Necrobiosis Lipoidica Workup

  • Author: Cheryl J Barnes, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Feb 3, 2012
 

Approach Considerations

Laboratory findings are not helpful in the diagnosis of necrobiosis lipoidica. When necrobiosis lipoidica is diagnosed, some advocate checking for glucose intolerance to evaluate for the presence or absence of diabetes mellitus. Necrobiosis lipoidica has been the first sign of diabetes in some patients and a clue to possible diabetic potential in others. [#WorkupHistologicFindings] Histologic findings

Histopathologically, necrobiosis lipoidica presents with interstitial and palisaded granulomas that involve the subcutaneous tissue and dermis. At low magnification, lesions of necrobiosis lipoidica have a very characteristic appearance. The granulomas are arranged in a tierlike (layered) fashion and are admixed with areas of collagen degeneration. The granulomas are composed of histiocytes (some of them multinucleated), lymphocytes, occasional plasma cells, and eosinophils. Reduction in the number of intradermal nerves is an additional feature of necrobiosis lipoidica.

The main findings on histopathology are thickening of the blood vessel walls and endothelial cell swelling found in the middle to deep dermis, characteristics shared with diabetic microangiopathy.

Direct immunofluorescence microscopy of necrobiosis lipoidica has demonstrated immunoglobulin M (IgM), IgA, C3, and fibrinogen in the blood vessels, which cause the vascular thickening.[6] In nondiabetic patients with necrobiosis lipoidica, the vascular changes are not as prominent.

Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Cheryl J Barnes, MD  Dermatologist, McIntosh Clinic, PC

Cheryl J Barnes, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Loretta Davis, MD  Professor, Department of Internal Medicine, Division of Dermatology, Medical College of Georgia

Loretta Davis, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

David F Butler, MD Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Edward F Chan, MD Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Gregory J Raugi, MD, PhD Professor, Department of Internal Medicine, Division of Dermatology, University of Washington at Seattle; Chief, Dermatology Section, Primary and Specialty Care Service, Veterans Administration Medical Center of Seattle

Gregory J Raugi, MD, PhD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

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Typical presentation of necrobiosis lipoidica on the lower pretibial legs.
Red-brown plaque with yellow atrophic center on lower leg.
 
 
 
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