Abstract
REPORT OF A CASE A 46-year-old man presented with a several-year history of an eruption involving the anterior right lower leg. Several variably sized ulcers subsequently developed at different sites within the lesion. A biopsy specimen showed a palisading, granulomatous dermatitis throughout the dermis consistent with necrobiosis lipoidica diabeticorum. The patient was otherwise healthy and his blood glucose level was normal. Several different methods had been used to treat the ulcers, including therapy with potent topical steroids, intralesional steroids, hydrocolloid occlusive dressings, pentoxifylline, and silver sulfadiazine cream. The smaller ulcerations healed; however, a large ulcer was unresponsive and increased in size (Figure 1). THERAPEUTIC CHALLENGE A variety of therapeutic strategies used in the management of ulcerative necrobiosis lipoidica diabeticorum (UNLD) have failed to consistently provide satisfactory results. The large, recalcitrant ulcer in this patient progressed despite treatment with a number of traditional therapies. Our challenge was to devise a treatment
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