getting a Foot Ulcer to Heal
Necrobiosis lipoidica is a long-term disease. Generally, treatment goals are to reduce symptoms and decrease the risk of ulceration. The risk of ulceration is more likely with late diagnosis and delayed treatment.
Lifestyle adjustments can complement medical treatments to manage chronic necrobiosis lipoidica. Common advised lifestyle modifications include the cessation of smoking and the avoidance of trauma in the affected area.
Adherence to appropriate wound care guidelines is crucial in cases in which ulcerations are evident. Understanding symptoms and ways to reduce the risk of infection is vital. If you have been diagnosed with necrobiosis lioidica, notify your healthcare provider about signs of infection, a lump, an ulcer, or a persistent scab as soon as possible.
Diabetic Ulcer: Improving Healing Success for Feet and Legs
Summary
Necrobiosis lipoidica is a chronic skin disease often linked with diabetes. It can also occur in healthy people or those with other systemic health problems such as thyroid disease.
Necrobiosis lipoidica causes lesions that form patches on your lower legs or shins. Concerns include ulceration, scarring, and sometimes, cancer. Treatment is individualized because there is little knowledge of how the disease occurs. Though researchers have reported good outcomes with many types of treatments, few large studies exist to confirm their results.
If you have been diagnosed with diabetes, contact your healthcare provider if you notice lesions on your lower shins or other signs of this disease. Early diagnosis and treatment can improve outcomes and reduce your risk of an ulcer, which can be a painful and severe complication.
13 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Sibbald C, Reid S, Alavi A.Necrobiosis lipoidica.Dermatol Clin. 2015 Jul;33(3):343-60. doi:10.1016/j.det.2015.03.003Ionescu C, Petca A, Dumitrașcu MC, et al.The intersection of dermatological dilemmas and endocrinological complexities: understanding necrobiosis lipoidica—a comprehensive review.Biomedicines. 2024 Feb 1;12(2):337. doi:10.3390/biomedicines12020337Marcoval J, Gómez-Armayones S, Valentí-Medina F, et al.Necrobiosis lipoidica: a descriptive study of 35 cases.Actas Dermosifiliogr. 2015;106(5):402-407. doi:10.1016/j.adengl.2015.04.008Genetic and Rare Diseases Information Center.Necrobiosis lipoidica.American Osteopathic College of Dermatology.Necrobiosis lipoidica diabeticorum.University of California San Francisco.Necrobiosis lipoidica diabeticorum.Naumowicz M, Modzelewski S, Macko A, et al.A breakthrough in the treatment of necrobiosis lipoidica? Update on treatment, etiopathogenesis, diagnosis, and clinical presentation.Int J Mol Sci. 2024 Mar 20;25(6):3482. doi:10.3390/ijms25063482Verheyden MJ, Rodrigo N, Gill AJ, Glastras SJ.A case series and literature review of necrobiosis lipoidica.Endocrinology, Diabetes & Metabolism Case Reports. 2022;2022(1). doi:10.1530/EDM-21-0185Bernia E, Llombart B, Bancalari B, et al.Photodynamic therapy for necrobiosis lipoidica: successful treatment in a series of 4 cases.Actas Dermosifiliogr. 2020;111(7):605-608. doi:10.1016/j.adengl.2020.08.012Welsh Wound Innovation Centre.Understanding necrobiosis lipoidica diabeticorum.Hashemi DA, Brown-Joel ZO, Tkachenko E, et al.Clinical features and comorbidities of patients with necrobiosis lipoidica with or without diabetes.JAMA Dermatol.2019;155(4):455–459. doi:10.1001/jamadermatol.2018.5635George SMC, Walton S.Necrobiosis lipoidica.British Journal of Diabetes. 2016;16(1):6-9. doi:10.15277/bjdvd.2015.043The Australasian College of Dermatologists.Necrobiosis lipoidica.
13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Sibbald C, Reid S, Alavi A.Necrobiosis lipoidica.Dermatol Clin. 2015 Jul;33(3):343-60. doi:10.1016/j.det.2015.03.003Ionescu C, Petca A, Dumitrașcu MC, et al.The intersection of dermatological dilemmas and endocrinological complexities: understanding necrobiosis lipoidica—a comprehensive review.Biomedicines. 2024 Feb 1;12(2):337. doi:10.3390/biomedicines12020337Marcoval J, Gómez-Armayones S, Valentí-Medina F, et al.Necrobiosis lipoidica: a descriptive study of 35 cases.Actas Dermosifiliogr. 2015;106(5):402-407. doi:10.1016/j.adengl.2015.04.008Genetic and Rare Diseases Information Center.Necrobiosis lipoidica.American Osteopathic College of Dermatology.Necrobiosis lipoidica diabeticorum.University of California San Francisco.Necrobiosis lipoidica diabeticorum.Naumowicz M, Modzelewski S, Macko A, et al.A breakthrough in the treatment of necrobiosis lipoidica? Update on treatment, etiopathogenesis, diagnosis, and clinical presentation.Int J Mol Sci. 2024 Mar 20;25(6):3482. doi:10.3390/ijms25063482Verheyden MJ, Rodrigo N, Gill AJ, Glastras SJ.A case series and literature review of necrobiosis lipoidica.Endocrinology, Diabetes & Metabolism Case Reports. 2022;2022(1). doi:10.1530/EDM-21-0185Bernia E, Llombart B, Bancalari B, et al.Photodynamic therapy for necrobiosis lipoidica: successful treatment in a series of 4 cases.Actas Dermosifiliogr. 2020;111(7):605-608. doi:10.1016/j.adengl.2020.08.012Welsh Wound Innovation Centre.Understanding necrobiosis lipoidica diabeticorum.Hashemi DA, Brown-Joel ZO, Tkachenko E, et al.Clinical features and comorbidities of patients with necrobiosis lipoidica with or without diabetes.JAMA Dermatol.2019;155(4):455–459. doi:10.1001/jamadermatol.2018.5635George SMC, Walton S.Necrobiosis lipoidica.British Journal of Diabetes. 2016;16(1):6-9. doi:10.15277/bjdvd.2015.043The Australasian College of Dermatologists.Necrobiosis lipoidica.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Sibbald C, Reid S, Alavi A.Necrobiosis lipoidica.Dermatol Clin. 2015 Jul;33(3):343-60. doi:10.1016/j.det.2015.03.003Ionescu C, Petca A, Dumitrașcu MC, et al.The intersection of dermatological dilemmas and endocrinological complexities: understanding necrobiosis lipoidica—a comprehensive review.Biomedicines. 2024 Feb 1;12(2):337. doi:10.3390/biomedicines12020337Marcoval J, Gómez-Armayones S, Valentí-Medina F, et al.Necrobiosis lipoidica: a descriptive study of 35 cases.Actas Dermosifiliogr. 2015;106(5):402-407. doi:10.1016/j.adengl.2015.04.008Genetic and Rare Diseases Information Center.Necrobiosis lipoidica.American Osteopathic College of Dermatology.Necrobiosis lipoidica diabeticorum.University of California San Francisco.Necrobiosis lipoidica diabeticorum.Naumowicz M, Modzelewski S, Macko A, et al.A breakthrough in the treatment of necrobiosis lipoidica? Update on treatment, etiopathogenesis, diagnosis, and clinical presentation.Int J Mol Sci. 2024 Mar 20;25(6):3482. doi:10.3390/ijms25063482Verheyden MJ, Rodrigo N, Gill AJ, Glastras SJ.A case series and literature review of necrobiosis lipoidica.Endocrinology, Diabetes & Metabolism Case Reports. 2022;2022(1). doi:10.1530/EDM-21-0185Bernia E, Llombart B, Bancalari B, et al.Photodynamic therapy for necrobiosis lipoidica: successful treatment in a series of 4 cases.Actas Dermosifiliogr. 2020;111(7):605-608. doi:10.1016/j.adengl.2020.08.012Welsh Wound Innovation Centre.Understanding necrobiosis lipoidica diabeticorum.Hashemi DA, Brown-Joel ZO, Tkachenko E, et al.Clinical features and comorbidities of patients with necrobiosis lipoidica with or without diabetes.JAMA Dermatol.2019;155(4):455–459. doi:10.1001/jamadermatol.2018.5635George SMC, Walton S.Necrobiosis lipoidica.British Journal of Diabetes. 2016;16(1):6-9. doi:10.15277/bjdvd.2015.043The Australasian College of Dermatologists.Necrobiosis lipoidica.
Sibbald C, Reid S, Alavi A.Necrobiosis lipoidica.Dermatol Clin. 2015 Jul;33(3):343-60. doi:10.1016/j.det.2015.03.003
Ionescu C, Petca A, Dumitrașcu MC, et al.The intersection of dermatological dilemmas and endocrinological complexities: understanding necrobiosis lipoidica—a comprehensive review.Biomedicines. 2024 Feb 1;12(2):337. doi:10.3390/biomedicines12020337
Marcoval J, Gómez-Armayones S, Valentí-Medina F, et al.Necrobiosis lipoidica: a descriptive study of 35 cases.Actas Dermosifiliogr. 2015;106(5):402-407. doi:10.1016/j.adengl.2015.04.008
Genetic and Rare Diseases Information Center.Necrobiosis lipoidica.
American Osteopathic College of Dermatology.Necrobiosis lipoidica diabeticorum.
University of California San Francisco.Necrobiosis lipoidica diabeticorum.
Naumowicz M, Modzelewski S, Macko A, et al.A breakthrough in the treatment of necrobiosis lipoidica? Update on treatment, etiopathogenesis, diagnosis, and clinical presentation.Int J Mol Sci. 2024 Mar 20;25(6):3482. doi:10.3390/ijms25063482
Verheyden MJ, Rodrigo N, Gill AJ, Glastras SJ.A case series and literature review of necrobiosis lipoidica.Endocrinology, Diabetes & Metabolism Case Reports. 2022;2022(1). doi:10.1530/EDM-21-0185
Bernia E, Llombart B, Bancalari B, et al.Photodynamic therapy for necrobiosis lipoidica: successful treatment in a series of 4 cases.Actas Dermosifiliogr. 2020;111(7):605-608. doi:10.1016/j.adengl.2020.08.012
Welsh Wound Innovation Centre.Understanding necrobiosis lipoidica diabeticorum.
Hashemi DA, Brown-Joel ZO, Tkachenko E, et al.Clinical features and comorbidities of patients with necrobiosis lipoidica with or without diabetes.JAMA Dermatol.2019;155(4):455–459. doi:10.1001/jamadermatol.2018.5635
George SMC, Walton S.Necrobiosis lipoidica.British Journal of Diabetes. 2016;16(1):6-9. doi:10.15277/bjdvd.2015.043
The Australasian College of Dermatologists.Necrobiosis lipoidica.
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