High dose nicotinamide in the treatment of necrobiosis lipoidica

An open study of high dose nicotinamide in the treatment of 15 patients with necrobiosis lipoidica is reported. Of 13 patients who remained on treatment for more than 1 month, eight improved. Improvement took the form of a decrease in pain and soreness, a decrease in erythema and the healing of ulcers if present, although the skin did not return completely to normal in any patient. There were no significant side‐effects, particularly with respect to diabetic control, an important finding as lesions tended to relapse if treatment was stopped. Necrobiosis lipoidica is a granulomatous condition which usually arises on the shins, although lesions have been reported to occur on other parts of the body. It is usually found in association with diabetes (although only a small proportion of diabetic patients develop this lesion) and the pathogenesis is unknown. However, abnormalities in dermal collagen,1 vascular supply of the skin,2 and immunological responses3, 4 have been demonstrated. The lesions, which comprise yellow, telangiectatic, atrophic plaques with a variable degree of erythema usually only present a cosmetic problem, although in some cases they can be painful or itchy, or may ulcerate. Available treatment, including topical steroids, systemic aspirin and dipyridamole, and surgical excision and grafting tend to be unsatisfactory. Following the report of the use of high dose nicotinamide in granuloma annulare,5 we report the results of an open study of high dose nicotinamide in patients with necrobiosis lipoidica and present an illustrative case history.