Successful treatment of chronic ulcerated necrobiosis lipoidica with 0.1% topical tacrolimus ointment

Conflicts of interest: none declared. Sir, Necrobiosis lipoidica (NL) is a recognized cutaneous manifestation of type 1 diabetes mellitus. It often proves recalcitrant to treatment and may ulcerate. NL is a degenerative disease of collagen within the mid‐ and lower dermis and subcutaneous fat. Its aetiology is still unknown, although various possible mechanisms have been implicated. A T‐cell‐mediated hypersensitive immune reaction with release of proinflammatory cytokines and lysosomal enzymes leading to local tissue destruction with inflammation has been suggested.1 Tacrolimus has recently been shown to be effective in patients with a short history of granuloma annulare (GA) or NL, and whose disease is still at the early acute inflammatory stage without any granulomatous tissue reaction.2 Several therapies have also been reported to be successful in patients with NL, including topical and systemic corticosteroids,3, 4 ciclosporin,1 pentoxifylline5 and topical psoralen plus ultraviolet A (PUVA).6 We report a 62‐year‐old diabetic woman with chronic NL, in whom the ulceration due to NL responded to 0·1% topical tacrolimus.