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Paul AJ, Louis RS, Julien AAI, Florvil F, Blaise W. Bullosis diabeticorum in a morbidly obese woman in Haiti. Arch Clin Cases 2023; 10:196-199. [PMID: 38155997 PMCID: PMC10754039 DOI: 10.22551/2023.41.1004.10274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023] Open
Abstract
Bullosis diabeticorum is a rare skin complication of diabetes mellitus, characterized by sudden onset bullous lesions with no history of trauma. It predominantly affects men and has an acral asymmetric presentation. Here, we report a case of bullous disease in a diabetic patient with morbid obesity, the first described in Haiti. A 40-year-old woman, with a strong history of diabetic for five years, poorly controlled and morbidly obese presented to our emergency for bullosis lesions in her limb. She had a prior presentation about two years ago and, approximately a week before this actual presentation, the same symptomatology occurred suddenly without any trauma. After evaluation and screening, the diagnosis of bullosis diabeticorum was kept. She was initially treated with antibiotics due to signs of superinfection. However, as soon as the symptoms improved, antibiotics were discontinued. An antiseptic lotion and topical antibiotic, neomycin, were used along with daily dressings. About a week after, her blood glucose came to control, signs of infection disappeared as did the bullous lesions and surgical evaluation was performed to ensure proper wound evolution. She was educated by a nutritionist, and our team emphasized the importance of regular follow-up at the hospital. Diabetic bullous disease is very rare and easy to confuse with other diabetic skin complications. A good clinical history is essential to make the diagnosis, and management requires good therapeutic education to avoid the burdensome complications of diabetes.
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Affiliation(s)
- Axler Jean Paul
- General Medicine Department, State University of Haiti, Port-au-Prince, Haiti
| | - Rebecca St Louis
- Department of Emergency, University Hospital of Mirebalais, Mirebalais, Haiti
| | | | - Frednel Florvil
- General Medicine Department, State University of Haiti, Port-au-Prince, Haiti
| | - Wendell Blaise
- Internal medicine Department, Health Equity International/Saint Boniface Hospital Foundation, Fond-des-Blancs, Haiti
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2
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Hamdan R, Mihai AM. Disabling bullosis diabeticorum despite optimal type 2 diabetes control. BMJ Case Rep 2022; 15:e254182. [PMID: 36521876 PMCID: PMC9756182 DOI: 10.1136/bcr-2022-254182] [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: 12/23/2022] Open
Affiliation(s)
- Rémy Hamdan
- Angiologie, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Anca-Maria Mihai
- Médecine Interne Gériatrie, Centre Hospitalier Universitaire de Dijon Centre Geriatrique de Champmaillot, Dijon, France
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3
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Passanisi S, Salzano G, Lombardo F. Skin Involvement in Paediatric Patients with Type 1 Diabetes. Curr Diabetes Rev 2022; 18:e030921196145. [PMID: 34477525 DOI: 10.2174/1573399817666210903153837] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 07/05/2021] [Accepted: 07/08/2021] [Indexed: 11/22/2022]
Abstract
Skin involvement is an overlooked aspect in the management of paediatric patients with type 1 diabetes. A comprehensive search of published literature using the PubMed database was carried out using the following key terms: "children," "pediatric/paediatric patients," "skin," "skin disorders," "type 1 diabetes." Dermatological side effects are frequently observed among diabetic children and adolescents. Insulin-induced lipodystrophies and allergic contact dermatitis caused by insulin pumps or glycaemic sensors are the most common skin reactions in these patients. Furthermore, several diabetes-associated skin diseases such as necrobiosis lipoidica, granuloma annulare, vitiligo, and bullosis diabeticorum may already be present in paediatric patients. Paediatric diabetes specialists should pay attention to their patients' skin to recognize these disorders, identify the potential causes, and choose the most suitable treatment. Finally, the evaluation of skin concentrations of advanced glycation end-products using non-invasive diagnostic techniques may be used to assess the risk of chronic complications of diabetes as early as adolescence.
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Affiliation(s)
- Stefano Passanisi
- Department of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy
| | - Giuseppina Salzano
- Department of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy
| | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy
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4
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Abstract
Diabetes mellitus is a significant worldwide health concern and cutaneous manifestations are common. This review describes characteristic skin findings of diabetes, general skin findings related to diabetes, and findings related to diabetes treatment with a focus on clinical presentation, diagnosis, pathophysiology, epidemiology, and treatment. As the prevalence of diabetes continues to rise, cutaneous manifestations of diabetes mellitus likely will be encountered more frequently by physicians in all disciplines including dermatologists and primary care physicians. Accordingly, knowledge regarding the prevention, diagnosis, and management of cutaneous manifestations is an important aspect in the care of patients with diabetes.
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Affiliation(s)
- Alex Hines
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Mark D P Davis
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.
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5
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Abstract
Bullous diabeticorum is a condition of unknown etiology with abrupt blister formation and spontaneous resolution. While commonly thought as rare, it is likely underdiagnosed resulting in mismanaged care and increased morbidity for individual patients. A shift in focus from empiric treatment to appropriate diagnostic workup is critical for this condition in the diabetic population.
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6
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Arnold L, Vennard KC, Gilbert MP. Bullous Diabeticorum. J Osteopath Med 2018; 118:832. [PMID: 30476996 DOI: 10.7556/jaoa.2018.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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7
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Abstract
We report two cases of patients with diabetes mellitus who developed bullae measuring 2 cm in diameter on the fingers or toes, which could be classified as bullosis diabeticorum after excluding several differential diagnoses that are discussed. Bullosis diabeticorum is a rare blister formation located on the palmoplantar region, which is mainly observed in the case of diabetic patients. The clinical picture is characterized by tense bullae measuring up to 10 cm in diameter, containing clear to hemorrhagic fluid. Generally, lesions heal without residual scarring, less frequently with residual postinflammatory pigmentation or tender scars. On histopathological examination, both intraepidermal and subepidermal bullae are found without any significant inflammatory infiltrate. The etiopathogenesis of bullosis diabeticorum has not yet been clarified.
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Chen Y, Ma Y, Li N, Wang H, Chen B, Liang Z, Ren R, Lu D, Boey J, Armstrong DG, Deng W. Efficacy and long-term longitudinal follow-up of bone marrow mesenchymal cell transplantation therapy in a diabetic patient with recurrent lower limb bullosis diabeticorum. Stem Cell Res Ther 2018; 9:99. [PMID: 29631615 PMCID: PMC5891952 DOI: 10.1186/s13287-018-0854-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 03/15/2018] [Accepted: 03/22/2018] [Indexed: 01/26/2023] Open
Abstract
Bullosis diabeticorum is a rare presentation of cutaneous manifestation most commonly affecting the lower limbs in patients with diabetes. The appearance, often as insidious as its resolution, is characterized by tense blisters on the skin surfaces of the lower limbs and the feet. The cause still remains unclear, but it may relate to microangiopathy and neuropathy. In this report, we present a case of a 64-year-old male with multiple episodes of blistering in the left lateral lower limb after a traumatic fall who was subsequently diagnosed with type 2 diabetes mellitus. The patient had a history of poorly controlled blood glucose and subsequently developed vasculopathy and peripheral neuropathy. Despite appropriate glycemic control and antibiotics therapy, the patient developed recurrent bullosis diabeticorum on five separate occasions during a 2-year span from 2005 to 2007. Building on our success with ischemic diabetic foot, we used bone marrow mesenchymal stem cell (BMMSC) transplantation therapy for bullosis diabeticorum. After a 9-month treatment, this patient developed another episode of cellulitis in the same lower limb which was successfully treated with antibacterial therapy. It is interesting that the patient reported no recurrence in the next 10-year follow-up span. This study demonstrates that bullosis diabeticorum could appear even before the onset of diabetes, and vascular insufficiency predisposes to the occurrence of bullosis diabeticorum. Our findings suggest that autologous BMMSC transplantation therapy may be an effective measure for recurrent bullosis diabeticorum; however, this will require further investigation to be conclusive. Early identification of diabetes and its complications and appropriate treatment may improve clinical outcomes and prevent lower limb amputation. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00955669 . Registered on August 10, 2009.
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Affiliation(s)
- Yan Chen
- Department of Endocrinology and Nephrology, Diabetic Foot Center, Affliated Central Hospital of Chongqing University, Chongqing Emergency Medical Hospital, Chongqing, China
| | - Yu Ma
- Department of Endocrinology and Nephrology, Diabetic Foot Center, Affliated Central Hospital of Chongqing University, Chongqing Emergency Medical Hospital, Chongqing, China
| | - Ning Li
- Department of Endocrinology and Nephrology, Diabetic Foot Center, Affliated Central Hospital of Chongqing University, Chongqing Emergency Medical Hospital, Chongqing, China
| | - Hongyan Wang
- Department of Endocrinology and Nephrology, Diabetic Foot Center, Affliated Central Hospital of Chongqing University, Chongqing Emergency Medical Hospital, Chongqing, China
| | - Bing Chen
- Department of Endocrinology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Ziwen Liang
- Department of Endocrinology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Rui Ren
- Department of Endocrinology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Debin Lu
- Department of Endocrinology, the 9th People's Hospital of Chongqing, Chongqing, China
| | - Johnson Boey
- Department of Podiatry, Singapore General Hospital, Bukit Merah, Singapore
| | - David G Armstrong
- Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Wuquan Deng
- Department of Endocrinology and Nephrology, Diabetic Foot Center, Affliated Central Hospital of Chongqing University, Chongqing Emergency Medical Hospital, Chongqing, China.
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Sonani H, Abdul Salim S, Garla VV, Wile A, Palabindala V. Bullosis Diabeticorum: A Rare Presentation with Immunoglobulin G (IgG) Deposition Related Vasculopathy. Case Report and Focused Review. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:52-56. [PMID: 29332930 PMCID: PMC5776741 DOI: 10.12659/ajcr.905452] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Bullosis diabeticorum (BD) is a condition characterized by recurrent, spontaneous, and non-inflammatory blistering in patients with poorly controlled diabetes mellitus. While etiopathogenesis remains unclear, roles of neuropathy, vasculopathy and UV light are hypothesized. Most literature reports negative direct and indirect immunofluorescence findings in diabetics with bullous eruptions. Porphyria cutanea tarda, bullous pemphigoid, epidermolysis bullosa, and pseudoporphyria are other differential diagnoses of bullous lesions, and they must be excluded. CASE REPORT We present a 42-year-old African American male with long standing poorly controlled insulin dependent diabetes mellitus with blisters on his left hand and feet. The blisters were noticed three weeks prior to presentation and, thereafter, rapidly increased in size and spontaneously ruptured. Physical examination revealed a multitude of both roofed and unroofed bullous painless skin lesions. Hematoxylin and eosin (H&E) staining dramatized the dermal-epidermal blistering and re-epithelization process. Direct Immunofluorescence (DIF) was positive for 2 + IgG deposition in the already thickened basement membrane of the capillaries of the superficial vascular plexus. After debridement, his wounds greatly improved with over three months of aggressive wound care. CONCLUSIONS Primary immunologic abnormality likely plays no role in the onset of BD. To date, only one article has reported nonspecific capillary-associated immunoglobulin M and C3. This is the first case of BD with IgG deposition in the superficial capillary basement membrane. Positive findings on DIF suggest vasculopathy. Dermal microangiopathy, secondary to immunologic abnormality, is a possible underlying pathogenesis to bullae formation. Punch biopsy with DIF can be an additional diagnostic modality in the management of such cases.
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Affiliation(s)
- Hardik Sonani
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Sohail Abdul Salim
- Department of Nephrology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Vishnu V Garla
- Department of Endocrinology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Anna Wile
- Department of Dermatology, University of Mississippi Medical Center, Jackson, MS, USA
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10
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Chiriac A, Costache I, Podoleanu C, Naznean A, Stolnicu S. Bullosis Diabeticorum in a Young Child: Case Report of a Very Rare Entity and a Literature Review. Can J Diabetes 2016; 41:129-131. [PMID: 28017292 DOI: 10.1016/j.jcjd.2016.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 09/24/2016] [Accepted: 10/05/2016] [Indexed: 10/20/2022]
Abstract
Bullosis diabeticorum (BD), or diabetic bulla, is 1 of the cutaneous manifestations of diabetes mellitus, reported in 0.5% of people with diabeties in the United States, mostly in adult men who have had long-lasting and uncontrolled diabetes associated with diabetic peripheral neuropathy. However, BD in young children is a mostly unrecognized entity. We present a case of BD in a 3-year-old girl with type 1 diabetes mellitus who had been treated with insulin for 7 months prior to hospitalization. Dermatologic examination revealed a large, tense bulla filled with clear fluid and not associated with pain or pruritus, localized on the lateral margin of the right hand. A 4 mm punch biopsy was taken from the peripheral edge of the bulla under local anesthesia, and histology showed subepidermal bulla and sparse nonspecific infiltrate in the dermis; direct immunofluorescence was negative to complements C3, IgM, IgG and IgA. The particularities of the present case include the bulla in the absence of local trauma or any other complications of diabetes and associated with well-controlled type 1 diabetes. The diagnosis was certified by histology, direct immunofluorescence and clinical outcome. To the best of our knowledge, BD in young children has been previously reported in only 2 other publications.
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Affiliation(s)
- Anca Chiriac
- Department of Dermato-Physiology, Apollonia University, Iasi, Romania; Department of Dermatology, Nicolina Medical Center, Iasi, Romania; P. Poni Research Institute of Macromolecular Chemistry, Romanian Academy of Science, Iasi, Romania
| | - Irina Costache
- First Medical Department, University of Medicine and Pharmacy Gr. T. Popa, Iasi, Romania
| | - Cristian Podoleanu
- Department of Cardiology, University of Medicine and Pharmacy Tirgu Mures, 540099 Tirgu Mures, Romania.
| | - Adrian Naznean
- Foreign Language Department, University of Medicine and Pharmacy Tirgu Mures, Tirgu Mures, Romania
| | - Simona Stolnicu
- Department of Pathology, University of Medicine and Pharmacy Tirgu Mures, Tirgu Mures, Romania
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11
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Onyekwelu E, Wright T, Benbow S. An unusually severe case of bullosis diabeticorum with marked morbidity ultimately resulting in bilateral trans-tibial amputation. PRACTICAL DIABETES 2016. [DOI: 10.1002/pdi.2064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Emeka Onyekwelu
- Aintree University Hospital NHS Foundation Trust; Liverpool UK
| | | | - Sue Benbow
- Aintree University Hospital NHS Foundation Trust; Liverpool UK
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12
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Arsanjani Shirazi A, Nasiri M, Yazdanpanah L. Dermatological and musculoskeletal assessment of diabetic foot: A narrative review. Diabetes Metab Syndr 2016; 10:S158-S164. [PMID: 27016885 DOI: 10.1016/j.dsx.2016.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 03/05/2016] [Indexed: 01/11/2023]
Abstract
AIMS Diabetic Foot Syndrome (DFS) is the most costly and devastating complication of diabetes mellitus (DM), which early effective assessment can reduce the severity of complications including ulceration and amputations. This study aimed to review dermatological and musculoskeletal assessment of diabetic foot. MATERIALS AND METHODS In this review article, we searched for articles published between March 1, 1980 and July 28, 2015 in PubMed, Science Direct, Embase, Web of Science, and Scopus, for both English and non-English language articles with the following keywords: "Diabetic foot syndrome", "Ulceration", "Amputation", "Foot assessment", "Skin disorders" and "Musculoskeletal deformities". RESULTS In dermatological dimension, most studies focused on elucidated changes in skin temperature, color, hardiness and turgor as well as common skin disorders such as Diabetic Dermopathy (DD), Necrobiosis Lipoidica Diabeticorum (NLD) and Diabetic Bullae (DB), which are common in diabetic patients and have high potential for leading to limb-threatening problems such as ulceration and infection. In musculoskeletal dimension, most studies focused on range of motion and muscle strength, gait patterns and as well as foot deformities especially Charcot osteoarthropathy (COA), which is the most destructive musculoskeletal complication of diabetes. CONCLUSION DFS as a common condition in DM patients lead to ulceration and lower limb amputation frequently unless a prompt and comprehensive assessment was taken. So that dermatological and musculoskeletal assessments are usually neglected in primary health care, these assessments should be done frequently to reduce the high risk of serious complications.
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Affiliation(s)
- Azam Arsanjani Shirazi
- Department of Midwifery, Nursing and Midwifery School, Dezful Islamic Azad University, Khouzastan, Iran.
| | - Morteza Nasiri
- Department of Operating Room, Paramedical School, Qom University of Medical Sciences, Qom, Iran.
| | - Leila Yazdanpanah
- Health Research Institute, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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13
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Bullosis diabeticorum: rare presentation in a common disease. Case Rep Endocrinol 2014; 2014:862912. [PMID: 25478251 PMCID: PMC4251093 DOI: 10.1155/2014/862912] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 10/31/2014] [Accepted: 10/31/2014] [Indexed: 11/18/2022] Open
Abstract
A 27-year-old African American male presented with a sudden onset of blisters. He had a past medical history of uncontrolled diabetes mellitus type I, diabetic vasculopathy, and neuropathy. The physical examination revealed nonerythematous skin denudations on both elbows and lateral aspect of arm bilaterally. Investigations which included skin biopsies confirmed the diagnosis of bullosis diabeticorum. The bullae were treated with hydrotherapy and healed with no complications in 4 weeks. We present this case to illustrate the rare occurrence of diabetic bulla in a diabetic patient especially with poor glycemic control. The case is also a reminder of the importance of diabetes screening in nondiabetic patients who are diagnosed with diabetic bulla.
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14
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Shahi N, Bradley S, Vowden K, Vowden P. Diabetic bullae: a case series and a new model of surgical management. J Wound Care 2014; 23:326, 328-30. [PMID: 24920203 DOI: 10.12968/jowc.2014.23.6.326] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Bullosis diabeticorum is considered a rare skin manifestation of diabetes mellitus. Tense blisters appear rapidly, mostly on the feet, the cause of which is unclear, with multiple pathophysiologies hypothesised. This is a retrospective review of 4 diabetic patients who presented over six months with diabetic bullae; the condition may therefore not be as rare as commonly believed. All the patients had early surgical debridement followed by topical negative pressure wound dressings. A multidisciplinary team that included vascular surgeons, diabetologists, diabetic foot care team, wound care team, physiotherapists and occupational therapists managed the patients and none of them required amputations. We propose an alternative way of managing these patients with early surgical debridement followed by topical negative pressure wound dressing.
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Affiliation(s)
- N Shahi
- MBChB, MRCS, MSc, ST6, Department of Vascular Surgery, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - S Bradley
- MBBS, General Practice Trainee, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - K Vowden
- Consultant nurse and wound care specialist, Department of Vascular Surgery, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - P Vowden
- Professor, Consultant Vascular Surgeon and Honorary Senior Lecturer, Department of Vascular Surgery, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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15
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Quondamatteo F. Skin and diabetes mellitus: what do we know? Cell Tissue Res 2013; 355:1-21. [PMID: 24318789 DOI: 10.1007/s00441-013-1751-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Accepted: 10/29/2013] [Indexed: 12/20/2022]
Abstract
Diabetes mellitus (DM) is becoming increasingly prevalent worldwide. Although major complications of this condition involve kidney, retina and peripheral nerves, the skin of diabetic patients is also frequently injured. Hence, interest is mounting in the definition of the structural and molecular profile of non-complicated diabetic skin, i.e., before injuries occur. Most of the available knowledge in this area has been obtained relatively recently and, in part, derives from various diabetic animal models. These include both insulin-dependent and insulin-resistant models. Structural work in human diabetic skin has also been carried out by means of tissue samples or of non-invasive methods. Indications have indeed been found for molecular/structural changes in diabetic skin. However, the overall picture that emerges is heterogeneous, incomplete and often contradictory and many questions remain unanswered. This review aims to detail, as much as possible, the various pieces of current knowledge in a systematic and synoptic manner. This should aid the identification of areas in which key questions are still open and more research is needed. A comprehensive understanding of this field could help in determining molecular targets for the prevention and treatment of skin injuries in DM and markers for the monitoring of cutaneous and systemic aspects of the disease. Additionally, with the increasing development of non-invasive optics-based deep-tissue-imaging diagnostic technologies, precise knowledge of cutaneous texture and molecular structure becomes an important pre-requisite for the use of such methods in diabetic patients.
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Affiliation(s)
- Fabio Quondamatteo
- Skin and ECM Research Group-Anatomy, NUI Galway, Anatomy Building, University Road, Galway, Ireland,
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16
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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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17
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Mota ANCDM, Nery NS, Barcaui CB. Case for diagnosis: bullosis diabeticorum. An Bras Dermatol 2013; 88:652-4. [PMID: 24068147 PMCID: PMC3760951 DOI: 10.1590/abd1806-4841.20132114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 10/22/2012] [Indexed: 11/22/2022] Open
Abstract
We present a case of bullosis diabeticorum. It is a rare disorder, probably underdiagnosed, associated with long-term diabetes mellitus. Its etiology remains unclear. It is characterized by tense blisters, with serous content, recurrent and spontaneous on normal skin especially in the acral regions. Displays self-limiting course. No specific laboratory tests for diagnosis of this bullous disease exist. Clinical and conservative management to prevent secondary infection reduces morbidity in diabetic patients.
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Affiliation(s)
| | - Natalia Solon Nery
- Resident in Dermatology at Pedro Ernesto University Hospital - Rio de
Janeiro State University (HUPE-UERJ) - Rio de Janeiro (RJ), Brazil
| | - Carlos Baptista Barcaui
- Doctorate in Dermatology awarded by the University of São Paulo (USP) -
Professor of Dermatology at Rio de Janeiro State University (UERJ) - Rio de Janeiro
(RJ), Brazil
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18
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2 Cases of Bullosis Diabeticorum following Long-Distance Journeys by Road: A Report of 2 Cases. Case Rep Endocrinol 2012; 2012:367218. [PMID: 23119191 PMCID: PMC3479936 DOI: 10.1155/2012/367218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 09/25/2012] [Indexed: 11/28/2022] Open
Abstract
Background. Bullosis diabeticorum is a distinct, spontaneous, noninflammatory, and blistering condition of acral skin that is unique to diabetics. It is rare. Exact aetiopathogenesis is not known, but many attributed peripheral neuropathy as a potent risk factor, others hypothesized the role of trauma, UV light, and nephropathy. Aim. To present cases of bullosis diabeticorum following long-distance journeys by road. Methods. History and physical examinations were done on 2 diabetics who presented with bilateral feet bullae following a long journey. Biopsy of a circumferential area of the bullae including adjoining apparently normal skin was done. Results. Features of peripheral neuropathy were noted. One developed digital gangrene without features of peripheral vascular disease. Culture of aspirate from a bullae yielded Staphylococcus aureus. Tissue biopsy showed hyperkeratotic focally acanthotic pigmented epidermis with subcorneal separation of the granular layer of the epidermis by aggregates of viable and nonviable polymorphs and lymphocytes. There is mild acantholysis of the epidermis, and a fibrocollagenous dermis which is moderately infiltrated by lymphocytes. Conclusion. Long journeys by road is a strong factor in the aetiopathogenesis of bullosis diabeticorum on a background of peripheral neuropathy. Diabetics especially those with peripheral neuropathy should be cautious while traveling long journeys by road.
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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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