What are the therapeutic options of necrobiosis lipoidica ?
1. Corticosteroids: Superpotent topical corticosteroids with occlusion, intralesional injections of triamcinolone suspension into the the active advancing edges but not the waxy yellow center (risk of ulceration) and systemic steroids in selected cases.
2. Topical calcineurin inhibitors.
3. Pharmalogical agents improving the blood circulation: low-dose aspirin, nicotinamide, pentoxifylline, and dipyridamole.
4. Phototherapy (PUVA and UVA1).
5. Oral immunomodulators (Antimalarial drugs and thalidomide).
6. Cyclosporin A in selected cases.
7. In refractory cases: TNF inhibitors (Infliximab and Etanercept): systemically or intralesionally.
8. Ulcerative cases: Surgical excision and grafting.