Clinical Improvement of Necrobiosis Lipoidica Diabeticorum with Opzelura (Ruxolitinib) Cream: A Case Report

Necrobiosis lipoidica (NL) is an idiopathic granulomatous, inflammatory skin disorder, traditionally linked to diabetes mellitus but often occurs independently of glucose metabolism abnormalities. Proposed pathogenic mechanisms include microangiopathy, collagen devitalization, metabolic changes, trauma, and immune dysregulation. Management of NL is limited by data on treatment efficacy but includes high-potency topical steroids, intralesional steroids, topical immunomodulators, psoralen-ultraviolet A photochemotherapy, hydroxychloroquine, or TNF-alpha inhibitors, pentoxifylline, topical ALA-PDT, and more recently Janus kinase (JAK) inhibitors. This case discusses a 66-year-old female with type 2 diabetes that presents with necrobiosis lipiodica diabeticorum (NLD) who was refractory to high-potency topical corticosteroid but showed improvement after use of Opzelura cream.