Een perioculaire vorm van necrobiosis lipoidica

Abstract

A periocular form of necrobiosis lipoidica Necrobiosis lipoidica (NL) is an uncommon granulomatous skin disease of unknown origin. It is more often seen in patients with diabetes mellitus. Other cases describe an association with conditions like autoimmune thyroid disease, inflammatory bowel disease, sarcoidosis and rheumatoid arthritis. The skin lesions usually appear on the legs of the patient. Rarely, the disease presents in the face and/or scalp, in this case it is called “facial necrobiosis lipoidica” (FNL). When one or multiple annular, non-scaly plaques are observed in the face and/or scalp, it is important to think about FNL. The lesions are usually yellowish in the centre with areas of depigmentation and/or atrophy of the skin. In the periphery, the colour might be brown-red and sometimes an elevated border can be observed. FNL may look like another skin disease called “necrobiotic xanthogranuloma”. For this reason, histology is crucial for a correct diagnosis. It is important to exclude underlying diabetes mellitus. Necrobiotic xanthogranuloma is frequently associated with paraproteinemia. Therefore, this condition has to be ruled out by means of a blood analysis. There are no guidelines available for the treatment of FNL, but topical tacrolimus 0,1% might be an effective therapy for these patients.