Treatment of necrobiosis lipoidica diabeticorum (NLD) with medications may not be necessary. However, medications are typically required if the lesions become ulcers. Treatment at this stage is difficult, especially if the lesions have already ulcerated.

Corticosteroids are typically the first treatment method for NLD. They may be administered in multiple ways. These immunosuppressant anti-inflammatories are likely to be applied as a skin cream (topical) that may be covered with airtight dressings during the early stages of the condition. Many types of topical corticosteroids cannot be used if the lesions have become ulcerated. Instead, the medication may be delivered through an inhaler, injected or taken orally as a pill.

Corticosteroids can cause hyperglycemia (high blood sugar), and long-term use can be a risk factor for diabetes, glaucoma, cataracts, osteoporosis and other conditions. The prescription of corticosteroids would take this effect into account, and some medication types may be considered a treatment of last resort or may not be an option for people with diabetes. If necessary, an individual’s physician can make adjustments in antidiabetic agents or insulin therapy and recommend that the patient perform glucose monitoring more often.

Several common diabetic complications can contribute to NLD, including high blood pressure, unhealthy levels of blood fats (hyperlipidemia), atherosclerosis, poor circulation and diabetic neuropathy. A physician may treat these factors by recommending tighter control of glucose (blood sugar), prescribing medications such as antihypertensives and cholesterol drugs, and suggesting lifestyle changes such as exercise, diet, quitting smoking and wearing compression stockings.

In addition to medications, other therapies that have been used to treat NLD with varying degrees of success. These include:

• Controlled exposure to ultraviolet light to control flare-ups
  
  
• Stockings or shin pads to protect against skin trauma
  
  
• Surgical excision, possibly performed with grafting skin to the site in severe cases of ulceration
  
  
• Psychological counseling to address depression, altered body image, impaired self-esteem and other issues that may result from scarring