Necrobiosis Lipidica: What It Is and How to Treat It

When I was pregnant with my youngest son, who will be 21 in March, I noticed a small rash, about the size of a quarter, on my lower left leg. Great, a skin disorder, just what I needed. Thought nothing of it and it just remained the same size for several years. Never got worse, never got better. Slowly, over time and several years, I began to notice other small spots appearing on my lower left leg. Then I noticed two on my lower right leg. Went to several dermatologists but nobody could tell me what it was. One dermatologist did a biopsy and, after leaving a dent in my lower right leg, told me she had no idea what it was – but whatever it was, it wasn’t cancerous!

Okay then.

The problem, however, is that the more it spread, the bigger it got and started to itch like nobody’s business. I’m talking itch so ferociously that it would cause me to scratch my legs until they bled. That led to open sores that would take f-o-r-e-v-e-r to heal. Several more trips to various dermatologists and I finally found one that could tell me what I had.

Necrobiosis Lipidica or Necrobiosis Lipidica Diabeticorum

Necrobiosis Lipidica (NL) is a chronic skin condition that causes a rash on the lower legs. NLD is more common in women and is characterized by several slightly raised, shiny, red-brown patches. The centers of the patches can sometimes be yellowish and develop open sores themselves that are slow to heal. Mine are usually characterized by shiny plaques that go from fire red (when inflamed and itching like crazy) to a dull reddish brown color. Doctors, however, are stumped as to what the various causes are.

Sigh … these are my legs. Those are the NL patches that drive me insane, and there are a few more on the back portion of my lower legs.

If the burning and itching pain were not so bad, I would have never kept going to dermatologists to figure out what it was and how to treat it. Unfortunately, there is no cure for it. Once NL or NLD takes hold of your legs (or any other location on your body) there is no getting rid of the patches. There is no cure and no definitive treatment that has proven to be effective.

You can imagine my disappointment when the dermatologist told me there was no cure. So I am resigned to living in the South with temperatures in the hundreds during the summer, and not being able to wear shorts or summer dresses. I have built up a nice collection of long maxi dresses that I can wear during the summer that are cool and hide these marks on my legs.

Common Treatment Options

Treatments for NL vary, and there’s no one-size-fits-all approach. Some common options include:

  1. Topical Steroids: These can help reduce inflammation and itching.
  2. Topical Calcineurin Inhibitors: Another option for managing inflammation.
  3. Corticosteroid Injections: For localized and severe cases, injections may be considered.
  4. Compression Therapy: Wearing compression stockings may help improve blood flow and reduce swelling.
  5. Phototherapy: Exposure to ultraviolet (UV) light under medical supervision might be recommended.
  6. Oral Medications: In more severe cases, doctors may prescribe oral medications like corticosteroids or immunosuppressants.
  7. Wound Care: For open sores, proper wound care is crucial to prevent infections.

Mine seem to bother me the most right after a shower and in the evenings. I drink so much water during the day trying to stay hydrated and hoping that will help ease the itching, but it seems to make it worse some days. My doctor prescribed me a very strong steroid cream to use for a week at a time and then switched to using Eucerin or CeraVe eczema relief cream. I alternate back and forth.

Unfortunately, still does not help with the itching. Once I start, I literally cannot stop. I’ve tried applying cold towels, but that only works for several minutes. So I started to experiment with different items to see what would work for me.

The Life in a House Treatment for NL

On the days when I am having a truly bad flair-up and the itching just will not go away – I use the steroid cream in the morning and the evening when I get home. In addition, I take one Benadryl tablet about an hour before bed. It is the only way I can sleep through the night without tearing my legs to pieces.

On other days, I have found that using an arnica cream works fairly well. Almost every day that I come home my feet are swollen, and arnica cream is pretty versatile and works great for easing muscle aches and inflammation and reducing pain and swelling. I’ve found it helpful for my knees on those really cold days when my arthritis is in overdrive. My personal preference is Doctor Hoy’s Arnica Boost Recovery Cream for my lower legs, and Doctor Hoy’s Pain Relief Gel Roll-On for my knees. My son, who works for Amazon, finds it beneficial after those 10-hour shifts to help ease the muscle aches. (yes, this is a shameless plug for you to visit Dr. Hoy’s and check out their products – because I personally love ’em!)

Arnica cream is like a multi-tasker for different issues. Here’s the lowdown:

  1. Workouts: After hitting the gym, applying arnica cream may help with muscle soreness. It’s thought to reduce inflammation and ease the ache, making your recovery a bit smoother.
  2. Arthritis: Some folks use arnica for joint pain associated with arthritis. The anti-inflammatory properties might bring a bit of relief. But again, it’s good to chat with a healthcare pro to figure out the best approach for your specific situation.
  3. Bruises: Arnica has been used for ages to speed up the healing of bruises. It’s believed to stimulate the flow of white blood cells, helping your body clear away the bruise more quickly.

Remember, while many find arnica helpful, results can vary. It’s crucial to follow any guidelines on the product and, of course, consult with a healthcare pro if you have any concerns or specific conditions.

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