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Correspondence |

Tuberous Necrobiosis Lipoidica

Brent D. Michaels, JD; Kimberly A. Mullinax, MD; Michael J. Wells, MD; Cloyce L. Stetson, MD
Arch Dermatol. 2007;143(4):543-551. doi:10.1001/archderm.143.4.546-b.
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Necrobiosis lipoidica (NL) is a cutaneous disorder that commonly presents bilaterally on the shins as well-circumscribed atrophic yellow-orange patches. Histologically, palisading granulomatous infiltrates oriented parallel to the epidermis are noted.1 When associated with diabetes mellitus (DM), it is referred to as necrobiosis lipoidica diabeticorum. More atypical presentations of plaques, papules, nodules, ulcerations, crusting, scarring, hyperpigmentation, and hemorrhage have been reported.2,3 Histologically, less common findings include cholesterol clefts, foamy macrophages, and hemosiderin deposition. Gibson et al4 and De la Torre et al5 found cholesterol clefts in 3 NL cases of 331 reviewed. Two of the 3 patients had elevated serum cholesterol levels, and all 3 had severe DM.

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Figure 1.

A coalescence of nodules noted within the left lateral ankle plaque, which slowly continued to grow more nodular and verrucous over years. A, Pretibial atrophic erythematous patches with superimposed yellow nodules. B, More tightly grouped coalescence of tuberous nodules.

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Figure 2.

Hematoxylin-eosinstained specimens of granulomatous inflammation. A, Dermal cakelike layers (original magnification ×200). B, Closer view of multinucleated giant cell without atypia (original magnification ×500).

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Figure 3.

Palisading granulomas with prominent extracellular cholesterol deposition. In the superficial portion, there is a linear (horizontal) arrangement of the palisading granulomas (hematoxylin-eosin, original magnification ×20).

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