Thursday, 29 November 2012

ESDV Conference 2013 and Competition

The Egyptian Society of Dermatology and Venereology (ESDV) is a charity registered in Egypt. Charity Registration Number: 5085 (Date 8/2/2003).

Annual ESDV Conference 2013,
17-19 January 2013
Marriott Hotel, Zamalek, Cairo, Egypt

Win full ESDV Conference Registration in 2013 (17 - 19 January 2013) - A competition is published in the ESDV Discussion Forum, and Google Plus Conference Event Page (Ten Best of Five MCQs). First Ten Highest Scorers Will Win The Full Registration

This page was last updated in December 2012

Friday, 9 November 2012

Diabetic dermopathy

Diabetic dermopathy is the most common dermatosis associated with diabetes mellitus. It is found in up to 50% of diabetics, but being asymptomatic, it is commonly overlooked. Men are frequently affected more than women. It is seen more frequently in older patients, and in those who have had diabetes mellitus for a longer period of time.

It begins as flat-topped, dull-red papules that are oval, discrete or grouped, and situated mainly on the pretibial areas. Involvement of the forearms and thighs has been recorded. As the lesions evolve slowly, they develop a thin scale leaving an atrophic brownish scar-like macule, sometimes called diabetic shin spots or brown pseudoscars. The colour of the scar-like macules is due to haemosiderin in histiocytes near the vessels. It should be noted that such lesions are not specific to diabetes mellitus. However, if four or more are present the specificity is high for diabetes.

It has been suggested that the lesions represent an exaggerated response to trauma in skin overlying bony prominences and that there may be an underlying diabetic microangiopathy and neuropathy. When questioned patients are often unable to detail preceding trauma. Blood flow levels are considerably higher at the dermopathy sites than at contiguous uninvolved skin sites, refuting the theory that they are ischaemic in origin.

Although not confirmed in all studies, some suggest that there is a significant correlation between the presence of diabetic dermopathy and other complications of diabetes, such as retinopathy, nephropathy and neuropathy. This remains controversial and it is generally regarded that diabetic dermopathy is not directly associated with an increase in morbidity.

In the early lesions, there are oedema of the papillary dermis and a mild perivascular lymphocytic infiltrate with some extravasation of red blood corpuscles.  There may be mild epidermal spongiosis and focal parakeratosis. Hyaline microangiopathy can be seen leading to PAS-positive thickening of the vessel wall. In atrophic lesions there are neovascularization of the papillary dermis, a sparse perivascular infiltrate of lymphocytes, and haemosiderin in histiocytes. Haemosiderin can also be present in the epidermis, between basal cells and along the basement membrane.  Perivascular plasma cells can be seen whenever there is haemosiderin deposition in the skin.

No treatment is necessary for diabetic dermopathy. 

This page was last updated in November 2012

Main Works of Reference List (The first eight are my top favourites)

  • British National Formulary
  • British National Formulary for Children
  • Guidelines (BAD - BASHH - BHIVA - Uroweb)
  • Oxford Handbook of Genitourinary Medicine, HIV, and Sexual Health
  • Oxford Handbook of Medical Dermatology
  • Rook's Textbook of Dermatology
  • Simple Skin Surgery
  • Weedon's Skin Pathology
  • A Concise Atlas of Dermatopathology (P Mckee)
  • Andrews' Diseases of the Skin
  • Andrology (Nieschlag E FRCP, Behre M and Nieschlag S)
  • Bailey and Love's Short Practice of Surgery
  • Davidson's Essentials of Medicine
  • Davidson's Principles and Practice of Medicine
  • Fitzpatrick's Colour Atlas and Synopsis of Clinical Dermatology (Klaus Wolff FRCP and Richard Allen Johnson)
  • Fitzpatrick’s Dermatology in General Medicine
  • Ganong's Review of Medical Physiology
  • Gray's Anatomy
  • Hamilton Bailey's Demonstrations of Physical Signs in Clinical Surgery
  • Hutchison's Clinical Methods
  • Lever's Histopathology of the Skin
  • Lever's Histopathology of the Skin (Atlas and Synopsis)
  • Macleod's Clinical Examination
  • Martindale: The Complete Drug Reference
  • Oxford Handbook of Clinical Examination and Practical Skills
  • Oxford Textbook of Medicine
  • Practical Dermatopathology (R Rapini)
  • Sexually Transmitted Diseases (Holmes K et al)
  • Statistics in Clinical Practice (D Coggon FRCP)
  • Stockley's Drug Interactions
  • Treatment of Skin Disease: Comprehensive Therapeutic Strategies
  • Yen & Jaffe's Reproductive Endocrinology