Skin-nontumor / Clinical dermatology
Other dermatoses
Necrobiosis lipoidica

Author: Mowafak Hamodat, M.D., MB.CH.B, MSc., FRCPC (see Authors page)

Revised: 18 July 2016, last major update August 2011

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PubMed Search: Necrobiosis lipoidica

Cite this page: Necrobiosis lipoidica. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/skinnontumornecrobiosislipoidica.html. Accessed December 5th, 2016.
Definition / General
  • Atrophic, yellow depressed plaques, usually on legs of diabetic patients
Clinical Features
  • Also associated with hypo- and hyperthyroidism, inflammatory bowel disease and vasculitis
  • Atrophic, yellow depressed plaques, telangiectasia, and active inflammatory edge
  • Chronic lesions may show ulceration and crusting
  • Solitary or multiple, often symmetrical in lower extremities in pretibial area
  • Involvement of penis with a lesion resembling chronic balanitis has been described
  • Rarely, squamous cell carcinoma may arise in chronic lesions
Clinical Images

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Necrobiosis lipoidica diabeticorum

Micro Description
  • Epidermal changes may be inconspicuous or absent; variable acanthosis, atrophy or hyperkeratosis
  • Palisading, necrobiotic granuloma consist of a large confluent area of necrobiosis centered in the superficial dermis and subcutaneous fat
  • Usually epithelioid histiocytes, giant cells and sometimes a well formed granuloma
  • Eosinophilic, swollen or degenerate collagen appears hyalinised with surrounding infiltrate of lymphocytes and histiocytes
  • Linear infiltrate of histiocytes between collagen bundles; occasionally lipomemebranous fat necrosis
  • Blood vessel wall thickening with intimal proliferation and narrowing of the lumen; also mild to moderate perivascular lymphocytic infiltrate
  • Plasma cells are almost always present
  • Cholesterol clefts are rare
  • Loss of elastic tissue
Micro Images

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Necrobiosis lipoidica

Negative Stains
Differential Diagnosis
  • Granuloma annulare: mucin+, lysozyme+, and no association with diabetes
  • Necrobiotic xanthogranuloma: head and neck of patients with paraproteinemia, not associated with diabetes
Additional References