Download Diabetic Skin Disease

ADVANCED FOOT AND ANKLE SPECIALISTS, PA
Jay S. Weingarten, DPM, FACFAS, FACFAOM
Podiatric Physician and Surgeon
Board Certified Physician – Treating Pediatrics to Geriatrics
Diabetic Skin Disease
Malignant Melanoma
Pigmented lesions should always be inspected and observed. Most pigmented
areas are nothing but freckles and moles. However a potentially deadly
pigmented lesion that can occur on the foot and lower extremity is Malignant
Melanoma. A physician should evaluate any pigmented lesion that suddenly
occurs or a pigmented lesion that starts to change its appearance. These changes
are usually subtle and may consist of increased size and depth of color, onset of
bleeding, seepage of clear fluid, tumor formation, ulceration and formation of
satellite pigmented lesions. The color is usually not uniform but is likely to be
scattered irregularity, being brown, bluish black or black. An increase in
pigmentation may precede enlargement of the lesion by several months.
Although any part of the body may be affected, the most frequent site is the foot,
then in order of frequency, the remainder of the lower extremity, head and neck,
abdomen, arms and back. Malignant melanoma may also form under the nails of
the feet and hands. The thumb and big toe are more commonly affected than the
other nails. Quite often the adjacent skin to the nail is ulcerated. Usually a fungal
infection is suspected and antifungal treatment may be administered for months
before the true nature of the lesion is discovered. A black malignant melanoma of
the toe can also be mistaken for gangrene. Overall, the incidence of malignant
melanoma is quite low. Surgical treatment is required or death is eminent.
Actinic Keratosis
Another cancer causing lesion that can occur on the feet are called Actinic
Keratosis. Although most commonly found in sun-exposed areas of the body
such as the face, ears, and back of the hands, these lesion can also occur on the
foot. Some patient call them barnicles. They are characterized as either flat or
elevated with a scaly surface. They can either be reddish or skin colored. On the
foot they are frequently mistaken for plantars warts. These lesions are the
precursor of epidermoid carcinoma. Treatment for these lesions should be
through as they are definitely precancerious. Treatment consists of freezing the
lesions with liquid nitrogen or sharp excision.
Kaposi's Sarcoma
Yet another cancerous lesion that can occur on the foot is called Kaposi's
Sarcoma. These lesions occur most commonly on the soles of the feet They are
irregular in shape and have a purplish, reddish or bluish black appearance. They
tend to spread and form large plaques or become nodular. The nodular lesions
have a firm rubbery appearance. The appearance of these lesions is an ominous
sign. In the late 1970's and early 1980's an outbreak of Kaposi's sarcoma
occurred in San Francisco, California. It was later learned that the disease was
associated with AIDS infection. It can occur without the concurrent AIDS infection
but this is very rare.
Chronic athlete's foot can cause an increased pigmentation to the bottom of the
foot. It is associated with dry scaling skin and may have a reddish appearance.
Venous Stasis
Generalized increased pigmentation occurs for a variety of other reasons. Dark
patches of skin occur about the ankles and lower legs in persons who suffer from
Venous Stasis. Venous stasis is caused by an accumulation of fluid in the lower
extremities. This is due to poor venous return of blood to the heart. Venous blood
flow back to the heart occurs by way of the veins in the feet and legs. Venous
stasis is associated with varicose veins that do a poor job of returning blood to
the heart. As a result the blood flow is slowed, becomes stagnant, and fluid
accumulates in the ankles and lower legs. As the fluid accumulates in the lower
legs, the small and medium-sized veins break or leak fluid into the tissues. As
blood cells break up in the tissue, they deposit the iron that is part of hemoglobin
in the blood cell. The iron stains the skin causing a light to dark brownish
appearance. With time, the skin and subcutaneous fat becomes thinned and will
break down creating weeping venous stasis ulcerations. At times, blistering will
form with a clear, watery fluid weeping from the skin. This condition requires
professional attention by a physician.
Diabetic Dermopathy
Another cause of generalized increased pigmentation is diabetes. The condition
termed Diabetic Dermopathy occurs most frequently on the shins and lower
legs. They may have the appearance of small scars. Their appearance may
precede the diagnosis of diabetes by several years. The actual cause of diabetic
dermopathy is not well understood, but it does not cause any particular problem
or pose any particular health threat.
Spider Veins:
Small, spider-like areas of increased pigmentation on the ankles are caused by
the break down of small veins in the area and are called Spider Veins; they also
pose no health risks
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