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Refractory Ulcerated Necrobiosis Lipoidica: Closure of a Difficult Wound with Topical Tacrolimus

Ginocchio, Luke BS; Draghi, Lisa RPA-c; Darvishian, Farbod MD; Ross, Frank L. MD, FACS

doi: 10.1097/01.ASW.0000521867.98577.a5
Features: Case Report

OBJECTIVE: To report a case of refractory ulcerated necrobiosis lipoidica (NL) with significant response to treatment with topical tacrolimus.

SUBJECT: A 55-year-old woman without diabetes and with a previous history of NL presented to the Helen L. and Martin S. Kimmel Hyperbaric and Advanced Wound Healing Center of NYU Langone Medical Center, New York, with bilateral lower-leg ulcerations resistant to wound healing techniques at other institutions.

MATERIALS AND METHODS: Repeat biopsy performed at the author’s institution confirmed the diagnosis of NL. Initial therapy was based on reports of other successful treatment methods, which included collagen wound grafts and collagen-based dressings coupled with compression. These methods initially showed promising results; however, the wounds reulcerated, and any gains in wound healing were lost. Alternative options were initiated, including topical clobetasol and narrowband ultraviolet B; however, no significant improvement was observed. The patient’s lower-extremity wounds began to deteriorate. The patient also refused systemic therapy. Treatment was changed to topical 0.1% tacrolimus ointment and was applied daily for 10 months with multilayer compression wraps.

RESULTS: Both lower-extremity ulcerations began to show significant improvement, with the ulcers progressing toward closure except for 1 very small area on the left lower extremity.

CONCLUSIONS: Topical tacrolimus seems to be an effective treatment option for patients with refractory chronic ulcerated NL who do not want systemic oral therapy. The authors found that successful wound closure may require a multimodal approach, which promotes wound healing, but also concurrently addresses the underlying disease process.

Luke Ginocchio, BS, is a Medical Student; Lisa Draghi, RPA-c, is a Physician Assistant; and Farbod Darvishian, MD, is Associate Professor, NYU Langone Medical Center, New York, New York. Frank L. Ross, MD, FACS, is Associate Director, Helen L. and Martin S. Kimmel Hyperbaric and Advanced Wound Healing Center; and Associate Professor of Surgery, NYU Langone Medical Center New York, New York.

The authors have disclosed that they discuss the off-label use of tacrolimus for the healing of leg ulcers related to necrobioisis lipoidica.

Submitted August 12, 2015; accepted in revised form January 14, 2016.

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