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Diabetic Man With Pruritic Pretibial Rash

Diabetic Man With Pruritic Pretibial Rash

 

HISTORY

A 69-year-old man seen because of a pruritic pretibial rash of 3 months' duration. Started as reddish brown papules that slowly enlarged and changed.

Type 2 diabetes mellitus for 10 years, treated with metformin, 500 mg bid; fairly good glycemic control. Nonsmoker; past health otherwise unremarkable.

PHYSICAL EXAMINATION

Several well circumscribed, brownish plaques in the left pretibial area. Borders somewhat raised, a bit firm, and more deeply pigmented than centers. Central atrophy with depression below the level of the skin surface in some lesions.

Physical examination apart from the skin, normal.
 

WHAT'S YOUR DIAGNOSIS?

(Answer and discussion on next page.)

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