12 Dec 2014

Skin manifestations of diabetes

In diabetes various skin manifestations are seen. The altered carbohydrate-lipid metabolism, lesions in the small blood vessels and, neural involvement all these may be associated with skin lesions. The common  skin manifestations are given below.
Most common skin manifestations in diabetes is delayed woud healing and skin ulceration. Chronic bacterial infection of the skin occur, especially in uncontrolled diabetes. There is increased chance of infection with staphylococcus, coliform, and pseudomonal infection.

Candidal infection (fungal) is more common in diabetic patients. It cause redness and edema in the area below breast, between fingers and in axilla. In uncontrolled diabetes candidal vulvovaginitis is commom. It produce pruritus.

Hypertriglyceridemia can produce Eruptive xanthomas if the glycemic control is poor.
Xerosis (dryness of skin ) and pruritus is common in diabetes, and moisturizers are used to relieve them.
Vitiligo (area of hypopigmentation ) is more common in type 1 diabetes.
Acanthosis nigricans (hyperpigmented velvety lesions seen in the neck, axilla, or extensor
surfaces) is a feature of insulin resistance

Specific skin lesions of diabetes
Diabetic dermopathy
Also called as Shin spots or diabetic skin spots They are seen in the legs over the shin and rarely on the thighs and forearms. More common in elderly men with a sex ratio 2:1, start as red area which later becomes circular hyperpigmented lesion. This  lesions is due to  minor mechanical trauma in the shin region
Granuloma annulare
They are circular raised lesion seen in the hands and feet. Other areas affected are elbow  knee and ankle. They start as raised area later fuse to form the circular lesion may be single or multiple. More common in women below 30 yrs. It may be associated with insulin dependent diabetes mellitus. This is a self limiting condition that clears over 2-3 yrs.
Necrobiosis lipoidica diabeticorum
An unusual lesion over the legs or ankle. Shin region is the most common site. It is an oval or irregular plaque with distinct bordes and glistening yellow surface. More common in women. These lesions rarely resolve.
Necrobiosis lipoidica diabeticorum
Diabetic bullae (bullosis diabeticorum seen  in longstanding diabetes  with diabetic neuropathy. They have rapid  origin seen in the toes, foot, and fingers. The blisters are tense, and the content may be serous and sometimes haemorrhagic fluid.

Lipoatrophy and lipohypertrophy may be seen at insulin injection sites but  now a days incidence is low with the use of human insulin. 

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