Large plaques in a patient with diabetes

Abstract

CASEA 35-year-old white woman was admitted to the hospital after an episode of diabetic ketoacidosis (DKA) that was treated per protocol. Physical examination revealed mild hirsutism and the presence of large plaques about 10 cm by 2 to 4 cm (3.9 by 0.8 to 1.6 inches) in size with irregular brownish borders and telangiectatic, somewhat atrophic centers on the bilateral pretibial surfaces (Figure 1). The lesions were not tender upon palpation. The patient said that the lesions developed several years before she was diagnosed with diabetes and have progressively enlarged.

An uncommon initial presentation of a common disease

“…Possible treatment includes topical glucocorticoids, tacrolimus, and tretinoin, intralesional triamcinolone, and systemic hydroxychloroquine. The successful use of TNF alpha inhibitors has also been reported (2)(3)(4). Our patient was treated with moisturizers and 0.03% tacrolimus ointment (Protopic) with limited clinical improvement.…”