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Dermopathy bệnh tiểu đường (Hình 10,10) trình bày như là sắc tố không có triệu chứng, sẩn có vảy và mảng bám trên ống quyển, do đó các bí danh 'shin điểm. Nó được phổ biến và xảy ra ở 24% bệnh nhân tiểu đường patients43 và 40% trên 50 years.44 của họ | 226 DIABETES AND THE SKIN probably represents under-reporting with one study finding the condition in 14 per cent of diabetic patients.37 Scleroedema is most common in obese noninsulin diabetics who are often difficult to control and go on to need insulin however it is not associated with an increase risk in other diabetic complications although this has not been universally found.37 Investigation should include an ASO titre and a screen for a paraproteinaemia to exclude other causes of the scleroedema. Treatment has been attempted with methotrexate38 and prostaglandin E1 39 but the most promising treatment is radiotherapy.40-42 10.7 Diabetic Dermopathy Diabetic dermopathy Figure 10.10 presents as asymptomatic pigmented scaly papules and plaques on the shins hence the alias shin spots . It is common and occurs in 24 per cent of diabetic patients43 and 40 per cent over 50 years.44 Their Figure 10.10 Diabetic dermopathy courtesy of Dr Richard Ashton Haslar Hospital Gosport importance is their link to other diabetic complications such as retinopathy neuropathy and nephropathy. They start as multiple small brown macules that develop fine scale and over a period of a few years will fade to leave subtle atrophic scars. At this stage they are difficult to see but because they are continually being produced it seems to the patient as if they do not go away. They are thought to be related to microangiopathy and endothelial basement membrane thickening with glycosylated collagen although a recent laser Doppler study demonstrated increased blood flow in the macules 45 this does not of course exclude a prior vascular insult. They are more common as the duration of diabetes increases. Since their first naming in 196546 they have been described in normal individuals. Treatment is unnecessary as they will resolve on their own but moisturization may help if symptoms are troublesome. INFECTIONS 227 10.8 Bullosis Diabeticorum Bullosis diabeticorum is rare 44 cases being reported .
