Journal of Urgent Care Medicine

Practice Management

A 71-Year-Old with Diabetes and Discoloration of the Skin

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The patient is a 71-year-old female with type 2 diabetes who calls attention to a rash on her shins during an annual physical. The rash appears to be pink, atrophic scars surrounded by hyperpigmented patches. They have developed since her last physical. She denies discomfort but is concerned as to what could have caused them.

View the image taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

Diabetic Dermopathy
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Differential Diagnosis

  • Diabetic dermopathy
  • Lichen planus
  • Necrobiosis lipoidica
  • Stasis dermatitis
Diabetic Dermopathy

Diagnosis

This patient was diagnosed with diabetic dermopathy, also known as shin spots. This is the most common cutaneous finding in patients with diabetes mellitus, presenting in up to half of diabetic patients.

Learnings/What to Look for

  • While there is no clear variation of incidence between diabetic dermopathy in patients with noninsulin-dependent diabetes mellitus vs insulin-dependent diabetes mellitus, a correlation exists between presence of skin lesions and the presence of microangiopathic complications (retinal, neuropathic, and/or nephrogenic)
  • Incidence increases with age (seen more often in patients older than 50 years of age)
  • Although located bilaterally, the distribution of lesions is asymmetric in appearance
  • Lesions do not itch or cause pain
  • Poor long-term blood sugar control, which increases the risk of diabetic microangiopathic complications, is seen in diabetic dermopathy

Pearls for Urgent Care Management

  • Diabetic dermopathy is self-resolving, though lesions may take months or up to a year to resolve (or be “permanent”)
  • Moisturizer may be recommended if patches are dry or scaly
  • Patients should be counseled on maintaining adequate blood sugar testing and control

Acknowledgment: Image and case presented by VisualDx (www.VisualDx.com/JUCM).

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A 71-Year-Old with Diabetes and Discoloration of the Skin
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