[Topical tacrolimus in necrobiosis lipoidica]

Necrobiosis lipoidica (NL) is a chronic inflammatory skin disease that is difficult to treat. The etiology is unknown, but vascular abnormalities and immunologic factors have been implicated. We treated a patient with long-standing NL with multiple vascular risk factors (diabetes mellitus, protein S-deficiency, and antiphospholipid syndrome) with topical tacrolimus, a non-steroidal immunomodulator that causes no skin atrophy. After 12 weeks of topical tacrolimus (0.1%) ointment, our patient already showed a good remission with a significant decrease in inflammatory signs.