10.1177/1534734603260680 ARTICLELOWER EXTREMITY WOUNDS 2(4); 2003KÖSTLER and WOLLINAULCERATED NECROBIOSIS LIPOIDICA Case Report Ulcerated Necrobiosis Lipoidica: A Combined Treatment Approach With Dermatosurgery and PUVA

Ulcerated necrobiosis lipoidica is one of the differential diag-noses in leg ulcers. The diagnosis is confirmed by histopathology. The authors report on a 68-year-old female patientwith ahistory of chronic venous insufficiencywhode-veloped a chronic leg ulcer that did not respond to good ulcer care and compression bandaging. Skin biopsies revealed necrobiosis lipoidica. The patient was recently discovered to have diabetes mellitus that was treated orally by ascarose. Phlebosurgery and mesh grafting were performed, and the patient was given pentoxyfiline, dapsone, and clofazimine, but none of these treatments was successful. Therefore, topi-cal PUVA therapy was introduced that resulted in partial re-mission and stabilizing of the residual pathology. Based on these experiences, the use of surgical methods alone is questionable