Necrobiosis lipoidica diabeticorum (NLD) is characterised by which histopathological pattern?
- A Palisading granulomas with central mucin deposition
- B Palisading granulomas with necrobiotic collagen and plasma cell infiltrate in the deep dermis ✓
- C Interstitial granulomatous dermatitis with altered collagen
- D Epithelioid granulomas with Langhans giant cells and caseation
Correct answer: B. Palisading granulomas with necrobiotic collagen and plasma cell infiltrate in the deep dermis
Explanation
NLD histologically shows layered palisading granulomas arranged parallel to the skin surface with areas of necrobiotic (degenerate) collagen in the dermis, a prominent plasma cell infiltrate (especially in the deep dermis/subcutis), and thickened blood vessel walls. This pattern — necrobiosis + plasma cells in a 'sandwich' or tiered arrangement — distinguishes NLD from granuloma annulare (central mucin, no plasma cells, superficial dermis) and rheumatoid nodules. Foreign body giant cells and lymphocytes are also present.
Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.
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