Diabetics are prone to bilateral skin lesions on the lower legs. These lesions often correlate with the presence of diabetic microangiopathy.


Location: bilateral, affecting the front and sides of both lower legs (pretibial region, over the shins)


Clinical features:

(1) The lesions initially appear as multiple small, reddish brown scaly papules and small plaques.

(2) With time the lesions evolve into circumscribed round to oval shallow brown pigmented atrophic scars.

(3) The lesions are usually asymptomatic.


Biopsy of the lesions shows intimal thickening in small arterioles and capillaries with PAS-positive material in the vessel walls.


Differential diagnosis:

(1) necrobiosis lipoidica diabeticorum

(2) lesions associated with peripheral vascular disease

(3) purpura

(4) traumatic scarring


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