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Chapter 45: Cutaneous Manifestations of Diabetes Mellitus

INTRODUCTION

KEY POINTS

  • Diabetes mellitus (DM) can have various cutaneous manifestations, which include acanthosis nigricans, necrobiosis lipoidica diabeticorum (NLD), and diabetic dermopathy.

  • Acanthosis nigricans (AN) is commonly seen on the neck and intertriginous sites and presents with velvety lichenified plaques that can be accompanied by acrochordons. In lighter skin, AN can be tan to dark brown, and in darker skin, it can be dark brown to black.

  • NLD presents with atrophic patches on the shins, which in lighter skin can be brawny to pink-brown, while in darker skin, they tend to be orange-yellow. It can also have underlying vasculature and background erythema, which is often less visible in darker skin.

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FIGURE 45-1.

Light-brown velvety plaque with background erythema and overlying pink and dark-brown acrochordons and seborrheic keratoses, respectively. (From Taylor SC, Kelly AP, Lim HW, et al. Taylor and Kelly’s Dermatology for Skin of Color, 2nd ed. New York, NY: McGraw Hill; 2016, Figure 68-9. Reproduced with permission from Visual Dx.)

A patient with light brown skin with a hyperpigmented light brown velvety patch on the neck. On top of and adjacent to the patch are skin colored acrochordons and hyperpigmented dark brown papules.
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FIGURE 45-2.

Dark-brown to black velvety plaque with overlying pedunculated dark-brown acrochordons. (From Usatine RP, Smith MA, Mayeaux EJ Jr, et al. The Color Atlas and Synopsis of Family Medicine, 3rd ed. New York, NY: McGraw Hill; 2019, Figure 228-4. Reproduced with permission from Richard P. Usatine, MD.)

A patient with a hyperpigmented, dark brown, velvety patch and dark colored acrochordons spread along the neck.
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FIGURE 45-3.

Velvety thickened tan plaque along the lateral neck with overlying and adjacent skin-colored acrochordons. (From Ali A. McGraw-Hill Education Specialty Board Review Dermatology: A Pictorial Review, 3rd ed. New York, NY: McGraw Hill; 2015, Figure 23-8. Reproduced with permission from Dr. Asra Ali.)

The posterior neck shows small round hyperpigmented, velvety plaques representing acanthosis nigricans.
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FIGURE 45-4.

Yellow-brown atrophic and hypopigmented waxy plaques with subtle visible vasculature on the bilateral anterior shins. (Reproduced with permission from Kane KS, Nambudiri VE, Stratigos AJ. Color Atlas & Synopsis of Pediatric Dermatology, 3rd ed. New York, NY: McGraw Hill; 2017, Figure 18-2.)

A patient with brown skin exhibits large hypopigmented yellow to light brown plaques with visible vasculature throughout on the bilateral anterior shins.
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FIGURE 45-5.

Pink-brown atrophic plaques with marked visibility of underlying vasculature and background erythema. (From Usatine RP, Smith MA, Mayeaux EJ Jr, et al. The Color Atlas and Synopsis of Family Medicine, 3rd ed. New York, NY: McGraw Hill; 2019, Figure 231-1. Reproduced with permission from Suraj Reddy, MD.)

A patient exhibits large, circular, brown patches with visible veins and erythema on both the knees.
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