Key points

• Insect stings can produce intensive erythema and oedema in the diabetic lower limb with local histamine release

• Long term there can be severe postinflammatory hyperpigmentation

Fig. 4.36 I ttucm wiivi ouaivcu ma ivjui m uui watcx. i lie resulting burns became secondarily infected leading to gangrene of the toes.

Fig. 4.37 Severe reaction following insect sting showing extent of inflammatory response.

• When swelling of the leg is persistent, it is wise to investigate for deep vein thrombosis.

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