Histopathologic features of necrobiosis lipoidica

Emma Johnson, Meera H. Patel, Caitlin M. Brumfiel, Kevin J. Severson, Puneet Bhullar, Blake Boudreaux, Richard J. Butterfield, David J. DiCaudo, Steven A. Nelson, Mark R. Pittelkow, Aaron R. Mangold

Research output: Contribution to journalArticlepeer-review


Background: Necrobiosis lipoidica (NL) is an uncommon granulomatous dermatosis that can occur in patients with or without associated diabetes mellitus (DM). Prior studies have attempted to determine distinctive histopathologic features of NL in patients with and without DM. Methods: A retrospective review of 97 patients with NL was performed to determine the similar and distinctive histopathologic features in patients with DM and without DM. Results: Of the 97 patients, 32% (n = 31) had DM. Epidermal acanthosis was seen more commonly in diabetics than nondiabetics (32.3% vs. 12.1%; p = 0.017). Naked (sarcoidal/tuberculoid) granulomas were more frequently observed in nondiabetics than diabetics (22.7% vs. 3.2%; p = 0.016). Eosinophils were more common in nondiabetics than diabetics (38.5% vs. 9.7%; p = 0.004), while neutrophilic infiltration was more common in diabetics than nondiabetics (45.2% vs. 17.5%; p = 0.004). Conclusions: This study corroborates well-documented histopathologic features of NL and shows distinctive histopathologic features of NL among patients with DM-I, DM-II, and without DM. These results support the hypothesis that there are different underlying drivers of NL between diabetics and nondiabetics.

Original languageEnglish (US)
Pages (from-to)692-700
Number of pages9
JournalJournal of Cutaneous Pathology
Issue number8
StatePublished - Aug 2022


  • diabetes mellitus
  • granulomatous
  • histopathology
  • necrobiosis lipoidica

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Histology
  • Dermatology


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