Understanding the Zebras of Wound Care: An Overview of Atypical Wounds

Elizabeth Ansert, DPM, MBA, MA; Anthony Tickner, DPM, FACCWS, FAPWCA, FAPWH; Donald Cohen, DPM; Weldon Murry, DPM; Samuel Gorelik, DPM


Wounds. 2022;34(5):124-134. 

In This Article

Necrobiosis Lipoidica

Necrobiosis lipoidica is a granulomatous disorder characterized by groups of papules that coalesce into well-circumscribed erythematous patches and plaques with yellow-brown centers (Figure 4). These lesions subsequently atrophy and ulcerate, especially when they are subjected to trauma.[31–34] The patches and plaques that form in the early stages of necrobiosis lipoidica have decreased or no sensation.[35] The ulcers, which form in the late stage of the disorder, may become painful, whereas the preulcerative lesions are generally asymptomatic. The complications of ulceration in necrobiosis lipoidica include secondary infection and progression to squamous cell carcinoma (SCC).[36] These lesions are most frequently located on the anterior surface of the leg but may also occur on the dorsal surface of the foot or the heel. First-line treatment typically involves corticosteroids. A recent case study noted success with a regimen of prednisone 1 mg/kg daily for 1 week, followed by 40 mg daily for 4 weeks and a titrated dose reduction regimen for another 4 weeks.[37] Other treatments include immunosuppressants, such as calcineurin inhibitors, cyclosporine, necrosis factor inhibitors, topical retinoids, hyperbaric oxygen, and ultraviolet phototherapy.[36]

Figure 4.

Necrobiosis lipoidica diabeticorum with ulcer. Used with permission; Terry Treadwell, MD.