Necrobiosis Lipoidica - Diagnosis

Diagnosis

NL is diagnosed by a skin biopsy, demonstrating superficial and deep perivascular and interstitial mixed inflammatory cell infiltrate (including lymphocytes, plasma cells, mononucleated and multinucleated histiocytes, and eosinophils) in the dermis and subcutis, as well as necrotising vasculitis with adjacent necrobiosis and necrosis of adnexal structures. Areas of necrobiosis are often more extensive and less well defined than in granuloma annulare. Presence of lipid in necrobiotic areas may be demonstrated by Sudan stains. Cholesterol clefts, fibrin, and mucin may also be present in areas of necrobiosis. Depending on the severity of the necrobiosis, certain cell types may be more predominant. When a lesion is in its early stages, neutrophils may be present, whereas in later stages of development lymphocytes and histiocytes may be more predominant.

There is no clearly defined cure for necrobiosis. Although there are some techniques that can be used to diminish the signs of necrobiosis such as a steroid cream or injection into the affected area, this process may be effective for only a small amount of those treated. Steroid cream has been known to cause thinning of the skin, so if used, it is best to wrap the area with some form of plastic wrap or cloth. Even then, this process can take long periods of time.