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Necrobiosis lipoidica (NL) is a rare chronic granulomatous skin disorder of unknown origin presenting as yellow-brown inflamrnatory plaques with raised borders and an atrophie centre (1, 2). NL typically appears on the anterior lower legs, and lesions are usually bilateral. Two-thirds of such cases are found in diabetic patients (2). Recently, several reports have suggested that neutralization of proinflammatory cytokines by biological agents (e.g. etanercept, infliximab) or tacrolimus is one ofthe optimal therapies forNL (1,3). Insulin-dependent type 1 diabetes mellitus (IDDM) is a chronic autoimmune disease caused by the selective destruction of pancreatic insulin-producing B cells (3). Autoimmunity comrnonly occurs when central or peripheral tolerance barriers are broken down, allowing the activation of self-reactive T cells (4). Recently, Thi 7 immunity has been reported to be correlated with IDDM (5). We describe here a case of NL associated with IDDM and demonstrate irnmunohistochemical staining for granuloma-forming cells, especially focusing on IL-17-producing cells and CD163* proinflammatory macrophages.

acta dermato-venereologica

Pigmented Necrobiosis Lipoidica Accompanied by Insulin-dependent Diabetes Mellitus Induces CD163 Proinflammatory Macrophages and Interleukin-17-producing Cells