What is the efficacy of topical treatments for necrobiosis lipoidica?

Updated: Mar 06, 2020
  • Author: Cheryl J Barnes, MD; Chief Editor: George T Griffing, MD  more...
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Answer

A study by Ginocchio et al also indicated that topical tacrolimus is effective, as demonstrated in the case of a nondiabetic woman aged 55 years with refractory ulcerated necrobiosis lipoidica. In the report, the ulcerations improved significantly after treatment, a 10-month therapy involving daily application of 0.1% tacrolimus ointment and multilayer compression wraps. [17]

Spencei and Nahass described a case of ulcerated necrobiosis lipoidica that was treated successfully with topically applied bovine collagen. [18] Collagen is believed to improve granulation tissue by supporting fibroblast activity and by promoting wound debridement by increasing the number of macrophages and neutrophils at the wound site.

De Rie et al reported successful treatment of necrobiosis lipoidica with topical psoralen plus ultraviolet-A (UVA) light therapy. [19] Thirty patients were treated with twice-weekly courses of topical psoralen plus UVA light therapy. Five patients had complete clearing of their ulceration and erythema, and 11 patients showed significant improvement in their disease. UVA-1 and photodynamic therapy have been reported to be as successful. [20, 21]

Ticlopidine, [22] nicotinamide, [23] clofazimine, [24, 25] and perilesional heparin injections [26] have been used in uncontrolled studies and appeared to benefit some patients with necrobiosis lipoidica.

According to W.R. Heymann, tretinoin has been used to diminish the atrophy associated with necrobiosis lipoidica (personal communication). [27]

Durupt et al reported successful treatment of necrobiosis lipoidica with chloroquine and hydroxychloroquine. Improvement was seen within 3- 6 months of treatment. [28]


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