In 1929, Oppenheim1 presented the case of a man with diabetes who exhibited coin-sized, firm, flat red papules with a yellowish center, distributed chiefly over the legs and sparsely on the trunk and upper extremities. Some of the older and larger lesions presented an irregular reddish-brown border and a whitish wrinkled atrophic glistening center. Histologically there were necrobiotic areas in the corium in which the elastic fibers were absent and the collagen fibers swollen. The latter were stained with sudan III, but showed no double refraction. Oppenheim believed that the metabolic disturbance of diabetes mellitus produced a transformation of the collagen and elastin into lipoid, and he named the disorder dermatitis atrophicans lipoides diabetica.
In 1932, Urbach2 presented a second case in a woman who had diabetes with similar clinical and histologic features, and gave the disorder the name of necrobiosis lipoidica diabeticorum. The lesions were chiefly below