Bullosis diabeticorum: rare presentation in a common disease

Bullosis diabeticorum in a morbidly obese woman in Haiti

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.

[Bullosis diabeticorum : Two case studies]

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.

Diabetes mellitus and the skin

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.