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Diabetic with unusual skin lesions

Discussion in 'Diabetic Foot & Wound Management' started by Mark Russell, Apr 14, 2008.

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    50+ y/o Type II dietary controlled diabetic presenting with irregular skin lesions on R/F sub 3 & 4 met heads. Lesions are slightly opaque/white with irregular margins, giving slight discomfort on weightbearing. Present for over a year. Any ideas?

    Attached Files:

  2. drsarbes

    drsarbes Well-Known Member

    they appear to be early verrucae formations.
    Shave a little off, punctate bleeding is diagnostic. Also squeeze them, if this is more painful then simply apply pressure this also indicates warts.
    I don't think they are anything more "exotic" - sorry!

  3. Not verrucae, Steve - not painful on lateral pressure and no thrombi capillaries. I thought perhaps an epidermoid or sebaceous cyst, but I have not seen any on the plantar aspect of the foot before - and there is no punctum. Debride the area and the epidermis is waxy in appearance but still intact - complete debridment removes the plaques, but they return within a few days.

    Attached Files:

  4. mifiros

    mifiros Member

    How about xanthomas? They occur in relation to systemic hypercholesterolaemia.
  5. DTT

    DTT Well-Known Member

    Hi Mark

    Do they correspond with 3/4 met heads on weightbearing ?? They look slightly distal in the picture.

    Does the Pt wear any forefoot padding ??

  6. Hello Derek

    They are distal to the met heads and no, the patient does not wear any forefoot padding.

    Kind regards

  7. DTT

    DTT Well-Known Member

    Hi Mark
    Back to the drawing board then:confused:

    I have had a couple of similar looking lesions in pts that had been wearing "Gel" PMP. The lesions were as you describe waxy, soggy but well defined.

    I advised against the gel padding and they went of their own accord.
    Sorry buddy worth a try
  8. Think the good money is on xanthomas - they were removed 9 months ago but returned again within 8 weeks. Sending her for some bloods.

  9. mifiros

    mifiros Member

    Hello Mark,

    Glad I could be of help; do let us know how it turns out.


  10. pd6crai

    pd6crai Active Member

    Would be interested to hear how this pans out and what the diagnosis is? I had a patient that had something very similar on his 2nd digit and the base of the nail. he had it months (nearly a year, no pain), and it kept returning. Unfortunately his ended in amputation, but we never found out the cause of this.
  11. Hi Mark

    Indeed you have 'boggled' our minds with this picture. I would like to know if these lesions are bilateral or not. I'm also not sure if by 'waxy appearance' you mean soft, atrophic and palpable, or there is a waxy discharge.

    From looking at the picture, it may or may not be associated with diabetes. If the lesions have an overlying hyperkeratosis, asymmetrical, with a large core of fibrous tissue - it could be a fibrous corn becoming neurofibrous if tender on palpation. But tenderness could also be due to weightbearing and hyperkeratosis on the area.

    My second diagnoses could either be Leucoderma-chemical leucoderma to be precise and /or vitiligo (acrofacial type). these conditions are characterized by marginated milky-white patches resulting from loss of melanocytes. Amongst others, these conditions are both associated with long standing diabetes mellitus and autoimmune disorders. Lesions may be symptomless unless, in this case they are on weightbearing areas.

    Hope this help

    Richard M - South Africa
  12. drsarbes

    drsarbes Well-Known Member

    Did the biopsy come back yet?
    I still think they look verrucoid.........
    my other "guess" would be a lipoidica or xanthoma type lesion.........but again, I'd still put my $$$ on Verrucae (since the dollar is weak right now)

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