Current Insights On Diabetic Dermopathy

I often see patients with diabetes in my office and wound center. These patients commonly present with diabetic dermopathy.

Diabetic dermopathy consists of small, round, brown atrophic skin lesions that occur on the shins of patients with diabetes.¹ The lesions are asymptomatic and reportedly occur in up to 55 percent of patients with diabetes but the incidence can vary.¹ The condition is more common in older patients and those with longstanding diabetes. It is associated with other microvascular complications of diabetes such as retinopathy, nephropathy and neuropathy, and also with large vessel disease.

Other names for diabetic dermopathy include pigmented pretibial patches, shin spots, spotted leg syndrome or diabetic dermangiopathy.

Diabetic dermopathy appears as small, circumscribed, brownish atrophic skin lesions less than 1 cm in diameter although some may be elongated and up to 2.5 cm.¹ Lesions begin spontaneously as non-blanching, scaly, red or purple, round or oval macules or papules. There may be induration with a central depression or vesiculation. These lesions subsequently progress to the characteristic scar-like lesions of diabetic dermopathy. The intensity of pigmentation corresponds to the degree of atrophy with the darkest lesions also being the most atrophic. Lesions last on average 18 to 24 months before fading to minimally atrophic macules or clearing completely. In some cases, the brownish color disappears and is replaced by a slight depigmentation. As older lesions clear, new lesions appear.

Diabetic dermopathy occurs on the shins in a bilateral asymmetrical distribution. It is more common in patients over the age of 50.²

The histology of diabetic dermopathy includes epidermal atrophy with flattening of the rete ridges, dermal fibroblast proliferation, altered collagen, dermal edema, increase in dermal capillaries, perivascular inflammatory infiltrate, changes to the vessel walls and melanin and hemosiderin deposition.¹

The mechanism of action is unknown although it may be related to local thermal trauma, decreased blood flow causing impaired wound healing or local subcutaneous nerve degeneration.¹

Diabetic dermopathy is a clinical diagnosis. Lesions of diabetic dermopathy are commonly recognized. Clinicians rarely pursue a biopsy for these lesions due to concerns about poor healing on the lower limbs of these patients.

The lesions of diabetic dermopathy are asymptomatic. At the current time, no treatment has demonstrated effectiveness for this condition.¹

References

1. McGeorge S, Walton S. Diabetic dermopathy. Br J Diabetes. 2014; 14(3):95–97.

2. Chakrabarty A, Norman RA, Phillips TJ. Cutaneous manifestations of diabetes. Wounds. 2002;14(8)267–74.  

3. Brzezinski P. Diabetic dermopathy (“shin spots”) and diabetic bullae (“bullosis diabeticorum”) at the same patient. Pak J Med Sci. 2015; 31(5):1275–1276.