What Is Diabetic Dermopathy? A Histopathologic Study of 14 Necropsies
SI McCash, PA Lento, PO Emanuel. Mount Sinai Medical Center, New York, NY
Background: Diabetic dermopathy is a common, however, nebulous and poorly understood entity seen as round, pigmented macules located on the anterior surface of the lower legs of diabetic patients. The clinical features have - in the past - been attributed to localized stasis dermatitis, arteriolosclerosis, and capillaritis.
Design: Skin biopsies of lesions of diabetic dermopathy were taken from 14 autopsies and examined histologically. Their diabetic status was determined from chart review. They were examined for histologic features, hemosiderin deposition, melanin deposition, and intimal thickening of the small vessels. Each were graded on a three tier system: mild, moderate, and severe. PAS and Fontana stains were done to evaluate for intimal thickening and melanin deposition, respectively. Comparison of the degree of intimal thickening was done between vessels in the skin and those in the kidneys.
Results: All patients had significant arteriolonephrosclerosis, however - surprisingly - only 2 cases exhibited intimal cutaneous arteriolar thickening in PAS stain. Iron deposition was noted in 9 cases. Ten samples were positive for mild to moderate positivity with Masson-Fontana stain. Nine cases were positive for melanin and iron. Five cases demonstrated the same dermal deposit with positivity for both melanin and iron stains. Only two cases had histologic features of stasis dermatitis.
Conclusions: The results suggest that microangiopathy does not play a significant role in the pathogenesis of diabetic dermopathy. Deposition of material which stained with both melanin and iron stains was a common finding. This histologic finding is characteristic of ingestion of certain medications which raises the possibility of this disorder being related to medication ingestion.
Wednesday, March 24, 2010 9:30 AM
Poster Session V # 20, Wednesday Morning