Diabetic Dermopathy Thomas Repas D.O. Diabetes, Endocrinology and Nutrition Center, Affinity Medical Group, Neenah, Wisconsin Member, Inpatient Diabetes Management Committee, St. Elizabeth’s Hospital, Appleton, WI Member, Diabetes Advisory Group, Wisconsin Diabetes Prevention and Control Program Website:

Diabetic Dermopathy Diabetic dermopathy is a condition characterized by the presence of multiple hyperpigmented atrophic macules on the legs. Typical lesions are depressed (atrophic) and appear to have post-inflammatory hyperpigmentation. These lesions have been classified with vascular disorders because histology sections may demonstrate red blood cell extravasation and capillary basement membrane thickening. Patients can usually relate antecedent trauma or inflammation and sometimes precipitating lesions coexist with the atrophic ones.

Figs 24,25. Legs of two patients with diabetes mellitus. The patient on the left is a teenage girl with insulin dependent diabetes. The patient on the right is an adult onset diabetic. Both have multiple atrophic hyperpigmented macules, so- called diabetic dermopathy.

Fig 23. Shin of a patient with diabetes mellitus demonstrating hyperpigmented atrophic macules. The patient relates previous trauma for each of these spots. The lesion on the left demonstrates evolution from the traumatic to the atrophic hyperpigmented phase. One or two hyperpigmented atrophic macules are occasionally encountered on the legs of non- diabetic patients, but these lesions are much more common in diabetics. The occurrence of 4 or more such lesions is almost always limited to persons with diabetes, and correlates well with the presence of retinopathy.

Pigmented purpura Known as a common phenomenon of aging, pigmented purpura of the legs is most often encountered in the elderly diabetic population. These areas of spontaneous focal extravasation from the microcirculation are recognized as brown to red macules and patches. Pigmented purpura often coexists with diabetic dermopathy