Necrobiosis lipoidica diabeticorum treated with the pulsed dye laser

Different treatment modalities have been advocated for necrobiosis lipoidica diabeticorum but clinical response is unpredictable. The purpose of this study was to evaluate the usefulness of pulsed dye laser (Candela SPTL, Irvine, MA, USA) in the treatment of an area of necrobiosis lipoidica of 4 cm in diameter on the anterior aspect of the leg in a non-diabetic patient.

A spot test was made at 6.0, 6.5 and 7.0 J/cm(2) energy fluences and the best energy fluence was selected after a 2-month postoperative evaluation. The patient received three treatment sessions with a fluence of 6.5 J/cm(2), 585-nm wavelength, 5-mm spot size, and 450 micro(s) pulse duration at 8-week intervals. The patient was given routine skin care advice with emollient cream and sunscreen (SPF 15) until the following session.

Overall cosmetic improvement was achieved, with a decrease of erythema and telangiectasis, and stabilization in terms of progression (size) in the left half of the lesion, with no modification of atrophy or pigmentary changes. The right upper quadrant of the lesion showed an erythematous peripheral halo with minimal reduction in the erythema and telangiectasia, and discrete size increase.

Pulsed dye laser may be a useful treatment for improving the telangiectasia and erythematous component of necrobiosis lipoidica.