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.
Michaels BD, Mullinax KA, Wells MJ, Stetson CL. Tuberous Necrobiosis Lipoidica. Arch Dermatol. 2007;143(4):543-551. doi:10.1001/archderm.143.4.546-b