~Dr Edward Chao
While we frequently discuss the macrovascular and microvascular complications of diabetes, there are also dermatologic conditions related to this disease. I’d like to highlight 3 of these issues relating to diabetes and skin complications in particular. While one is relatively uncommon, keep these in mind – you may impress your friends, see this in your next medical Jeopardy session, or even a board exam.
1. Necrobiosis lipoidica diabeticorum (NLD)
These are shiny patches that begin as an elevated, red nodule with an irregular border.1 NLD then becomes yellow-brown, with only the periphery remaining red, and gradually enlarges over months to years. Lesions can ulcerate though they are asymptomatic.
NLD is found in ~0.3% of patients with diabetes; it tends to occur in women (3:1); The etiology is unclear. Treatment is often ineffective. Corticosteroids, both topical and intralesional, can mitigate the inflammation of early lesion, but have less impact on atrophic lesions. Surgical treatment is an option, but lesions can recur due to underlying vascular damage.
Photo: Barnes, CJ. Necrobiosis Lipoidica. Medcape.http://emedicine.medscape.com/article/1103467-overview#a4http://emedicine.medscape.com/article/1103467-overview#a4. Accessed: August 1, 2015.
2. Diabetic dermopathy
These asymptomatic, round, brown lesions (usually < 1 cm in diameter) are the most common dermatological condition in individuals with diabetes.2 Diabetic dermopathy is due to changes to the vasculature to the skin. Up to 55% of patients with diabetes have these. This condition is more common in those with longer duration of diabetes, and in those >50 years of age. Diabetic dermopathy tends to occur over the anterior lower extremities. Treatment is neither effective nor recommended.
Photo: http://www.skinsight.com/adult/diabeticDermopathy.htm. Accessed August 23, 2015.
3. Diabetic bullae
Also known as bullosis diabeticorum or bullous disease of diabetes, these blisters spontaneously occur and spontaneously resolve in approximately 2-6 weeks without scarring, for reasons unknown.3 These benign, noninflammatory lesions tend to be large, asymmetrical, and are most often found on the lower extremities. Diabetic bullae tend to occur predominantly in men who have had diabetes for a long period.
Interestingly, glycemic control does not appear to correlate with whether these blisters develop. A significant number of patients with bullosis diabeticorum have neuropathy or nephropathy. The blister should be undisturbed to prevent secondary infections from occurring; no treatment is recommended unless these infections arise. These lesions may recur in the same or different areas.
Photo: Poh-Fitzpatrick, MB. Bullous disease of diabetes. Medscape. http://emedicine.medscape.com/article/1062235-overview. Accessed: August 8, 2015.
1. Kota SK, Jammula S, Kota SK, Meher LK, Modi KD. Necrobiosis lipoidica diabeticorum: A case-based review of literature. Indian J Endocrinol Metab. 2012 Jul. 16(4):614-20.
2. McGeorge S, Walton S. Diabetic dermopathy. Br J of Diabetes and Vascular Disease. 2014;14(3):95-97.
3.Basarab T, Munn SE, McGrath J, Russell Jones R. Bullosis diabeticorum. A case report and literature review. Clin Exp Dermatol. 1995;20:218-220.
Dr. Chao practices at the VA San Diego Healthcare System and is Associate Clinical Professor of Medicine at the University of California, San Diego. He received his medical degree from the University of New England College of Osteopathic Medicine. He completed residency in internal medicine at Loma Linda University Medical Center and fellowship in endocrinology and metabolism at the University of California, San Diego. Dr. Chao’s interests include diabetes research and medical education. He was recently elected to the UCSD Academy of Clinician Scholars.