Thalidomide for the Treatment of Refractory Necrobiosis Lipoidica

A 51-year-old woman with a 2-year history of biopsyproved necrobiosis lipoidica (NL) and a 10-year history of recurrent lower limb ulcerations was referred to the dermatology clinic because of a new ulceration on her right lower extremity. At her initial presentation, her physical examination was remarkable for 2 atrophic plaques with active disease and palpable reddish brown borders on her right lower extremity. The larger of the 2 plaques had a 3.02.0-cm ulceration. The left lower extremityhad3atrophicplaqueswithsimilarpalpablereddish brown borders (Figure 1). Although past ulcerations were related to trauma, the patient reported that the new ulcer had developed spontaneously and denied any history of diabetes. Multiple therapies, including intralesional and topical steroids, pentoxifylline, and compression, had been tried, with only partial healing of the ulceration. Her medical history was unremarkable, with no associated difficulties with blood glucose control and no family history of diabetes. Her medications included cetirizine hydrochloride (Zyrtec), venlafaxine hydrochloride (Effexor), and mupirocin (Bactroban).