Disclosures: Gary B. Allen: No financial relationships or conflicts of interest

Case Diagnosis: Necrobiosis Lipodica

Case Description or Program Description: A 66-year-old female with a history of necrobiosis lipodica (NL), type 2 diabetes mellitus, and coronary artery disease presented three weeks after noting two severely painful wounds on her left anterior leg after sand hit the area while mowing grass. She found no relief with soaking, topical lidocaine, occlusive petroleum dressing, or a ten-day course of clindamycin.

Setting: Ambulatory Wound Clinic

Assessment/Results: Examination found chronic red-brown skin changes on the anterior legs bilaterally. Significantly tender ulcerations were present on the left anterior distal leg and left anterior proximal leg with moderate serosanguinous drainage. Treatment began with debridement bimonthly, clobetasol 0.5% twice daily, and doxycycline 100 mg twice daily for ten days. After three weeks, she discontinued clobetasol due to pain and increasing wound size, and she began applying a calcium alginate dressing with leptospermum honey daily. After two months, she noted significant pain reduction with improved granulation tissue formation and improvement in the size of the wounds.

Discussion (relevance): NL is a rare condition characterized by chronic granulomatous inflammation with collagen degeneration. NL has been associated with diabetes historically, however the incidence among patients with diabetes ranges from only 0.3 to 1.2%. Patients typically present in their fourth decade with yellow-brown plaques on the anterior legs that have well-demarcated, violaceus borders. Definitive diagnosis is via biopsy. Initial treatment options for NL without ulcers include topical high-potency steroid or topical tacrolimus, though limited high-quality evidence exists. For ulcerated lesions, the first-line therapy is regular wound care. Our patient presented with a combination of ulcerated and non-ulcerated lesions and displayed improvement with regular wound care with calcium alginate dressing and leptospermum honey along with regular debridement.

Conclusions: Regular wound care with serial debridement and calcium alginate dressing with leptospermum honey was effective at improving symptoms and granulation tissue formation in a patient with NL.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/conservative-management-of-necrobiosis-lipodica-ulcers-a-case-report/