Skin rash, sometimes, is not due to a dermatological disorder but many systemic diseases can manifest as skin rash.
Rash on the shin in systemic disorders has a narrow differential so let’s proceed to this topic..
The differential diagnosis of skin lesions on the shin includes mainly four conditions:
- Erythema nodosum
- Pretibial myxoedema
- Pyoderma Gangrenosum
- Necrobiosis lipoidica dibeticorum
1. Erythema nodosum
Erythema nodosum is a symmetrical, erythematous, tender nodular rash, which heals without scarring.
The most common causes of erythema nodosum are:
– Streptococcal infections
– Sarcoidosis
– Inflammatory bowel disease (IBD)
– Drugs – penicillins, sulphonamides, or oral contraceptive pills (OCPs).
2. Pretibial myxoedema
This rash appears as shiny, orange peel skin. These are symmetrical, erythematous lesions seen in Graves’ disease.
3. Pyoderma gangrenosum
Initially, pyoderma gangrenosum appears as a small, red papule. Later on, it becomes a deep, red, necrotic ulcer with a violaceous border.
It is idiopathic in 50% of cases, and may also be seen in inflammatory bowel disease (IBD), connective tissue disorders, and myeloproliferative disorders.
4. Necrobiosis lipoidica diabeticorum
Necrobiosis lipoidica diabeticorum is a shiny, painless area of yellow-red skin typically on the shin seen in diabetic patients. It is often associated with telangiectasia.
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