A 60-year-old Japanese woman was referred to our hospital for yellow-brown plaques accompanied by ulceration on her left lower leg. Her medical history included neither diabetes mellitus nor minor trauma. A histopathological examination of the plaques showed necrobiotic changes within the dermal collagen surrounded by granulomas that comprised lymphocytes, histiocytes, and giant cells. The lower dermis revealed fibrotic changes that extended into the subcutaneous tissue. The patient’s blood glucose and glycated hemoglobin levels were within the normal ranges. We considered a diagnosis of necrobiosis lipoidica (NL) in the absence of diabetes mellitus. We reviewed 116 cases of NL that were reported in the Japanese medical literature between 1986 and 2014 and found that NL onset was most common in individuals of both sexes ≥ 60 years of age. Previous reports that reviewed NL cases in the Japanese medical literature that were published during the1900s indicated that NL occurs in people ≥ 40 years of age. We suggest that the aging population and increasingly longer life spans have increased the average age of NL onset in Japan. With regard to treatments, there were no effective treatments, but skin grafts were curative. NL treatment is very difficult, especially when ulcers are present; hence, we suggest that further research is needed to determine effective NL treatments.
Cite this paper
Korekawaka, A. , Nakajima, K. , Nakano, H. and Sawamura, D. (2014) Necrobiosis Lipoidica in the Absence of Diabetes Mellitus: A Case Report and an Analysis of 116 Japanese Cases. Case Reports in Clinical Medicine
, 639-643. doi: 10.4236/crcm.2014.312136
 Chung, C.G., Rosengrant, A., Helm, K.F. and Shupp, D.L. (2014) Necrobiosis Lipoidica Occurring in a Patient with Rheumatoid Arthritis on Concurrent Tumor Necrosis Factor-α Inhibitor Therapy. International Journal of Dermatology. http://dx.doi.org/10.1111/ijd.12309
 Reid, S.D., Ladizinski, B., Lee, K., Baibergenova, A. and Alavi, A. (2013) Update on Necrobiosis Lipoidica: A Review of Etiology, Diagnosis, and Treatment Options. Journal of the American Academy of Dermatology, 69, 783-791. http://dx.doi.org/10.1016/j.jaad.2013.05.034
 Erfurt-Berge, C., Seitz, A.T., Rehse, C., Wollina, U., Schwede, K. and Renner, R. (2012) Update on Clinical and Laboratory Features in Necrobiosis Lipoidica: A Retrospective Multicentre Study of 52 Patients. European Journal of Dermatology, 22, 770-775.
 Patrascu, V., Giurca, C., Ciurea, R.N., Georgescu, C.C. and Ciurea, M.E. (2014) Ulcerated Necrobiosis Lipoidica to a Teenager with Diabetes Mellitus and Obesity. Romanian Journal of Morphology and Embryology, 55, 171-176.
 Masatoshi, A., Kazunori, O., Osamu, I., Yoshiki, M., Toshiya, I. and Kyohei, S. (1999) Twocases of Necrobiosis Lipoidica—Its Relationships with Diabetes Mellitus and Preceding Trauma in the Japanese Patients. Rinsho Derma (Tokyo), 53, 529-532.
 Mariko, Y., Yasuhiko, M., Takekuni, N., Shinichiro, Y., Takashi, H. and Kenichiro, I. (2006) A Case of Necrobiosis Lipoidica without Diabetes Mellitus. Rinsho Derma (Tokyo), 60, 1020-1022.
 Misaki, O., Yoshihiro, S., Yuichi, T. and Seiichi, I. (2011) A Case of Necrobiosis Lipoidica Associated with Venous Insufficiency of Both Legs. Rinsho Derma (Tokyo), 65, 497-500.
 Uva, L., Freitas, J., Soares de Almeida, L., Vasques, H., Moura, C. and Miguel, D. (2013) Squamous Cell Carcinoma Arising in Ulcerated Necrobiosis Lipoidica Diabeticorum. International Wound Journal. http://dx.doi.org/10.1111/iwj.12206