Smoking, Necrobiosis Lipoidica, Granulomatosis Disciformis Chronica Progressiva

Smoking by constitutionally predisposed persons causes necrobiosis lipoidica "diabeticorum" in nondiabetics, causes the apparently identical granulomatosis disciformis chronica progressiva, and aggravates necrobiosis lipoidica diabeticorum in diabetics—this hypothesis may be important in clarifying the etiology of necrobiosis lipoidica and granulomatosis disciformis chronica progressiva. The condition recognized by most dermatologists as necrobiosis lipoidica diabeticorum was first described by Oppenheim,¹in 1929, as dermatitis atrophicans lipoides diabetica. Urbach,²in 1932, gave it the name by which we now call it, but, ever since Goldsmith,³in 1934, recorded a case without diabetes, more and more nondiabetic patients have been seen with this condition. Thus, Hildebrand, Montgomery, and Rynearson,⁴in 1940, found approximately 10% of their cases, and those reported in the literature prior to that time, were nondiabetics. Kaalund-Jørgensen,⁵in 1948, found approximately one-third of his cases and the cases reported