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Alhammadi N, Al-Jallal M, AlKaabi HA, Malibari WM, Al Jallal RS, Almarshad AS, Binshalhoub FH, Albalawi AN, Adam TA, Al-Khairat AH. Prevalence and Factors Associated With Tinea Pedis Among Diabetic Patients in Saudi Arabia: A Descriptive Cross-Sectional Study. Cureus 2023; 15:e51210. [PMID: 38288233 PMCID: PMC10823190 DOI: 10.7759/cureus.51210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND It has been estimated that 30% of diabetic people experience dermatological problems. Fungal infections are the most frequent cause of these lesions. While tinea infections in non-diabetic individuals rarely cause symptoms, in diabetes patients, they can create fistulas and entry sites that can result in catastrophic bacterial infections. AIM This research paper aims to evaluate the prevalence and factors associated with tinea pedis among diabetic patients in Saudi Arabia. METHODS The research paper incorporated a cross-sectional study approach with the involvement of a questionnaire-based response aimed at all Saudi inhabitants with diabetes mellitus (DM) who conceded to be part of the study. This research was carried out from March 22, 2023, to May 22, 2023, spanning for three months. The participants who satisfied our requirements provided data using computerized Google Forms for data collection; no nominative information disseminated via social media platforms was visible. The three components of the questionnaire address diabetic information, tinea pedis infections, and foot care. RESULTS A total of 295 people with diabetes case were involved in the study. Among them, 149 (50.5%) were males, and their ages stretched from 16 to above 60 years, with a mean age of 49.5 ± 12.9 years old. A total of 194 (65.8%) of the study patients had type II DM. Of 134 (45.4%) were diagnosed with diabetes for more than 10 years. Exact 152 (52%) of the study diabetic patients were diagnosed with tinea pedis. Only patients' BMI showed a significant association with having tinea pedis as 47 of overweight diabetics were diagnosed with tinea pedis versus 47 of obese patients and only five patients of others who were underweight (p=0.049). CONCLUSION This research concluded that almost 50% of patients with diabetes were suffering from obesity and were earlier diagnosed with tinea pedis and poor glycemic control irrespective of reported good diabetic foot care.
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Affiliation(s)
| | | | | | | | - Rahaf S Al Jallal
- Radiology, Applied Medical Sciences, King Khalid University, Abha, SAU
| | | | - Fahad H Binshalhoub
- Medicine and Surgery, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | | | - Tahani A Adam
- Statistics and Operation Research, Qassim University, Buraydah, SAU
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Azuma H, Ikura K, Miura J, Babazono T. A fact-finding survey on pre-ulcerative lesions of foot in patients with diabetes: analysis using the Diabetes Study from the Center of Tokyo Women's Medical University 2018 (DIACET 2018). Diabetol Int 2023; 14:397-405. [PMID: 37781473 PMCID: PMC10533771 DOI: 10.1007/s13340-023-00649-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 07/05/2023] [Indexed: 10/03/2023]
Abstract
Aims/introduction We aimed to identify the frequency and risk factors of pre-ulcerative lesions of foot in Japanese individuals with diabetes. Materials and methods This was a single-center cross-sectional observational study. We conducted a questionnaire survey of 5029 individuals with diabetes (mean age 63 years; 2185 women; 1015 individuals with type 1 diabetes and 4014 individuals with type 2 diabetes) who (a) participated in the Diabetes Study from the Center of Tokyo Women's Medical University: DIACET 2018, and (b) responded to the presence of pre-ulcerative lesions of foot. A pre-ulcerative lesions of foot was defined as a calluses, ingrown nails, or symptoms of fungal infection. The associations between pre-ulcerative lesions of foot and commonly available clinical information were examined using the logistic regression analysis. Results 412 of 1015 (40.6%) individuals with type 1 diabetes and 1585 of 4014 (39.5%) individuals with type 2 diabetes reported having any type of pre-ulcerative lesions of foot. The frequency of calluses, ingrown nails, and symptoms of fungal infection, respectively, were 16.8%, 15.8%, and 21.9% in type 1 diabetes and 10.5%, 18.5%, and 24.7% in type 2 diabetes. In the separate analysis by type of diabetes, common risk factors found to be significantly correlated with pre-ulcerative lesions of foot were female gender, numbness in the feet and foot deformation. Conclusion Proactive foot screening by health care professionals was considered important, especially in individuals with type 1 and type 2 diabetes with advanced complications and foot deformation. Supplementary Information The online version contains supplementary material available at 10.1007/s13340-023-00649-7.
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Affiliation(s)
- Haruna Azuma
- Division of Diabetology and Metabolism Department of Internal Medicine, Tokyo Women’s Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666 Japan
| | - Kazuki Ikura
- Division of Diabetology and Metabolism Department of Internal Medicine, Tokyo Women’s Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666 Japan
| | - Junnosuke Miura
- Division of Diabetology and Metabolism Department of Internal Medicine, Tokyo Women’s Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666 Japan
| | - Tetsuya Babazono
- Division of Diabetology and Metabolism Department of Internal Medicine, Tokyo Women’s Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666 Japan
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Khalifa A, Alreshidi IG, Alaradi LA, Alrashidi YM. Tinea Unguium and Tinea Pedis and Their Correlation With Diabetes Mellitus in the General Population in the Hail Region, Saudi Arabia: A Cross-Sectional Study. Cureus 2023; 15:e40116. [PMID: 37425521 PMCID: PMC10329282 DOI: 10.7759/cureus.40116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 07/11/2023] Open
Abstract
Background Tinea pedis or foot ringworm is an infection of the feet affecting the soles, interdigital clefts of toes, and nails, with a dermatophyte fungus. It is also called athlete's foot. Onychomycosis of the nail is caused by dermatophytes called Tinea unguium. An abnormal nail not caused by a fungal infection is a type of dystrophic nail. Onychomycosis can infect both fingernails and toenails, but onychomycosis of the toenail is much more prevalent. Aim The study aimed to assess the knowledge, perception, and awareness among a sample from Ha'il City, Saudi Arabia, of the definitions, risk factors, symptoms, diagnosis, complications, and treatment of both Tinea pedis and Tinea unguium, along withtheir correlation with diabetic patients. Material A cross-sectional survey was distributed throughout Ha'il City. An online questionnaire was designed and distributed via various social media apps, which included questions concerning participants' sociodemographic information, alongside questions regarding the risk factors, signs, symptoms, complications, and management of both Tinea pedis and Tinea unguium. Methods SPSS for Windows v22.0 (IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.) was used for statistical analysis. Results The overall awareness of the study's participants about Tinea Pedis and Tinea unguium infection was low (34.82%).
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Evaluation of Immunomodulatory Responses and Changed Wound Healing in Type 2 Diabetes-A Study Exploiting Dermal Fibroblasts from Diabetic and Non-Diabetic Human Donors. Cells 2021; 10:cells10112931. [PMID: 34831154 PMCID: PMC8616411 DOI: 10.3390/cells10112931] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 11/16/2022] Open
Abstract
The dermis is the connective layer between the epidermis and subcutis and harbours nerve endings, glands, blood vessels, and hair follicles. The most abundant cell type is the fibroblast. Dermal fibroblasts have a versatile portfolio of functions within the dermis that correspond with different types of cells by either direct contact or by autocrine and paracrine signalling. Diabetic skin is characterized by itching, numbness, ulcers, eczema, and other pathophysiological changes. These pathogenic phenotypes have been associated with the effects of the reactive glucose metabolite methylglyoxal (MGO) on dermal cells. In this study, dermal fibroblasts were isolated from diabetic and non-diabetic human donors. Cultured dermal fibroblasts from diabetic donors exhibited reduced insulin-induced glucose uptake and reduced expression of the insulin receptor. This diabetic phenotype persists under cell culture conditions. Secretion of IL-6 was increased in fibroblasts from diabetic donors. Increased secretion of IL-6 and MIF was also observed upon the treatment of dermal fibroblasts with MGO, suggesting that MGO is sufficient for triggering these immunomodulatory responses. Remarkably, MIF treatment resulted in decreased activity of MGO-detoxifying glyoxalase-1. Given that reduced glyoxalase activity results in increased MGO levels, these findings suggested a positive-feedback loop for MGO generation, in which MIF, evoked by MGO, in turn blocks MGO-degrading glyoxalase activity. Finally, secretion of procollagen Type I C-Peptide (PICP), a marker of collagen production, was reduced in fibroblast from diabetic donors. Remarkably, treatment of fibroblasts with either MGO or MIF was sufficient for inducing reduced PICP levels. The observations of this study unravel a signalling network in human dermal fibroblasts with the metabolite MGO being sufficient for inflammation and delayed wound healing, hallmarks of T2D.
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Engineering of diseased human skin equivalent using 3D cell printing for representing pathophysiological hallmarks of type 2 diabetes in vitro. Biomaterials 2021; 272:120776. [PMID: 33798956 DOI: 10.1016/j.biomaterials.2021.120776] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/26/2021] [Accepted: 03/21/2021] [Indexed: 02/06/2023]
Abstract
Despite many significant advances in 3D cell printing for skin, a disease model displaying the pathological processes present in the native skin has not been reported yet. Therefore, we were motivated for modeling a 3D diseased skin tissue with pathophysiological hallmarks of type 2 diabetes in vitro based on 3D cell printing technique. By stimulating epidermal-dermal intercellular crosstalk found in the native skin, it was hypothesized that normal keratinocytes would be differentiated as diabetic epidermis when interacting with the diabetic dermal compartment. To prove this, a novel wounded skin model was successfully devised during tissue maturation in vitro. Interestingly, the slow re-epithelization was observed in our diabetic model, which is a representative hallmark of diabetic skin. Using the versatility of 3D cell printing, the structural similarities and diabetic properties of the model were further augmented by addition of perfusable vascularized diabetic hypodermis. Insulin resistance, adipocyte hypertrophy, inflammatory reactions, and vascular dysfunction, as the typical hallmarks in diabetes, were found under hyperglycemia. Finally, the feasibility of this new disease model for drug development was successfully demonstrated through application of test drugs. We trust that this study provides a pioneering step towards 3D cell printing-based in vitro skin disease modeling.
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Casadei G, Filippini M, Brognara L. Glycated Hemoglobin (HbA1c) as a Biomarker for Diabetic Foot Peripheral Neuropathy. Diseases 2021; 9:16. [PMID: 33671807 PMCID: PMC8006047 DOI: 10.3390/diseases9010016] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Diabetic peripheral neuropathy (DPN) is known to predict foot ulceration, lower-extremity amputation and mortality. Patients with diabetes mellitus have a predisposition toward developing chronic inflammatory demyelinating polyneuropathy, and this may also facilitate the formation of diabetic foot and cutaneous impairment, which are considered one of the most serious impairments of diabetes mellitus, with a prevalence of 4-10% in this population. Biomarkers research provides opportunities for the early diagnosis of these complications for specific treatments useful to prevent amputation and, therefore, physical inability and mental disturbance. The recent literature has suggested that glycemic levels may be a novel factor in the pathogenesis of diabetic foot complications and is an important mediator of axonal dysfunction. The aim of this systematic literary review is to determine whether hemoglobin A1c (HbA1c) is a positive predictor for diabetic foot peripheral neuropathy and its complications, such as foot cutaneous impairments. There is a lack of consensus regarding the effect of glycemic variability on diabetic foot peripheral neuropathy, unlike other complications such as retinopathy, nephropathy or micro/macrovascular pathology Methods: Relevant articles were searched in the Medline database using PubMed and Scopus and relevant keywords. The primary search terms used were "glycated hemoglobin" OR "HbA1c" AND "diabetic neuropathies" AND "Foot". RESULTS A number of articles (336) were initially identified while searching the scientific literature regarding this topic, and 32 articles were selected and included in this review. CONCLUSIONS This review highlights the role of HbA1c in diabetic foot peripheral neuropathy. Biomarkers play an important role in the decision-making process, and HbA1c levels are extensively used for diabetic foot clinical outcomes and settings, but biomarker research in diabetic foot peripheral neuropathy is in its infancy and will require careful attention to a number of factors and associations, since the consequences of DPN also include neurological alterations. HbA1c is an accurate and easy-to-administer test and can be an effective biomarker in establishing the diagnosis of diabetes, but future research should focus on standardizing the HbA1c level and selecting which DPN value and its correlated complications, such as foot cutaneous impairments, are the most informative.
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Affiliation(s)
- Giulia Casadei
- Medical Clinic of Doctor Accorsi, Via della Ghisiliera 5, 40123 Bologna, Italy; (G.C.); (M.F.)
| | - Marta Filippini
- Medical Clinic of Doctor Accorsi, Via della Ghisiliera 5, 40123 Bologna, Italy; (G.C.); (M.F.)
| | - Lorenzo Brognara
- Department of Biomedical and Neuromotor Science, University of Bologna, Via Ugo Foscolo 7, 40123 Bologna, Italy
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Salari N, Hosseinian-Far A, Hosseinian-Far M, Kavoussi H, Jalali R, Vaisi-Raygani A, Rasoulpoor S, Rasoulpoor S, Mohammadi M, Shabani S. Evaluation of skin lesions in diabetic patients: a systematic review and meta-analysis. J Diabetes Metab Disord 2020; 19:1909-1916. [PMID: 33520868 PMCID: PMC7843671 DOI: 10.1007/s40200-020-00629-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/04/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUD Prevalence of skin lesions among diabetic patients is a major health concern. Therefore, this systematic review and meta-analysis study was conducted to determine the prevalence of skin lesions in diabetic patients. METHODS To identify and select relevant articles, the SID, MagIran, IranMedex, IranDoc, Google Scholar, Cochrane, Embase, ScienceDirect, Scopus, PubMed, and Web of Science (WoS) databases were searched without a lower time limit and until April 2020. The random effects model was used to perform the analysis, and the heterogeneity of studies was assessed using the I2 index. Data were analyzed within the Comprehensive Meta-Analysis (Version 2) software. RESULTS After evaluating the 22 final articles with a total sample size of 8406, the prevalence of skin lesions among diabetes patients were found as 70.3% (95% CI: 63-76.7%). Moreover, according to the meta-regression analysis, the effect of 'sample size' on th prevalence of skin lesions was significantly different in diabetes patients (p < 0.05). CONCLUSION The results of this study show that skin lesions are common in diabetes patients. Therefore, appropriate policies needs to be adopted to improve the situation and to monitor patients and outcomes at all levels.
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Affiliation(s)
- Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Amin Hosseinian-Far
- Department of Business Systems & Operations, University of Northampton, Northampton, UK
| | - Melika Hosseinian-Far
- Department of Food Science & Technology, Ferdowsi University of Mashhad (FUM), Mashhad, Iran
| | - Hossein Kavoussi
- Department of Dermatology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Rostam Jalali
- Medical Biology Research Centre, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Aliakbar Vaisi-Raygani
- Medical Biology Research Centre, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shabnam Rasoulpoor
- Medical Biology Research Centre, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shna Rasoulpoor
- Medical Biology Research Centre, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Mohammadi
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shervin Shabani
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
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The Association between Cognitive Impairment and Diabetic Foot Care: Role of Neuropathy and Glycated Hemoglobin. PATHOPHYSIOLOGY 2020; 27:14-27. [PMID: 35366252 PMCID: PMC8830443 DOI: 10.3390/pathophysiology27010003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/23/2020] [Accepted: 11/23/2020] [Indexed: 12/29/2022] Open
Abstract
Diabetes mellitus is associated with impairment in cognitive functions which can complicate adherence to self-care behaviors. We evaluated the incidence of cognitive impairment in patients with diabetes mellitus to determine the strength of the association between diabetic foot (a complication that occurs in about 10% of diabetic patients), adherence to the clinician’s recommendations, glycemic control, and cognitive function. A prospective study was carried out in a probabilistic sample of older patients with diabetic foot living in three nursing homes. Cognitive functions were evaluated by the MMSE (Mini-Mental State Examination), the Trail Making test (TMT), and the Michigan neuropathy screening instrument (MNSI). There were no significant associations between cognitive function and neuropathy or foot alterations, although glycated hemoglobin (HB1Ac > 7%) significantly (p < 0.05) associated with MMSE and adherence to treatment in the 1 month follow-up visit. Receiver operating characteristic curve analysis showed that both HB1Ac and the MNSI score significantly (p < 0.05) discriminate subsequent adherence to treatment for foot complication, with a sensitivity of 80.0–73.3% and specificity 70.6–64.7%, respectively. Proper control of foot complications in diabetic patients involves appropriate glycemic control and less severe neuropathy, and seems to be unrelated to cognitive dysfunction, and warrants further studies in order to tailor appropriate treatments to central and peripheral nervous system disorders. Poor glycemic control (Hb1Ac level > 7%) and a neuropathy score of 5.5 in the MNSI are the best-cut off points to discriminate poor adherence to the clinician’s recommendations for self-care behaviors in people with diabetic foot complication. In this study, we observed that foot disorders were associated with impaired global cognitive function in elderly patients (aged ≥ 65). Podiatrists and physicians should consider cognitive dysfunction as an important chronic complication in the management of diabetic foot.
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von Krogh F, Zink A. [Diabetes mellitus - the skin as a monitor]. MMW Fortschr Med 2020; 162:49-53. [PMID: 32124344 DOI: 10.1007/s15006-020-0219-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
| | - Alexander Zink
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein Fakultät für Medizin, Technische Universität München, Biedersteiner Straße 29, D-80802, München, Deutschland.
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Berezhnoi A, Aguirre J, Hindelang B, Garzorz-Stark N, Omar M, Darsow U, Eyerich K, Ntziachristos V. Optical features of human skin revealed by optoacoustic mesoscopy in the visible and short-wave infrared regions. OPTICS LETTERS 2019; 44:4119-4122. [PMID: 31465343 DOI: 10.1364/ol.44.004119] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 07/15/2019] [Indexed: 06/10/2023]
Abstract
Detailed assessment of skin conditions or the efficacy of skin treatments could greatly benefit from noninvasively assessing the distribution of cutaneous and subcutaneous structures and biomolecules. We considered ultrawideband raster scan optoacoustic mesoscopy with an extended wavelength range from visible to short-wave infrared and observed previously unseen high-resolution images of lipids colocalized with water, melanin, and hemoglobin distribution in human skin. Based on this contrast, the technique resolves subcutaneous fat, the pilosebaceous unit with complete hair strand and bulb, dermal microvasculature, and epidermal structures. We further visualize melanoidins that form via the Maillard reaction in the ultrathin stratum corneum layer, analyze their absorption spectrum, and separate them from the melanin layer. The suggested method may allow novel interrogation of skin conditions, possibly impacting diagnostics and medical and cosmetic treatments.
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Prevalence Study of Dermatologic Manifestations among Diabetic Patients. Adv Prev Med 2019; 2019:5293193. [PMID: 31355008 PMCID: PMC6634127 DOI: 10.1155/2019/5293193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/19/2019] [Accepted: 02/12/2019] [Indexed: 11/24/2022] Open
Abstract
Background Diabetes mellitus (DM) is an interdisciplinary disorder that needs many different specialties' attention; however, the importance of dermatologists' knowledge has not been highlighted regarding this issue. As a result, we aim to assess the prevalence and variety of DM skin and nail manifestations in an effort to further acquaint dermatologists and other clinicians with diabetic dermatologic manifestations. Methods This was a cross-sectional study; subjects who had a diagnosis of DM, attending to the outpatient endocrinology clinics of Rassoul Akram Hospital, Tehran, Iran, were evaluated by one dermatologist for diabetic dermopathy. The results were recorded in prepared data sheets, and general descriptions of DM duration, DM type, DM control, and drug history as well as the demographic data were gathered. Results Among a total of 255 subjects, the prevalence of one or more identifiable skin conditions was 88.4%. 15.7% of the subjects had nail manifestations. Among cutaneous manifestations, acanthosis nigricans, acral erythema, and onychoschizia showed a significant relationship with the age and disease duration (p<0.05); and knuckle pebbles, eczema, facial erythema, and koilonychias had a meaningful relationship with FBS level and glycated hemoglobin, HbA1c (p<0.05). Conclusion This study provides an overview that facilitates earlier detection and treatment of DM. Also, this data can help physicians and endocrinologists to visualize DM control level.
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Abstract
The skin barrier is mainly present in the stratum corneum (SC), composed of corneocytes surrounded by intercellular lipid lamellae, and attached by corneodesmosome. The tight junction attached to the lateral walls of keratinocytes in the upper part of the stratum granulosum is also included in the skin barrier. During aging, the following structures and functions of the skin barrier are changed or disturbed: (1) skin barrier structure, (2) permeability barrier function, (3) epidermal calcium gradient, (4) epidermal lipid synthesis and SC lipid processing, (5) cytokine production and response after insults, (6) SC acidity, (7) SC hydration, and (8) antimicrobial barrier. Patients with diabetes also show changes in the skin barrier similar to those in aged skin, and the characteristics of the skin barrier are very similar. Understanding the pathogenic mechanisms of the skin barrier in aging will permit us to develop therapeutic strategies for aged or diabetic skin.
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Affiliation(s)
- Eung Ho Choi
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Korea.
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13
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Reichert O, Fleming T, Neufang G, Schmelz M, Genth H, Kaever V, Wenck H, Stäb F, Terstegen L, Kolbe L, Roggenkamp D. Impaired glyoxalase activity is associated with reduced expression of neurotrophic factors and pro-inflammatory processes in diabetic skin cells. Exp Dermatol 2018; 26:44-50. [PMID: 27306297 DOI: 10.1111/exd.13118] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2016] [Indexed: 12/18/2022]
Abstract
Patients suffering from type II diabetes develop several skin manifestations including cutaneous infections, diabetic dermopathy, diabetic bullae and acanthosis nigricans. Diabetic micro- and macroangiopathy as well as diabetic neuropathy are believed to play a crucial role in the development of diabetic skin disorders. A reduced cutaneous nerve fibre density was reported in diabetic subjects, which subsequently leads to impaired sensory nerve functions. Using an innervated skin model, we investigated the impact of human diabetic dermal fibroblasts and keratinocytes on porcine sensory neurons. Diabetic skin cells showed a reduced capacity to induce neurite outgrowth due to a decreased support with neurotrophic factors, such as NGF. Furthermore, diabetic keratinocytes displayed insulin resistance and increased expression of pro-inflammatory cytokines demonstrating the persistent effect of diabetes mellitus on human skin cells. Dysregulations were related to a significantly reduced glyoxalase enzyme activity in diabetic keratinocytes as experimentally reduced glyoxalase activity mimicked the increase in pro-inflammatory cytokine expression and reduction in NGF. Our results demonstrate an impaired crosstalk of diabetic skin cells and sensory neurons favouring hypo-innervation. We suggest that reduced methylglyoxal detoxification contributes to an impaired neurocutaneous interaction in diabetic skin.
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Affiliation(s)
- Olga Reichert
- Research and Development, Beiersdorf AG, Hamburg, Germany
| | - Thomas Fleming
- Department of Medicine I and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany
| | - Gitta Neufang
- Research and Development, Beiersdorf AG, Hamburg, Germany
| | - Martin Schmelz
- Department of Anesthesiology Mannheim, Heidelberg University, Mannheim, Germany
| | - Harald Genth
- Institute of Toxicology, Hannover Medical School, Hannover, Germany
| | - Volkhard Kaever
- Institute of Pharmacology, Hannover Medical School, Hannover, Germany
| | - Horst Wenck
- Research and Development, Beiersdorf AG, Hamburg, Germany
| | - Franz Stäb
- Research and Development, Beiersdorf AG, Hamburg, Germany
| | - Lara Terstegen
- Research and Development, Beiersdorf AG, Hamburg, Germany
| | - Ludger Kolbe
- Research and Development, Beiersdorf AG, Hamburg, Germany
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Moazzami B, Razavi N, Babaei M, Haghparast M, Bayani MA. The association between Solar Lentigines and Type-2 Diabetes. CASPIAN JOURNAL OF INTERNAL MEDICINE 2017; 8:317-320. [PMID: 29201325 PMCID: PMC5686313 DOI: 10.22088/cjim.8.4.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Limited information exists between the associations of diabetes mellitus (DM) and solar lentigo (SL); a benign, common skin lesion characterized by hyperpigmented macules. Methods This study was conducted on 90 patients diagnosed with DM and their age and sex matched controls who were referred to the Departments of Endocrinology at Babol University of Medical Science in Northern of Iran from January 2013 to December 2015. All demographic data including age, gender, occupation, family history of DM, estimated average sun exposure and presence of skin lesions were collected and analyzed. Results Presence of SL was significantly higher among patients with DM compared to controls (61.9% vs 33.6%, P<0.001). After adjusting for age, sex and sun exposure rate, results indicated that DM was independently associated with the presence of SL (p=0.002). Stratifying patients based on gender, indicated that DM was significantly associated with SL in females (p=0.03), but not in male patients (p=0.06). Conclusion The findings of the present study indicate that DM is an independent risk factor for the occurrence of SL lesions. These findings could represent a novel association between DM as a chronic oxidation state and SL as an early sign of aging.
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Affiliation(s)
- Bobak Moazzami
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran.,Department of Rheumatology, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Niloofar Razavi
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Mansour Babaei
- Department of Rheumatology, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Motahareh Haghparast
- Department of Internal Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Mohammad Ali Bayani
- Department of Internal Medicine, Babol University of Medical Sciences, Babol, Iran
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Mendes AL, Miot HA, Haddad V. Diabetes mellitus and the skin. An Bras Dermatol 2017; 92:8-20. [PMID: 28225950 PMCID: PMC5312172 DOI: 10.1590/abd1806-4841.20175514] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 06/29/2016] [Indexed: 11/22/2022] Open
Abstract
Several dermatoses are routinely associated with diabetes mellitus, especially in patients with chronic disease. This relationship can be easily proven in some skin disorders, but it is not so clear in others. Dermatoses such necrobiosis lipoidica, granuloma annulare, acanthosis nigricans and others are discussed in this text, with an emphasis on proven link with the diabetes or not, disease identification and treatment strategy used to control those dermatoses and diabetes.
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Affiliation(s)
- Adriana Lucia Mendes
- Department of Clinical Medicine - Faculdade de Medicina de Botucatu - Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP) - Botucatu (SP), Brazil
| | - Helio Amante Miot
- Department of Dermatology and Radiotherapy - Faculdade de Medicina de Botucatu - Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP) -Botucatu (SP), Brazil
| | - Vidal Haddad
- Department of Dermatology and Radiotherapy - Faculdade de Medicina de Botucatu - Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP) -Botucatu (SP), Brazil
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16
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Skin changes in streptozotocin-induced diabetic rats. Biochem Biophys Res Commun 2017; 490:1154-1161. [DOI: 10.1016/j.bbrc.2017.06.166] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 06/27/2017] [Indexed: 12/12/2022]
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17
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Abnormal skin in toe webs is a marker for abnormal glucose metabolism. A cross-sectional survey among 1,849 adults in Finland. Sci Rep 2017; 7:9125. [PMID: 28831117 PMCID: PMC5567349 DOI: 10.1038/s41598-017-09354-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/26/2017] [Indexed: 12/16/2022] Open
Abstract
Diabetes is undiagnosed disease and easy screening tools for it are warranted. Because foot complications are usual in diabetes, we aimed to test hypothesis that skin abnormalities are found already from patients who are not aware of having diabetes, by studying the possible association between unhealthy toe web skin and abnormal glucose metabolism. 1,849 cases without previously diagnosed diabetes participated to the 46-year follow-up study of the Northern Finland Birth Cohort. A skin investigation was performed for all, and abnormal skin findings in toe web spaces were taken as explanatory variables. Abnormal glucose tolerance was the main outcome and it was tested with an oral glucose tolerance test (OGTT), glycosylated haemoglobin fraction (HbA1c) Values are numbers (percentages) of sub and fasting blood glucose. The participants who had any abnormal skin findings in toe webs were associated with 2.5-fold (OR 2.5, 95% CI 1.3–4.9) and 6-fold (OR 6.2, 1.4–27.6) increased risk of having previously undiagnosed diabetes detected by a 2-hour OGTT and HbA1c, respectively. The predictive power of toe web findings was comparable with FINDRISC score. Abnormal skin findings in the toe webs show increased risk of occult diabetes, and may, thus serve as an additional sign of undiagnosed diabetes.
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Abstract
Diabetes mellitus is a widespread endocrine disease with severe impact on health systems worldwide. Increased serum glucose causes damage to a wide range of cell types, including endothelial cells, neurons, and renal cells, but also keratinocytes and fibroblasts. Skin disorders can be found in about one third of all people with diabetes and frequently occur before the diagnosis, thus playing an important role in the initial recognition of underlying disease. Noninfectious as well as infectious diseases have been described as dermatologic manifestations of diabetes mellitus. Moreover, diabetic neuropathy and angiopathy may also affect the skin. Pruritus, necrobiosis lipoidica, scleredema adultorum of Buschke, and granuloma annulare are examples of frequent noninfectious skin diseases. Bacterial and fungal skin infections are more frequent in people with diabetes. Diabetic neuropathy and angiopathy are responsible for diabetic foot syndrome and diabetic dermopathy. Furthermore, antidiabetic therapies may provoke dermatologic adverse events. Treatment with insulin may evoke local reactions like lipohypertrophy, lipoatrophy and both instant and delayed type allergy. Erythema multiforme, leukocytoclastic vasculitis, drug eruptions, and photosensitivity have been described as adverse reactions to oral antidiabetics. The identification of lesions may be crucial for the first diagnosis and for proper therapy of diabetes.
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Mistry BD, Alavi A, Ali S, Mistry N. A systematic review of the relationship between glycemic control and necrobiosis lipoidica diabeticorum in patients with diabetes mellitus. Int J Dermatol 2017. [DOI: 10.1111/ijd.13610] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Bhavik D. Mistry
- Faculty of Medicine; University of British Columbia; Vancouver British Columbia Canada
| | - Afsaneh Alavi
- Department of Medicine (Dermatology); University of Toronto; Toronto Ontario Canada
| | - Saima Ali
- Faculty of Medicine; University of British Columbia; Vancouver British Columbia Canada
| | - Nisha Mistry
- Department of Medicine (Dermatology); University of Toronto; Toronto Ontario Canada
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20
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21
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Makrantonaki E, Jiang D, Hossini AM, Nikolakis G, Wlaschek M, Scharffetter-Kochanek K, Zouboulis CC. Diabetes mellitus and the skin. Rev Endocr Metab Disord 2016; 17:269-282. [PMID: 27432328 DOI: 10.1007/s11154-016-9373-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Diabetes is a debilitating, life-threatening disease accounting in 2015 for the death of 5 million people worldwide. According to new estimations, 415 million adults currently suffer from the disease, and this number is expected to rise to 642 million by 2040. High glucose blood levels also affect the skin among systemic organs, and skin disorders can often predict the onset of this metabolic disorder. In this review, we address the pathomechanistic effects of diabetes on the skin and give an overview on the most common skin diseases associated with diabetes.
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Affiliation(s)
- E Makrantonaki
- Department of Dermatology and Allergic Diseases, Universitätsklinikum Ulm, Life Science Building N27, James-Franck Ring/Meyerhofstrasse 11c, 89081, Ulm, Germany.
- Department of Dermatology, Venereology, Allergology and Immunology, Städtisches Klinikum Dessau, Dessau, Germany.
| | - D Jiang
- Department of Dermatology and Allergic Diseases, Universitätsklinikum Ulm, Life Science Building N27, James-Franck Ring/Meyerhofstrasse 11c, 89081, Ulm, Germany
| | - A M Hossini
- Department of Dermatology, Venereology, Allergology and Immunology, Städtisches Klinikum Dessau, Dessau, Germany
| | - G Nikolakis
- Department of Dermatology, Venereology, Allergology and Immunology, Städtisches Klinikum Dessau, Dessau, Germany
| | - M Wlaschek
- Department of Dermatology and Allergic Diseases, Universitätsklinikum Ulm, Life Science Building N27, James-Franck Ring/Meyerhofstrasse 11c, 89081, Ulm, Germany
| | - K Scharffetter-Kochanek
- Department of Dermatology and Allergic Diseases, Universitätsklinikum Ulm, Life Science Building N27, James-Franck Ring/Meyerhofstrasse 11c, 89081, Ulm, Germany
| | - C C Zouboulis
- Department of Dermatology, Venereology, Allergology and Immunology, Städtisches Klinikum Dessau, Dessau, Germany
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22
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Argyropoulos AJ, Robichaud P, Balimunkwe RM, Fisher GJ, Hammerberg C, Yan Y, Quan T. Alterations of Dermal Connective Tissue Collagen in Diabetes: Molecular Basis of Aged-Appearing Skin. PLoS One 2016; 11:e0153806. [PMID: 27104752 PMCID: PMC4841569 DOI: 10.1371/journal.pone.0153806] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 04/04/2016] [Indexed: 12/15/2022] Open
Abstract
Alterations of the collagen, the major structural protein in skin, contribute significantly to human skin connective tissue aging. As aged-appearing skin is more common in diabetes, here we investigated the molecular basis of aged-appearing skin in diabetes. Among all known human matrix metalloproteinases (MMPs), diabetic skin shows elevated levels of MMP-1 and MMP-2. Laser capture microdissection (LCM) coupled real-time PCR indicated that elevated MMPs in diabetic skin were primarily expressed in the dermis. Furthermore, diabetic skin shows increased lysyl oxidase (LOX) expression and higher cross-linked collagens. Atomic force microscopy (AFM) further indicated that collagen fibrils were fragmented/disorganized, and key mechanical properties of traction force and tensile strength were increased in diabetic skin, compared to intact/well-organized collagen fibrils in non-diabetic skin. In in vitro tissue culture system, multiple MMPs including MMP-1 and MM-2 were induced by high glucose (25 mM) exposure to isolated primary human skin dermal fibroblasts, the major cells responsible for collagen homeostasis in skin. The elevation of MMPs and LOX over the years is thought to result in the accumulation of fragmented and cross-linked collagen, and thus impairs dermal collagen structural integrity and mechanical properties in diabetes. Our data partially explain why old-looking skin is more common in diabetic patients.
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Affiliation(s)
- Angela J. Argyropoulos
- Department of Psychiatry, University of Washington, Seattle, Washington, United States of America
| | - Patrick Robichaud
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Rebecca Mutesi Balimunkwe
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Gary J. Fisher
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Craig Hammerberg
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Yan Yan
- Department of Dermatology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Taihao Quan
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- * E-mail:
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Ramirez HA, Liang L, Pastar I, Rosa AM, Stojadinovic O, Zwick TG, Kirsner RS, Maione AG, Garlick JA, Tomic-Canic M. Comparative Genomic, MicroRNA, and Tissue Analyses Reveal Subtle Differences between Non-Diabetic and Diabetic Foot Skin. PLoS One 2015; 10:e0137133. [PMID: 26318001 PMCID: PMC4552836 DOI: 10.1371/journal.pone.0137133] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 08/12/2015] [Indexed: 12/24/2022] Open
Abstract
Diabetes Mellitus (DM) is a chronic, severe disease rapidly increasing in incidence and prevalence and is associated with numerous complications. Patients with DM are at high risk of developing diabetic foot ulcers (DFU) that often lead to lower limb amputations, long term disability, and a shortened lifespan. Despite this, the effects of DM on human foot skin biology are largely unknown. Thus, the focus of this study was to determine whether DM changes foot skin biology predisposing it for healing impairment and development of DFU. Foot skin samples were collected from 20 patients receiving corrective foot surgery and, using a combination of multiple molecular and cellular approaches, we performed comparative analyses of non-ulcerated non-neuropathic diabetic foot skin (DFS) and healthy non-diabetic foot skin (NFS). MicroRNA (miR) profiling of laser captured epidermis and primary dermal fibroblasts from both DFS and NFS samples identified 5 miRs de-regulated in the epidermis of DFS though none reached statistical significance. MiR-31-5p and miR-31-3p were most profoundly induced. Although none were significantly regulated in diabetic fibroblasts, miR-29c-3p showed a trend of up-regulation, which was confirmed by qPCR in a prospective set of 20 skin samples. Gene expression profiling of full thickness biopsies identified 36 de-regulated genes in DFS (>2 fold-change, unadjusted p-value ≤ 0.05). Of this group, three out of seven tested genes were confirmed by qPCR: SERPINB3 was up-regulated whereas OR2A4 and LGR5 were down-regulated in DFS. However no morphological differences in histology, collagen deposition, and number of blood vessels or lymphocytes were found. No difference in proliferative capacity was observed by quantification of Ki67 positive cells in epidermis. These findings suggest DM causes only subtle changes to foot skin. Since morphology, mRNA and miR levels were not affected in a major way, additional factors, such as neuropathy, vascular complications, or duration of DM, may further compromise tissue's healing ability leading to development of DFUs.
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Affiliation(s)
- Horacio A. Ramirez
- Human Genetics and Genomics Graduate Program in Biomedical Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
- Wound Healing and Regenerative Medicine Research Program, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School Of Medicine, Miami, FL, United States of America
| | - Liang Liang
- Wound Healing and Regenerative Medicine Research Program, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School Of Medicine, Miami, FL, United States of America
| | - Irena Pastar
- Wound Healing and Regenerative Medicine Research Program, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School Of Medicine, Miami, FL, United States of America
| | - Ashley M. Rosa
- Wound Healing and Regenerative Medicine Research Program, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School Of Medicine, Miami, FL, United States of America
| | - Olivera Stojadinovic
- Wound Healing and Regenerative Medicine Research Program, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School Of Medicine, Miami, FL, United States of America
| | - Thomas G. Zwick
- University of Miami Hospital, UM Health System, Miami, FL, United States of America
| | - Robert S. Kirsner
- Wound Healing and Regenerative Medicine Research Program, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School Of Medicine, Miami, FL, United States of America
- University of Miami Hospital, UM Health System, Miami, FL, United States of America
| | - Anna G. Maione
- Cell, Molecular, Developmental Biology, Tufts University, Sackler School of Graduate Biomedical Sciences, Boston, MA, United States of America
- Department of Oral and Maxillofacial Pathology, Oral Medicine and Craniofacial Pain School of Dental Medicine, Tufts University, Boston, MA, United States of America
| | - Jonathan A. Garlick
- Cell, Molecular, Developmental Biology, Tufts University, Sackler School of Graduate Biomedical Sciences, Boston, MA, United States of America
- Department of Oral and Maxillofacial Pathology, Oral Medicine and Craniofacial Pain School of Dental Medicine, Tufts University, Boston, MA, United States of America
| | - Marjana Tomic-Canic
- Human Genetics and Genomics Graduate Program in Biomedical Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
- Wound Healing and Regenerative Medicine Research Program, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School Of Medicine, Miami, FL, United States of America
- * E-mail:
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24
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Knaś M, Wołosik K, Zalewska A, Mikucka-Niczyporuk A, Kasacka I, Niczyporuk M. The skin remodeling in type 1 diabetes and insulin resistance animal models. Physiol Res 2015; 64:875-81. [PMID: 26047379 DOI: 10.33549/physiolres.932991] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The skin matrix metalloproteinase 3, tissue inhibitors of matrix metalloproteinase 2 and collagen III content changes in type 1 diabetes and insulin resistance treated with insulin and metformin were studied. Healthy adult male Wistar rats were obtained from experimental animal house, Department of Experimental Pharmacology, Medical University in Bialystok. The rats were divided randomly into five groups of 8 rats each. Control rats were injected intraperitoneally by NaCl. Type IDDM was induced by a single injection of Streptozocin. Insulin resistance was induced by a high-fat diet. The chosen groups of rats were also treated with insulin or metformin. ELISA Kits (USCN Life Science, China) were used to measure content of matrix metallo-proteinase 3 (ELISA Kit for Matrix Metalloproteinase 3 - MMP3), tissue inhibitor of matrix metalloproteinase 2 (ELISA Kit for Tissue Inhibitors of Metalloproteinase 2 - TIMP2) and content of collagen type 3 (ELISA Kit for Collagen Type III - COL3). The results were reported as a median. The statistical significance was defined as p<0.05. Type 1 diabetes and insulin resistance have significantly reduced the quality of the skin, shown by the increase in content of matrix metalloproteinase 3 and the decrease in content of tissue inhibitors of matrix metalloproteinase 2. Type 1 diabetes and insulin resistance have reduced the quality of the skin expressed by type III collagen content decrease but for future studies it is recommend to determine rat interstitial collagenase, MMP-13, as well. Insulin and metformin treatment improved the quality of the diabetic skin, demonstrated by the type III collagen content increase.
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Affiliation(s)
- M Knaś
- Institute of Health Care, Higher Vocational School, Suwalki, Poland; Research Laboratory of Cosmetology, Medical University of Bialystok, Poland.
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25
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Tseng HW, Ger LP, Liang CK, Liou HH, Lam HC. High prevalence of cutaneous manifestations in the elderly with diabetes mellitus: an institution-based cross-sectional study in Taiwan. J Eur Acad Dermatol Venereol 2014; 29:1631-5. [PMID: 25178455 DOI: 10.1111/jdv.12664] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 06/25/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUNDS Diabetes mellitus (DM) is a common endocrine disorder and an increasing epidemic worldwide. Proportional diabetic patients eventually develop cutaneous diseases. OBJECTIVES This study determined the statistical association of cutaneous manifestations and DM as well as the DM-associated cutaneous manifestations in elderly male residents. METHODS A cross-sectional study was conducted in a Veterans Home in Taiwan. The cutaneous manifestations and major systemic diseases of the residents were recorded separately. Univariate logistic regression and multivariate analysis after adjustment for age, body mass index and significant major systemic diseases provided odds ratios and P values for the statistical association. RESULTS A total of 313 male residents (age ≥65 years) were recruited, including 70 (22.4%) with DM. Their most common cutaneous manifestations included fungal infection (77%) and brown spots on the legs (38.3%). Chronic ulcers adjusted odds ratios (AOR 4.90, 95%CI: 1.82-13.19; P = 0.002), brown spots on the legs (AOR 6.82, 95%CI: 3.60-12.89; P < 0.001) and pruritus (AOR 12.86, 95%CI: 4.40-37.59; P < 0.001) were significantly associated with DM. The diabetic residents were inclined to have chronic ulcers, brown spots on the legs and pruritus at a 7.46-fold higher risk (AOR 7.46, 95%CI: 3.86-14.43; P < 0.001). The diabetic residents exhibited marginally higher risks of bacterial infection, scabies, or skin tags. CONCLUSION The DM-associated cutaneous manifestations were chronic ulcers, brown spots on the legs, and pruritus. By observing clues of diabetic cutaneous features, a more complete condition of diabetic patients can be appreciated. The information is essential for providing appropriate treatment and key nursing points regarding the diabetes-associated skin diseases.
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Affiliation(s)
- H-W Tseng
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Department of Nursing, Meiho University, Neipu, Pingtung, Taiwan
| | - L-P Ger
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - C-K Liang
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Division of Neurology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - H-H Liou
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - H-C Lam
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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26
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Murphy-Chutorian B, Han G, Cohen SR. Dermatologic manifestations of diabetes mellitus: a review. Endocrinol Metab Clin North Am 2013; 42:869-98. [PMID: 24286954 DOI: 10.1016/j.ecl.2013.07.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Diabetes mellitus affects every organ of the body including the skin. Certain skin manifestations of diabetes are considered cutaneous markers of the disease, whereas others are nonspecific conditions that occur more frequently among individuals with diabetes compared with the general population. Diabetic patients have an increased susceptibility to some bacterial and fungal skin infections, which account, in part, for poor healing. Skin complications of diabetes provide clues to current and past metabolic status. Recognition of cutaneous markers may slow disease progression and ultimately improve the overall prognosis by enabling earlier diagnosis and treatment.
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27
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Piérard GE, Seité S, Hermanns-Lê T, Delvenne P, Scheen A, Piérard-Franchimont C. The skin landscape in diabetes mellitus. Focus on dermocosmetic management. Clin Cosmet Investig Dermatol 2013; 6:127-35. [PMID: 23696712 PMCID: PMC3658433 DOI: 10.2147/ccid.s43141] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Some relationships are established between diabetes mellitus (DM) and a series of cutaneous disorders. Specific dermatoses are markers for undiagnosed DM. Other disorders represent supervening complications in an already treated DM patient. Objective To review the information about dermocosmetic care products and their appropriate use in the management and prevention of dermatoses related to DM. Method The peer-reviewed literature and empiric findings are covered. Owing to the limited clinical evidence available for the use of dermocosmetics, a review of the routine practices and common therapies in DM-related dermatoses was conducted. Results Some DM-related dermatoses (acanthosis nigricans, pigmented purpuric dermatosis) are markers of macrovascular complications. The same disorders and some others (xerosis, Dupuytren’s disease) have been found to be more frequently associated with microangiopathy. Other skin diseases (alopecia areata, vitiligo) were found to be markers of autoimmunity, particularly in type 1 DM. Unsurprisingly, using dermocosmetics and appropriate skin care has shown objective improvements of some DM-related dermatoses, such effects improve the quality of life. The most common skin manifestations of DM fall along continuum between “dry skin,” xerosis, and acquired ichthyosis, occurring predominately on the shins and feet. Dermocosmetic products improve the feeling of well-being for DM patients.
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Affiliation(s)
- Gérald E Piérard
- Laboratory of Skin Bioengineering and Imaging (LABIC), University of Liège, Liège, Belgium
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28
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Daly SM, Leahy MJ. 'Go with the flow ': a review of methods and advancements in blood flow imaging. JOURNAL OF BIOPHOTONICS 2013; 6:217-55. [PMID: 22711377 DOI: 10.1002/jbio.201200071] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 05/22/2012] [Accepted: 05/23/2012] [Indexed: 05/25/2023]
Abstract
Physics has delivered extraordinary developments in almost every facet of modern life. From the humble thermometer and stethoscope to X-Ray, CT, MRI, ultrasound, PET and radiotherapy, our health has been transformed by these advances yielding both morphological and functional metrics. Recently high resolution label-free imaging of the microcirculation at clinically relevant depths has become available in the research domain. In this paper, we present a comprehensive review on current imaging techniques, state-of-the-art advancements and applications, and general perspectives on the prospects for these modalities in the clinical realm.
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Affiliation(s)
- Susan M Daly
- Biophotonics Research Facility, Department of Physics & Energy, University of Limerick, Ireland.
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29
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Federici A, Federici G, Milani M. An urea, arginine and carnosine based cream (Ureadin Rx Db ISDIN) shows greater efficacy in the treatment of severe xerosis of the feet in Type 2 diabetic patients in comparison with glycerol-based emollient cream. A randomized, assessor-blinded, controlled trial. BMC DERMATOLOGY 2012; 12:16. [PMID: 23009311 PMCID: PMC3506450 DOI: 10.1186/1471-5945-12-16] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 09/20/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND Xerosis is a common skin disorder frequently observed in diabetic patients. An effective hydration of foot skin in diabetics is a relevant preventive strategy in order to maintain a healthy foot. Urea is considered an effective hydrating and emollient topical product. The aim of the present study was to evaluate the efficacy of topical urea 5% with arginine and carnosine (Ureadin Rx Db, ISDIN Spain) (UC) in comparison with glycerol-based emollient topical product (Dexeryl, Pierre Fabre) (EC), in Type 2 diabetic patients. METHODS We assessed the effect of UC on skin hydration in a randomized, evaluator-blinded comparative study in 40 type II diabetic patients, aged 40-75 years, treated with UC or the comparator for 28 days with a twice-daily application. The principal outcomes were the Dryness Area Severity Index (DASI) Score and the Visual Analogue Score (VAS) for skin dryness evaluated at baseline and at the end of study period by an investigator unaware of treatment allocation. RESULTS UC induced significantly greater hydration than EC with an 89% reduction in DASI score (from 1.6 to 0.2; p < 0.001) in comparison with baseline values. After 4 weeks, compared with the control group, DASI score in UC treated group was significantly lower (0.2 vs. 1.0; p = 0.048). VAS score (high values mean better hydration) significantly increased in both groups during treatment. VAS score at the end of treatment period was significantly higher in UC group in comparison with EC group (9.8 vs. 8.2; p = 0.05). CONCLUSION Application of urea 5%, arginine and carnosine cream increases skin hydration and alleviates the condition of skin dryness in Type 2 diabetic patients in comparison with a control glycerol-based emollient product. (Dutch Trials Register trial number 3328).
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30
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Niu Y, Cao X, Song F, Xie T, Ji X, Miao M, Dong J, Tian M, Lin Y, Lu S. Reduced Dermis Thickness and AGE Accumulation in Diabetic Abdominal Skin. INT J LOW EXTR WOUND 2012; 11:224-30. [DOI: 10.1177/1534734612457570] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Dermatological problems in diabetes might play an important role in the spontaneous ulcers and impaired wound healing that are seen in diabetic patients. Investigation of the cause of diabetic skin disorders is critical for identifying effective treatment. The abdominal full-thickness skin tissues of 33 patients (14 nondiabetic and 19 diabetic) were analyzed. The cell viability and malondialdehyde (MDA) production of fibroblasts were measured after advanced glycosylation end product (AGE)–bovine serum albumin (BSA) exposure. Cutaneous histological observation showed reduced thickness of the diabetic abdominal dermis with morphological characteristics of obscured multilayer epithelium and shortened, thinned, and disorganized collagen fibrils with focal chronic inflammatory cell infiltration when compared with controls of the same age. Accumulation of AGEs in diabetic skin was prominent. Less hydroxyproline, higher myeloperoxidase activity, and increased MDA content were detected in diabetic skin. In vitro, the time- and dose-dependent inhibitory effects of AGE-BSA on fibroblast viability as well as the fact that AGE-BSA could promote MDA production of fibroblasts were shown. It is shown that the accumulation of AGEs in diabetic skin tissue induces an oxidative damage of fibroblasts and acts as an important contributor to the thinner diabetic abdominal dermis. The authors believe that diabetic cutaneous properties at baseline may increase the susceptibility to injury, and diabetic wounds possess atypical origin in the repair process.
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Affiliation(s)
- Yiwen Niu
- Shanghai Jiao Tong University School of Medicine, Shanghai, Peoples’ Republic of China
| | - Xiaozan Cao
- Shanghai Jiao Tong University School of Medicine, Shanghai, Peoples’ Republic of China
| | - Fei Song
- Shanghai Jiao Tong University School of Medicine, Shanghai, Peoples’ Republic of China
| | - Ting Xie
- Shanghai Jiao Tong University School of Medicine, Shanghai, Peoples’ Republic of China
| | - Xiaoyun Ji
- Shanghai Jiao Tong University School of Medicine, Shanghai, Peoples’ Republic of China
| | - Mingyuan Miao
- Shanghai Jiao Tong University School of Medicine, Shanghai, Peoples’ Republic of China
| | - Jiaoyun Dong
- Shanghai Jiao Tong University School of Medicine, Shanghai, Peoples’ Republic of China
| | - Ming Tian
- Shanghai Jiao Tong University School of Medicine, Shanghai, Peoples’ Republic of China
| | - Yuan Lin
- The First Affiliated Hospital of Guangxi Medical University, Guangxi, Peoples’ Republic of China
| | - Shuliang Lu
- Shanghai Jiao Tong University School of Medicine, Shanghai, Peoples’ Republic of China
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31
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Drage LA, Bundrick JB, Litin SC. Clinical pearls in dermatology. Mayo Clin Proc 2012; 87:695-9. [PMID: 22683054 PMCID: PMC3498091 DOI: 10.1016/j.mayocp.2012.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 03/22/2012] [Accepted: 04/02/2012] [Indexed: 10/28/2022]
Affiliation(s)
- Lisa A Drage
- Department of Dermatology, Mayo Clinic, Rochester, MN 55905, USA.
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Abstract
Diabetes mellitus is the most common endocrine disorder with continuously increasing prevalence. Blood vessels, nerves, eyes, kidneys and skin are affected, which causes both an enormous financial burden and a reduced quality of life of the affected patients. Long-standing diabetes may impair skin homeostasis resulting in skin manifestations in at least one third of all diabetics. The skin involvement may be the first presenting sign of diabetes, thus the respective skin signs should lead to diabetes focused diagnostic. Besides, the skin signs may be considered as a marker for the course of the disease or for the success of therapeutic interventions.
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Affiliation(s)
- B Behm
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
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Abstract
Obesity is a serious global health problem, perhaps the biggest public health issue of our times. Excess body weight may be a factor in carcinogenesis in general, as well as contributing to the pathogenesis of metabolic, cardiovascular and musculoskeletal disorders. Obesity also has many cutaneous features, which form the basis for this review article. Many of these clinical entities are common to the majority of obese patients, e.g. striae distensae, plantar hyperkeratosis and an increased risk of skin infections. However, it may also be associated with poor wound healing, malignant melanoma and an increased risk of inflammatory dermatoses, such as psoriasis, as well as some rarer disorders. Therapeutic interventions for obesity, whether over-the-counter, prescription medicines or surgical interventions, are increasingly commonplace. All of these treatment modalities potentially have dermatological side-effects too.
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Affiliation(s)
- A R Shipman
- Department of Dermatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich NR4 7UY, UK
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34
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Abstract
The skin should not be considered as an isolated organ but rather as a definite functioning system that communicates with the internal environment. Skin signs of systemic diseases occur frequently and sometimes feature the first symptoms of an internal disease; furthermore, these manifestations may be the sole expressions of otherwise asymptomatic systemic disorders. A number of dermatologic signs, symptoms, and disorders can be invaluable as markers of systemic disease. Although a plethora of specialized modern diagnostic tests are available, the skin still remains the only organ of the body that is immediately and completely accessible to direct clinical examination. This contribution reviews the skin signs of systemic diseases. The description of the clinical features of skin lesions observed in several internal diseases will be useful to general physicians, internists, and dermatologists in the diagnosis of a systemic disease.
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Affiliation(s)
- Dimitris Rigopoulos
- Department of Dermatology, University of Athens, Andreas Sygros Hospital, 5th Ionos Dragoumi St, 16121 Athens, Greece.
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35
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Park HY, Kim JH, Jung M, Chung CH, Hasham R, Park CS, Choi EH. A long-standing hyperglycaemic condition impairs skin barrier by accelerating skin ageing process. Exp Dermatol 2011; 20:969-74. [DOI: 10.1111/j.1600-0625.2011.01364.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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36
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Seité S, Khemis A, Rougier A, Ortonne JP. Importance of treatment of skin xerosis in diabetes. J Eur Acad Dermatol Venereol 2011; 25:607-9. [PMID: 21492247 DOI: 10.1111/j.1468-3083.2010.03807.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cutaneous complications are common in diabetes patients and previous studies have shown that diabetes can affect some biophysical skin characteristics. However, the interest of emollients in diabetes has never been clearly demonstrated; i.e. whether they are able to limit skin complications in diabetes patients. OBJECTIVE The aim of this study was to evaluate the tolerance and the effect of an emollient on patient with diabetes. METHOD Forty patients with diabetes applied the emollient twice daily for 1 month on one arm and one leg, in normal conditions. RESULTS A 1-month treatment with an emollient allows a similar skin hydration rate in diabetics to that in healthy people. This dry skin improvement is accompanied by a significant reduction in pruritus and desquamation, and a significant improvement in the skin barrier function. CONCLUSION Emollient treatment can be useful in the management of diabetes by limiting skin complications associated with elevated blood sugar.
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Affiliation(s)
- S Seité
- La Roche-Posay Pharmaceutical Laboratories, Asnières, Hôpital L'Archet 2, Nice, France.
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37
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Abstract
Diabetic dermopathy presents as well-demarcated, hyperpigmented, atrophic depressions, macules or papules located on the anterior surface of the lower legs of diabetic patients. The histopathology remains poorly defined which may in part be due to the fact that the lesions are rarely biopsied. An advantage of studying autopsy material is the ease of obtaining large biopsy specimens. To further define the histopathological features of this entity, we studied tissue taken from characteristic lesions at autopsy. Inclusion criteria included the presence of the lesions and diabetes-related nephroarteriolosclerosis at autopsy. Surprisingly, only four out of 14 skin biopsies showed moderate to severe wall thickening of arterioles or medium-sized arteries on periodic acid Schiff (PAS) stains. Only mild basement membrane thickening was noted in 11 of 14 which was highlighted by the PAS stain. Pigmented material was identified within the dermis of 13 cases. In 10 of the cases, the material was positive for Perl's iron stain. Ten cases had material staining positive for Fontana-Masson in the dermis. Nine cases had markedly increased epidermal melanin. The findings suggest that hemosiderin deposition in conjunction with the deposition of melanin contribute to the clinical features of diabetic dermopathy.
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Affiliation(s)
- Samuel McCash
- Division of Dermatopathology, Mount Sinai Medical Center, New York, New York, USA
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38
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Shahzad M, Al Robaee A, Al Shobaili HA, Alzolibani AA, Al Marshood AA, Al Moteri B. Skin manifestations in diabetic patients attending a diabetic clinic in the Qassim region, Saudi Arabia. Med Princ Pract 2011; 20:137-41. [PMID: 21252568 DOI: 10.1159/000321219] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Accepted: 06/01/2010] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate the prevalence of skin manifestations in diabetic patients attending a diabetic clinic in the Qassim region, Saudi Arabia. SUBJECTS AND METHODS A prospective observational study was performed on 320 patients (174 males and 146 females) attending the diabetic clinic. A detailed dermatological examination was carried out by a consultant dermatologist and the cutaneous findings were recorded. RESULTS The overall prevalence of skin manifestations was 91.2%. Cutaneous lesions were seen in 12 patients (34.3%) of type 1 diabetes mellitus (DM) and 280 (98.2%) of type 2 diabetics. There was a statistically significant difference (p < 0.001) in skin manifestations between type 1 and type 2 DM patients. For those patients having diabetes of less than 5 years' duration, the incidence of skin manifestations was 80.6%; for those having had diabetes for more than 5 years, the incidence was 98%. This difference was statistically significant (p < 0.001). The skin manifestations that had a statistically significant difference (p < 0.05) in prevalence between the 2 durational groups were gangrene, diabetic dermopathy, paresthesia, diabetic feet, diabetic bullae and fungal infections. CONCLUSION Diabetics had a greater prevalence of skin manifestations in type 2 than type 1, and as the duration of diabetes increased, the likelihood of developing skin manifestations also increased. Early referral to the dermatologist may help to detect complications of the skin in diabetes at an early stage and may prevent disability caused by these complications.
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Affiliation(s)
- Muhammad Shahzad
- Department of Dermatology, College of Medicine, Qassim University, Qassim Region, Saudi Arabia. shahzad.derm @ gmail.com
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39
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Kim HS, Lee JSS, Tang MBY. Localized ecthyma gangrenosum in patients with diabetes mellitus: Diagnosis and management. J Dermatol 2010; 37:758-61. [PMID: 20649725 DOI: 10.1111/j.1346-8138.2010.00837.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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40
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Effects of extracellular matrix glycosylation on proliferation and apoptosis of human dermal fibroblasts via the receptor for advanced glycosylated end products. Am J Dermatopathol 2008; 30:344-51. [PMID: 18645306 DOI: 10.1097/dad.0b013e31816a8c5b] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The balance between proliferation and apoptosis of skin cells is responsible for skin turnover and the success of the wound healing process. Recent reports have shown that advanced glycosylation end product (AGE) formation participates in dermatologic problems in diabetes. However, the effect on proliferation and apoptosis of dermal fibroblasts remains unclear. The aim of this study was to investigate the effects of dermal microenvironment glycosylation on the balance of cellular proliferation and apoptosis. Histology and immunohistochemical staining were performed on type II diabetic and nondiabetic skin tissue specimens to determine the distributions of proliferating cell nuclear antigen, apoptotic cells, AGEs, and receptors for AGEs (RAGEs). Matrix secreted by cultured human fibroblasts was glycosylated by 0.5 M D-ribose. RAGE-blocking antibodies were applied to inhibit the interaction of RAGE and AGEs in this system and then cell viability, cell cycle phase distribution, and apoptosis were measured. Diabetic skin has degenerative, loosely arranged collagen and increased apoptotic cells compared with normal skin. Expression of AGE and RAGE in diabetic skin tissue increased. Glycosylated matrix induced cell cycle arrest and apoptosis of cultured dermal fibroblasts, whereas application of RAGE-blocking antibodies redressed these changes. The accumulation of glycosylated extracellular matrix in diabetic skin tissue is a critical mediator of cellular function. Mediation of RAGE affects the balance of cellular proliferation and apoptosis, which confirms that diabetic wounds possess atypical origin in the repair process.
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41
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Thomas CL, Badminton MN, Rendall JRS, Anstey AV. Sclerodermatous changes of face, neck and scalp associated with familial porphyria cutanea tarda. Clin Exp Dermatol 2008; 33:422-4. [DOI: 10.1111/j.1365-2230.2007.02579.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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42
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Velasco-Pastor A, Gil-Mateo MP, Martínez-Aparicio A, Aliaga-Boniche A. Necrobiosis lipoidica of the glans penis. Br J Dermatol 2008. [DOI: 10.1046/j.1365-2133.1996.d01-965.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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43
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Chang SJ, Hsu SC, Tien KJ, Hsiao JY, Lin SR, Chen HC, Hsieh MC. Metabolic syndrome associated with toenail onychomycosis in Taiwanese with diabetes mellitus. Int J Dermatol 2008; 47:467-72. [PMID: 18412863 DOI: 10.1111/j.1365-4632.2008.03606.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Onychomycosis is a complication of diabetes mellitus (DM), which has a deleterious impact on the quality of life. Aim To explore the prevalence of onychomycosis amongst Taiwanese diabetics, and to analyze the factors associated with onychomycosis after adjusting for age and sex. METHODS A total of 1245 Taiwanese diabetics were enrolled, and a nested case-control study was performed by onychomycosis outcome and the exposures were compared. RESULTS The overall prevalence of onychomycosis among DM patients was 30.76% (383/1245), with a significantly higher prevalence in men than in women (P = 0.024). The factors associated with onychomycosis in matched pairs by gender and age were analyzed in 375 pairs. It was found that metabolic syndrome, obesity, triglyceride (TG) levels, and glycosylated hemoglobin (HbA1c) were associated with onychomycosis (P < 0.05). CONCLUSION Higher prevalence rates of onychomycosis were found in men and older DM patients. Metabolic syndrome, obesity, high TG levels, and poor glycemic control were associated with onychomycosis.
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Affiliation(s)
- Shun-Jen Chang
- Department of Public Health, Faculty of Medicine, College of Medicine, Graduate Institute of Medical Genetics, and Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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44
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Abstract
Many of the complications of the diabetes are well studied but robust research documenting the cutaneous effects of the disease remains sparse. Various studies have suggested that the majority of patients with diabetes will suffer a skin disorder during the course of their disease and for some, the skin changes may even precede the diagnosis of diabetes. Cutaneous pathology of the diabetic foot and lower leg can arise as a result of the direct or indirect effects of diabetic complications. The most common manifestations include fungal and bacterial skin infection, nail disease and diabetic dermopathy. Other less commonly observed conditions include diabetic bullae, necrobiosis lipoidica diabeticorum (NLD), granuloma annulare and reddening of the soles. For many of the less common disorders, there is little in the way of effective treatment. However, much can be done in the clinical setting in the management of the more common manifestations such as bacterial and fungal infection. Fungal infection, in particular, although relatively inconspicuous, is a very common foot problem and if left untreated can threaten tissue viability in the diabetic foot leading to secondary bacterial infection and cellulitis. Management of fungal disease is often considered difficult due to high relapse and re-infection rates, although by introducing a combination of therapies including mechanical and pharmacological the success in treating this stubborn condition can be greatly improved.
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Affiliation(s)
- Ivan Bristow
- School of Health Professions and Rehabilitation Sciences, University of Southampton, UK.
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45
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Cutting K. Impact of adhesive surgical tape and wound dressings on the skin, with reference to skin stripping. J Wound Care 2008; 17:157-8, 160-2. [DOI: 10.12968/jowc.2008.17.4.28836] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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46
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Onychomycosis Incidence in Type 2 Diabetes Mellitus Patients. Mycopathologia 2008; 166:41-5. [DOI: 10.1007/s11046-008-9112-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Accepted: 03/11/2008] [Indexed: 10/22/2022]
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47
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Mendoza V, Vahid B, Kozic H, Weibel S. Clinical and pathologic manifestations of necrobiosis lipoidica-like skin involvement in sarcoidosis. Joint Bone Spine 2007; 74:647-9. [DOI: 10.1016/j.jbspin.2006.12.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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48
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Rubio Cabezas O, Argente Oliver J. Diabetes mellitus en niños y adolescentes: complicaciones crónicas y enfermedades asociadas. An Pediatr (Barc) 2007; 66:282-9. [PMID: 17349255 DOI: 10.1157/13099691] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Diabetes is one of the most common chronic diseases. Type 1, or autoimmune, diabetes accounts for more than 95 % of cases in children and adolescents. Chronic hyperglycemia per se is responsible for the development of several microvascular (retinopathy, nephropathy, neuropathy) and macrovascular complications (ischemic heart disease, cerebrovascular disease, and peripheral vascular disease). Other autoimmune diseases are also more frequent in type 1 diabetic patients. The present review aims to provide an update on some recent advances in this field to aid early detection of these complications and prevent or delay their progression through improved metabolic control.
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Affiliation(s)
- O Rubio Cabezas
- Servicio de Endocrinología, Departamento de Pediatría, Hospital Infantil Universitario Niño Jesús, Universidad Autónoma de Madrid, España.
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49
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Tabor CA, Parlette EC. Cutaneous manifestations of diabetes. Signs of poor glycemic control or new-onset disease. Postgrad Med 2006; 119:38-44. [PMID: 17128644 DOI: 10.1080/00325481.2006.11446049] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Diabetes attacks multiple organ systems, and the skin is not spared its detrimental effects. Pathologic consequences of diabetes, such as vasculopathy, neuropathy, immunologic disturbances, defects in collagen formation, and poor glycemic control, contribute to its numerous cutaneous manifestations. In this article, Drs Tabor and Parlette present the implications of, and treatment options for, infections and dermatoses that appear in established diabetes or that indicate new-onset disease. They also discuss diabetes medications that commonly cause cutaneous reactions.
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50
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Abstract
Dermatologic problems are common in diabetes, with approximately 30% of patients experiencing some cutaneous involvement during the course of their illness. Skin manifestations generally appear during the course of the disease in patients known to have diabetes, but they may also be the first presenting sign of diabetes or even precede the diagnosis by many years. The skin involvement can be autoimmune in nature, such as acanthosis nigricans, necrobiosis lipoidica, diabetic dermopathy, scleredema, and granuloma annulare, or infectious in the form of erythrasma, necrotizing fasciitis, and mucormycosis. Pharmacologic management of diabetes, in addition, can also result in skin changes, such as lipoatrophy and lipohypertrophy, at the site of injection of insulin, and oral antidiabetic agents can cause multiple skin reactions as adverse effects. The management of these cutaneous manifestations is tailored according to the underlying pathophysiology, but a tight control of blood glucose is a prerequisite in all management strategies.
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Affiliation(s)
- Intekhab Ahmed
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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