Dermatology: Practical and Conceptual


Image Letter | Dermatol Pract Concept. 2022;12(4):e2022185 1

Dermoscopy of Diabetic Dermopathy
Montserrat Navarro-Gilo1, Nuria Alberti-Masalleras2, Mercedes de Gea-Fernández1,  

Anna Domingo3, Marc Sagristà3

1 EAP, Pineda de mar, Spain

2 EAP, Tordera, Spain

3 Sant Jaume de Calella Hospital, Calella, Spain

Citation: Navarro-Gilo M, Alberti-Masalleras N, de Gea-Fernández M, Domingo A, Sagristà M. Dermoscopy of diabetic dermopathy. 
Dermatol Pract Concept. 2022;12(4):e2022185. DOI: https://doi.org/10.5826/dpc.1204a185

Accepted: March 23, 2022; Published: October 2022

Copyright: ©2022 Navarro-Gilo et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, 
distribution, and reproduction in any medium, provided the original authors and source are credited.

Funding: None.

Competing interests: None.

Authorship: All authors have contributed significantly to this publication.

Corresponding author: Marc Sagristà, Department of Dermatology and Venereology, Sant Jaume de Calella Hospital, C/Sant Jaume, 
209-217. Calella, Spain. E-mail address: marc_sagrista@yahoo.es

Figure 1. (A) Clinical picture. (B) Dermoscopic image shows two central areas (inside blue dotted-line) surrounded by an ill-defined brown periph-

eral rim. (C) High magnification dermoscopic image. “Ring-like” globular structures can be identified in the brown peripheral rim (black arrows). 

Fine scarcely branching linear vessels (white arrows) are separated by blurred grayish-white streaks (*) which look like dusky Wickham striae.

Case presentation

A 43-year-old man presented with asymptomatic multiple, 

bilateral, small, brown macules on pretibial areas which had 

been present for the last 3 years (Figure 1A). The patient was 

diagnosed with type 2 diabetes 18 years ago, with associated 

retinopathy and nephropathy.



2 Image Letter | Dermatol Pract Concept. 2022;12(4):e2022185

Dermoscopic evaluation of the lesions revealed a distinc-

tive pattern which was characterized by a one or multiple cen-

tral area/s surrounded by an ill-defined brown peripheral rim 

(Figure 1B). “Ring-like” globular structures could be identi-

fied in the brown peripheral rim. Finally, central areas dermo-

scopically demonstrated several fine scarcely branching linear 

vessels separated by blurred greyish-white streaks which re-

sembled dusky Wickham striae (Figure 1C).

The diagnosis of diabetic dermopathy was confirmed by 

histopathological assessment. These dermoscopic features show 

an excellent correlation with histologic findings [1,2]. Thus, the 

greyish-white color of the central area probably corresponds to 

increased collagen density and fibroblastic proliferation, and 

the fine branching vessels probably are telangiectasias in the 

papillary dermis underlying an atrophic epidermis. The brown 

peripheral rim can be explained by hemosiderin deposition in 

dermis and increased melanin of basal cells.

Teaching point

Dermoscopic features of diabetic dermopathy (as described 

above) are different from other diseases that can also pres-

ent with pretibial pigmented patches, such as early lesions 

of necrobiosis lipoidica, pigmented purpuric dermatosis or 

lichen planus.

References

1. Morgan AJ, Schwartz RA. Diabetic dermopathy: A subtle sign with 

grave implications. J Am Acad Dermatol. 2008;58(3):447-451. 

DOI: 10.1016/j.jaad.2007.11.013. PMID: 18155320.

2. Naik PP, Farrukh SN. Clinical Significance of Diabetic Derma-

topathy. Diabetes Metab Syndr Obes. 2020;13: 4823-4827. 

DOI: 10.2147/DMSO.S286887. PMID: 33324080. PMCID: 

PMC7733392.