Photo Rounds

Red lesion on shins

A 60-year-old woman with diabetes asked her family physician (FP) to look at the reddish lesions on both anterior shins that had turned brown over the past year. She reported no pain with the hyperpigmented areas, but did have foot pain secondary to neuropathy.

What's your diagnosis?


The patient was given a diagnosis of diabetic dermopathy. This condition is the most common cutaneous marker of diabetes mellitus and is found in 12% to 40% of patients—typically the elderly. The cause of diabetic dermopathy is unknown, thought the condition may be related to mechanical or thermal trauma, especially in patients with neuropathy.

Lesions have been classified as vascular because the histology demonstrates red blood cell extravasation and capillary basement membrane thickening. There is an association between diabetic dermopathy and retinopathy, nephropathy, and neuropathy.

Lesions often begin as pink patches (0.5–1 cm), which become hyperpigmented, with surface atrophy and fine scale. Pretibial and lateral areas of the calf are involved. Histology shows epidermal atrophy, thickened small superficial dermal blood vessels, and hemorrhage with hemosiderin deposits. There is no effective treatment, and the lesions may resolve spontaneously. It’s not known whether the lesions improve with better diabetes control.

In this case, the patient promised to work harder with her physician to achieve better control of her diabetes.

Text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. Photo courtesy of University of Texas Health Sciences Center, Division of Dermatology. This case was adapted from: Smith M. Diabetic dermopathy. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:945-947.

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