B15. Cutaneous manifestation of diabetes mellitus

Diabetes mellitus (DM) is a group of disorders characterised by chronic hyperglycaemia due to abnormal carbohydrate metabolism. There are many types, but the most common types are type 1 diabetes mellitus and type 2 diabetes mellitus. DM is a very common disease, and the most common form, type 2, is associated with inactivity and obesity, which are increasing globally. Chronic hyperglycaemia causes severe long-term and short-term complications which may be lethal or cause significant morbidity.

Cutaneous manifestations

30% of all diabetes patients will experience skin symptoms
Non-specific skin conditions
- Impetigo
- Candida intertrigo
- Psoriasis
- Necrotizing fasciitis
- Acanthosis nigricans
Specific skin conditions
- Diabetic dermopathy
  - Reddish, oval/round scaly patches
  - Often on the shins
- Diabetic bullae
  - Painless bullae
  - Can be very large
  - Intraepidermal bullae
    - More common
    - Filled with clear fluid
    - Heal without scarring or atrophy
  - Subepidermal bullae
    - Less common
    - Filled with blood
    - Heal with scarring and atrophy
- Diabetic sclerosis
  - In diabetes type 1
  - Sclerosis of finger skin -> restricted mobility
- Foot ulcers (diabetic foot)
- Necrobiosis lipoidica diabeticorum
  - Erythematous patches on lower legs
  - May ulcerate and become infected