Abstract
The diabetic state is usually manifested by the well-known vascular lesions occurring in the eye and kidney. However, there is also a skin manifestation with striking hues of brown, red, yellow, and purple due to vascular damage, which clamors for attention. This lesion is not only a sign of overt diabetes, but also of the "prediabetic" state and may occur several years before any abnormality in carbohydrate metabolism can be found. Necrobiosis lipoidica diabeticorum (NLD) usually appears in the pretibial region as an asymptomatic, nonulcerating, sclerotic plaque. Brownishred coloration gradually gives way to the more characteristic yellows and purples. Fine telangiectatic vessels can be seen through an atrophic "glazed" surface covered by slight scale (Figure,<i>left</i>). Occasionally more wide-spread lesions occur (Figure,<i>center</i>). A biopsy specimen is diagnostic when necrobiotic collagen surrounded by a granulomatous response, thickened vessel walls, and positive fat stains are found. About 60% of people with
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