Atypical Necrobiosis Lipoidica in a Non-Diabetic Patient: A Case Report

Necrobiosis lipoidica (NL) is a rare granulomatous skin disorder commonly associated with diabetes but may also occur in non-diabetic individuals. We present the case of a 52-year-old non-diabetic woman with NL, highlighting the rarity of its presentation and the importance of considering alternative etiologies such as autoimmune disorders and thyroid abnormalities. Clinically, NL manifests as erythematous papules merging into plaques with central atrophy, predominantly affecting the lower limbs. Diagnosis is confirmed through dermoscopy and histopathology, revealing characteristic features such as granulomatous inflammation and necrobiotic collagen. Therapeutically, there are no standardized guidelines for NL management due to its low prevalence. Topical glucocorticoids are commonly used but carry risks of skin atrophy and other adverse effects. Calcineurin inhibitors, such as tacrolimus, offer a safer alternative, especially in atrophic lesions. Biological therapies, including TNF-α inhibitors and Janus kinase inhibitors, have shown promise in severe cases. Despite various treatment options, strict glycemic control does not appear to prevent NL development or progression, and spontaneous resolution occurs in about 19% of diabetic cases after an average of 12 years. This case emphasizes the importance of a comprehensive evaluation in NL diagnosis and highlights the potential of alternative therapies for refractory cases.