Various NL treatment modalities have been described, but there is no single universally effective modality; no double-blind, randomized, controlled trials have been conducted. Mainstays of treatment include potent topical or intralesional glucocorticoids. Antiplatelet agents such as aspirin and agents that decrease blood viscosity, such as pentoxifylline, also have been used. Topical tretinoin and tacrolimus have been used, as have systemic agents, which include mycophenolate mofetil, cyclosporin, niacinamide, thalidomide, and etanercept [ 6 , 15 ]. Successful treatment of NL also has been described with PUVA photochemotherapy [ 16 ]. Our patient responded well to one month of clobetasol percent ointment twice daily and tretinoin cream nightly, with improvement in the induration of the plaques and pruritus. As is recommended for all patients diagnosed with NL, our patient underwent diabetes screening with a serum hemoglobin A1C and fasting serum glucose, which were normal upon diagnosis. A hemoglobin A1C and fasting serum glucose were repeated by the patient’s primary care physician six months later and also were normal.