Perforating necrobiosis lipoidica is a very rare clinical variant which consists of degeneration and transepidermal elimination of the collagen with few cases reported in the literature. In two-thirds of the patients it associates with diabetes, with no relation with the glucose control. We present a 42-year-old female patient with a 7-year history of diabetes on insulin therapy, referred to ou...

A 47-year-old woman reported an 18-month-old pretibial rash on her left shin during a routine office visit. She had a history of type 1 diabetes mellitus (DM) and has been on insulin therapy for the past 13 years. She did not complain of any itching, pain, or bleeding from the rash. On examination, an 8 3 cm elongated indurated plaque with telangiectases, central atrophy, and yellow pigmentatio...

Necrobiosis lipoidica is a rare granulomatous and inflammatory disease. Its management is particularly difficult when ulceration is present. The authors describe the clinical case of a 65-year-old female patient with necrobiosis lipoidica, who had been submitted in the past to several topical and systemic treatments with little or no improvement. She started treatment with subcutaneous etanerce...