Effectiveness of topical tacrolimus for treatment of necrobiosis lipoidica

Topical 0.1% tacrolimus ointment was used for treatment of necrobiosis lipoidica that occurred on a lower leg of a patient with diabetes mellitus. The patient was a 53-year-old woman who had been receiving medication for diabetes mellitus type 2. In January 2004, she noticed erythema with palpable induration on the anterior aspect of her right lower leg but left it untreated because the symptoms were not severe. The eruption gradually spread medially and the degree of induration increased, and she visited our department on September 18, 2007. A scaly purplish-red plaque area with board-like induration measuring 90 x 80 mm with a relatively clear border was seen on the anterior aspect of the right lower leg. A diagnosis of NL was made from biopsy results, and treatment with topical butyric propionic acid betametazon ointment was started. However, there was no change in the degree or area of inflammation and hardening, and the treatment was changed to topical 0.1% tacrolimus ointment treatment. An obvious reduction in the degree of induration was seen 4 weeks after the change in treatment, and the degree of inflammation had decreased at 8 weeks. At 16 weeks after the change in treatment, the erythema had almost completely subsided with only pigmentation remaining.