Necrobiosis Lipoidica in Pregnancy Complicated by Gestational Diabetes Mellitus: A Case Report

Necrobiosis lipoidica (NL) is a rare chronic granulomatous skin disease that usually presents as well-defined, yellowish-brown atrophic plaques with telangiectasia on the lower extremities. Its pathogenesis is not fully understood, and it is commonly associated with diabetes mellitus. A 39-year-old gravida 4, para 3 woman at 36 + 5 weeks' gestation presented with painful, erythematous to yellow-brown atrophic plaques with mild telangiectasia on the lower limbs and lower abdomen. Her pregnancy was complicated by insulin-requiring gestational diabetes and late-onset pre-eclampsia. Lesions progressively enlarged and ulcerated over several weeks and were later confirmed as NL. She was admitted for optimization of maternal glycemic and blood pressure control and underwent induction of labor, with favorable maternal and fetal outcomes. NL during pregnancy is exceedingly uncommon, and its clinical features may mimic pregnancy-specific dermatoses, often delaying diagnosis. We report a case of NL in late pregnancy associated with gestational diabetes mellitus (GDM), highlighting an atypical prenatal presentation. This case highlights the atypical prenatal presentation of NL associated with GDM and the diagnostic challenges of pregnancy-related dermatoses. Recognizing NL in pregnant women with atypical or ulcerative plaques is crucial, and glycemic optimization, along with multidisciplinary management, supports favorable maternal and dermatologic outcomes.