Diabetic Dermopathy
Diabetic Dermopathy
Diabetic dermopathy is a term used to describe the small, round, brown atrophic skin lesions that occur on the shins of patients with diabetes. The lesions are asymptomatic and occur in up to 55% of patients with diabetes, but incidence varies between different reports. Diabetic dermopathy 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. Histological changes include epidermal atrophy with flattening of the rete ridges, dermal fibroblastic proliferation, altered collagen, dermal oedema and an increase in dermal capillaries, with a perivascular inflammatory infiltrate, changes to the vessel walls and melanin and haemosiderin deposition. The underlying mechanism for diabetic dermopathy is unknown, although it may be related to local thermal trauma, decreased blood flow causing impaired wound healing or local subcutaneous nerve degeneration. Diabetic dermopathy requires no treatment, but may be a surrogate for more serious complications of diabetes, which require investigation and management.
Diabetic dermopathy is the commonest skin condition that occurs in patients with diabetes mellitus. The condition was first reported in 1964 by Melin, who described small, circumscribed, brownish atrophic skin lesions occurring on the lower extremities. The phrase diabetic dermopathy was coined by Binkley in 1965, but the lesions have variously been termed "pigmented pretibial patches", "shin spots", "spotted leg syndrome" and "diabetic dermangiopathy". In his original clinical description, Melin concluded that they were more or less specific for diabetes mellitus and, while most reports published since then agree with his findings, other authors suggest that the lesions may be seen in patients without diabetes. One study found that they occurred in 1.5% of non-diabetic medical students and in 20.2% of non-diabetic controls, derived from the endocrine clinic population. It has been suggested that at least four lesions are characteristic of diabetes.
Diabetic dermopathy has been reported to occur in between 0.2–55% of patients with diabetes. The lowest incidence was reported in a study from India of 500 patients with diabetes (98.8% type 2 diabetes), in which only one patient (0.2%) was found to have diabetic dermopathy. The reason suggested for the low incidence reported in most studies from India is that the skin lesions may be more difficult to see in individuals with darker skin types. However, a notable exception is a study from the Western Himalayas in which diabetic dermopathy was identified in 36%.
Diabetic dermopathy is more common in patients older than 50 years and in those with a longer duration of diabetes. In older patients diabetic dermopathy was found to occur after a shorter duration of diabetes, whereas in younger patients lesions occurred only after ten years in patients less than 20 years of age. The lesions have been reported to occur more frequently in male patients, however, this difference is not always significant and other studies have not found any difference. It is uncertain as to whether diabetic dermopathy is more common in patients with type 1 or type 2 diabetes.
Abstract and Introduction
Abstract
Diabetic dermopathy is a term used to describe the small, round, brown atrophic skin lesions that occur on the shins of patients with diabetes. The lesions are asymptomatic and occur in up to 55% of patients with diabetes, but incidence varies between different reports. Diabetic dermopathy 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. Histological changes include epidermal atrophy with flattening of the rete ridges, dermal fibroblastic proliferation, altered collagen, dermal oedema and an increase in dermal capillaries, with a perivascular inflammatory infiltrate, changes to the vessel walls and melanin and haemosiderin deposition. The underlying mechanism for diabetic dermopathy is unknown, although it may be related to local thermal trauma, decreased blood flow causing impaired wound healing or local subcutaneous nerve degeneration. Diabetic dermopathy requires no treatment, but may be a surrogate for more serious complications of diabetes, which require investigation and management.
Introduction
Diabetic dermopathy is the commonest skin condition that occurs in patients with diabetes mellitus. The condition was first reported in 1964 by Melin, who described small, circumscribed, brownish atrophic skin lesions occurring on the lower extremities. The phrase diabetic dermopathy was coined by Binkley in 1965, but the lesions have variously been termed "pigmented pretibial patches", "shin spots", "spotted leg syndrome" and "diabetic dermangiopathy". In his original clinical description, Melin concluded that they were more or less specific for diabetes mellitus and, while most reports published since then agree with his findings, other authors suggest that the lesions may be seen in patients without diabetes. One study found that they occurred in 1.5% of non-diabetic medical students and in 20.2% of non-diabetic controls, derived from the endocrine clinic population. It has been suggested that at least four lesions are characteristic of diabetes.
Diabetic dermopathy has been reported to occur in between 0.2–55% of patients with diabetes. The lowest incidence was reported in a study from India of 500 patients with diabetes (98.8% type 2 diabetes), in which only one patient (0.2%) was found to have diabetic dermopathy. The reason suggested for the low incidence reported in most studies from India is that the skin lesions may be more difficult to see in individuals with darker skin types. However, a notable exception is a study from the Western Himalayas in which diabetic dermopathy was identified in 36%.
Diabetic dermopathy is more common in patients older than 50 years and in those with a longer duration of diabetes. In older patients diabetic dermopathy was found to occur after a shorter duration of diabetes, whereas in younger patients lesions occurred only after ten years in patients less than 20 years of age. The lesions have been reported to occur more frequently in male patients, however, this difference is not always significant and other studies have not found any difference. It is uncertain as to whether diabetic dermopathy is more common in patients with type 1 or type 2 diabetes.
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