top of page

Necrobiosis Lipoidica 

Author: Dr Caitlin Hopkins

Chief Editor: Dr Daniel Keith

Background

Necrobiosis lipoidica is a rare, chronic condition of unknown cause that can be challenging to diagnose and often requires both clinical evaluation and pathological confirmation because of the many conditions it can resemble.

 

It typically presents as an erythematous, waxy plaque that may enlarge and coalesce to form larger yellow-brown plaques with visible telangiectasia. Lesions most commonly occur on the lower limbs, particularly over the pretibial area.

 

Most cases are seen in patients with diabetes mellitus, particularly type 1 diabetes. 

 

The condition is mostly asymptomatic, though more severe cases may cause symptoms such as pruritus, dysesthesia and severe pain, often due to complications such as ulcerated plaques. 

 

Koebner phenomenon is a recognised feature, where new lesions form as a result of trauma to the skin.

Macroscopic Appearance 

701877_1.png

Well circumscribed erythematous, atrophic plaques with some showing development of yellowing.

 

Waxy looking centrally, with an erythematous border.

 

Telangiectasia often visible

Dermoscopic Appearance

Arborising telangiectasia with yellow background. These can be linear or branching and cross over the yellow background.

 

Linear vessels with branches distributed uniformly.

 

White linear streaks may be presents - representing dermal fibrosis or scarring.

701877_3.png
701877_2.png

Key points

  • Necrobiosis lipoidica is classically seen in patients with type 1 diabetes

  • Waxy, erythematous plaques which turn into yellow-brown plaques

  • Visible telangiectasia is a common feature

  • Key Dermoscopic features are the arborising telangiectasia on a yellow background

  • Koebner phenomenon can occur

bottom of page