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Ulcerated necrobiosis lipoidica treated with cyclosporin A.

Sir, Necrobiosis lipoidica (NL) is a skin disease of unknown aetiology. It is a relatively rare cutaneous complication of diabetes mellitus, occurring in 0.3% of manifest diabetics (1). The course of NL appears unrelated to duration of the diabetes or to adequacy of the diabetic control. There may be a correlation with diabetic micro-angiopathy (1). NL is characterized by sharply demarcated, smooth surfaced, irregularly shaped plaques of atrophic skin varying in colour from yellowish to reddish brown. The usual location is the anterior lower part of the leg, often bilaterally, but lesions can be seen on the thighs, popliteal areas and feet. The arms, trunk, face and scalp may be affected, but only in rare cases (1). A complication of the more extended lesions is ulceration, which often occurs following trauma and heals with difficulty leaving scars. At present there is no treatment that can be considered satisfactory, although numerous therapeutic protocols have been proposed. The ulcerated forms may need surgical treatment with excision of the affected areas and subsequent grafting. Recently, there have been reports of good results obtained with the use of cyclosporin A (CyA) (2, 3).