Defining diabetic dermopathy

Abstract

Diabetic dermopathy presents as well-demarcated, hyperpigmented, atrophic depressions, macules or papules located on the anterior surface of the lower legs of diabetic patients. The histopathology remains poorly defined which may in part be due to the fact that the lesions are rarely biopsied. An advantage of studying autopsy material is the ease of obtaining large biopsy specimens. To further define the histopathological features of this entity, we studied tissue taken from characteristic lesions at autopsy. Inclusion criteria included the presence of the lesions and diabetes-related nephroarteriolosclerosis at autopsy. Surprisingly, only four out of 14 skin biopsies showed moderate to severe wall thickening of arterioles or medium-sized arteries on periodic acid Schiff (PAS) stains. Only mild basement membrane thickening was noted in 11 of 14 which was highlighted by the PAS stain. Pigmented material was identified within the dermis of 13 cases. In 10 of the cases, the material was positive for Perl's iron stain. Ten cases had material staining positive for Fontana-Masson in the dermis. Nine cases had markedly increased epidermal melanin. The findings suggest that hemosiderin deposition in conjunction with the deposition of melanin contribute to the clinical features of diabetic dermopathy.

A study on the association of diabetic dermopathy with nephropathy and retinopathy in patients with type 2 diabetes mellitus

“…In other studies, diabetic dermopathy has been reported most prevalent in 45- to 70-year-old patients and significantly associated with age (11,14,15,25), as well. Further, the mean duration of diabetes was 9.16±5.42 years and the number of dermopathy lesions was significantly associated with the duration of illness, which is in agreement with other studies (17,21,26).…”

“…According to the available references, the prevalence of diabetic dermopathy is higher in elderly men (28), and some other studies have demonstrated that diabetic dermopathy is more prevalent in men with a significant association between gender and diabetic dermopathy (11,22,24). These findings are consistent with our investigation, which could be explained by lower number of the men than women referring to our clinic.…”

“…Approximately 40%-45% of the diabetes patients clearly present with the symptoms of diabetic nephropathy in lifetime (9,10). Out of the microvascular complications, diabetic dermopathy is the most prevalent skin presentation (11,12), including hyperpigmented and atrophic macules or papules with no sharp border and usually occurring on the front leg in diabetes patients. These lesions are asymptomatic and often do not cause pain and itching.…”

“…The diagnosis of diabetic dermopathy is clinical and is made by description and physical examination. The occurrence of scars and hyperpigmented, atrophic spots with sharp borders on the legs of a diabetes patients is very likely to result in diagnosis with diabetic dermopathy (11,13,14). Diabetic dermopathy has been reported 9%-55% prevalent and is likely to be more prevalent in the patients over 50 years and with longer duration of diabetes.…”

Skin Examination: An Important Diagnostic Tool in Renal Failure Patients

“…Diabetic dermopathy is characterized by small scar-like atrophic depressions occurring on the shins of diabetic patients; its presence is associated with microangiopathic complications of diabetes, such as nephropathy, neuropathy, and retinopathy [11]. Correlation with nephropathy and other microangiopathic complications is also seen with rubeosis facei diabeticorum.…”