Necrobiosis lipoidica (NL) is a rare granulomatous disease that predominantly affects middle aged women and is often associated with diabetes mellitus and other metabolic disorders . About 30 % of the patients develop ulcerations within NL lesions on the lower leg, which complicate the course of disease and are often recalcitrant to standard wound care procedures . Systemic therapies for NL are reported only for single cases or in small case series with varying outcome . Randomized controlled trials are missing due to the character of NL as an orphan disease.