Gerald is a 52-year-old IT technician who presents with a six-month history of otherwise asymptomatic pigmented spots on his shins.

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<p>Gerald is a 52-year-old IT technician who presents with a six-month history of otherwise asymptomatic pigmented spots on his shins. These evolved initially over 1-2 weeks. </p><p>There was no clear precipitating injury, exposure or illness. He does yard work rarely and wears long pants when he does.</p><p>Gerald has had type 2 diabetes for 15 years, with inconsistent adherence to therapy and follow-up.</p><p>He has had microalbuminuria for a year and at his last check-up six months ago his HbA1c was 9%.</p><p>His current medications are candesartan, hydrochlorothiazide, metformin, a sulfonylurea and semaglutide, the latter added at his last check-up. </p><p>On examination, Gerald’s BMI is 34kg/m2, BP is 145/92mmHg and there are multiple irregularly shaped, pigmented, atrophic pretibial patches.</p><p>Pedal pulses are present but there is reduced sensation to both soles, a new finding since his last review six months ago. </p>

Dr Kate Kelso is a GP and medical editor at Australian Doctor.