LAUSR

A 42-year-old man of South-Asian descent with insulin-dependent type 2 diabetes mellitus presented with a 2year history of an asymptomatic hyperpigmented plaque on his lower abdomen. He described a 10-year regimen of self-injecting insulin aspart, 60 U, and insulin detemir, 120 U, subcutaneously, twice daily to his lower abdominal area exclusively without rotating areas of injections. Clinical examination found an extensive diffuse hyperpigmented and hyperkeratotic dark-brown corrugated plaque on his lower abdomen (Fig 1). A skin biopsy from the abdominal plaque found epidermal hyperplasia and mild hyperkeratosis (Fig 2).