- Affects shin of insulin-dependent diabetics.
- Can also occur in non-diabetic patients.
- One or more tender yellowish brown patches develop over months.
- May be round, oval or an irregular shape.
- They may persist for years.
- The centre of the patch becomes shiny, pale, thinned, with telangiectasia.
- Painless ulcers can occur when patch is injured.
- Topical steroids if border is raised and mauve.
- Cosmetic camouflage.
- Ulcers that are difficult to heal may require protective dressing, systemic steroids or skin graft.
- Itchy rash on the lower legs.
- Preceded by 'venous' or 'stasis' eczema.
- Affected leg is swollen after standing and in hot weather.
- Dermatitis can be discrete patches or circumferential.
- Lower leg is red and scaly, and may ooze, crust and ulcerate.
- Complications are cellulitis, lichenification, hyperpigmentation and lipodermatosclerosis.
- Avoid standing for long time.
- Use moisturising cream.
- Walk regularly.
- When sitting elevate feet above hips.
- Elevate foot end of bed when sleeping.
- Compression stocking unless contraindicated by Doppler.
- Dry up oozing patches with Condy's solution (potassium permanganate).
- Topical steroid and coal tar ointment.
- Antibiotics for secondary infection.
Text contributed by Dr Vasa Gnanapragasam, a GP in Sutton, Surrey.