Diabetic Dermopathy

Diabetic dermopathy ("shin spots") is the commonest cutaneous marker of diabetes, with atrophic hyperpigmented papules on the shins.

• Present in 30 to 50% of long standing diabetics, more in men and in those with retinopathy, nephropathy, neuropathy.
• Believed to follow minor trauma in microangiopathic skin.
• Related skin disorders: necrobiosis lipoidica, acanthosis nigricans, bullosis diabeticorum, diabetic thick skin, skin tags.

• Multiple round or oval, 5 to 12 mm, red brown atrophic patches on the anterior tibial areas.
• Asymptomatic, heal with depressed pigmented scars; new lesions appear in crops.
• Usually bilateral and asymmetric.

• Clinical diagnosis.
• Biopsy only if atypical (histology: epidermal atrophy, dermal fibrosis, haemosiderin).
• Exclude venous stasis, necrobiosis lipoidica, vasculitis, stasis dermatitis.
• Assess for microvascular complications.

• No treatment needed; benign.
• Reassure, optimise glycaemic control.
• Protect shins from trauma, emollients.
• Screen for retinopathy, nephropathy, neuropathy.