Necrobiosis lipoidica is a rare inflammatory granulomatous skin disease of 
unknown etiology which is associated with diabetes mellitus in about 60 % of the 
patients. In up to 30 % of these patients extremely painful and often 
hard-to-heal ulcerations occur in the course of the disease. We present a new 
therapeutic option using adalimumab to treat refractory ulcerated necrobiosis 
lipoidica non diabeticorum. The clinical efficacy of adalimumab probably 
reflects an immunomodulatory effect through the specific TNF-α inhibition which 
is one central aspect of the underlying inflammation. Thus, adalimumab could 
represent promising new treatment option, especially for patients with otherwise 
therapy-refractory ulcerated necrobiosis lipoidica.