Efi.

Gelerstein 2011

Topic 15. Cutaneous manifestations of diabetes mellitus The skin and diabetes mellitus The following are more common in those with diabetes than in others. 1. Necrobiosis lipoidica < 1% of diabetics have necrobiosis, but most patients with necrobiosis will have diabetes. The lesions appear as one or more discolored areas on the fronts of the leg. They are shiny, atrophic and brown-red or slightly yellow. The underlying blood vessels are easily seen through the atrophic skin and the margin may be erythematous or violet. Minor knocks can lead to slow-healing ulcers; biopsy can do the same. No treatment is reliably helpful. 2. Granuloma annulare Clinically, the lesions often lie over the knuckles and are composed of dermal nodules fused into a rough ring shape. On the hands, the lesions are skin-colored or slightly pink; elsewhere a purple color may be seen. Although a biopsy is seldom necessary, the histology shows a diagnostic palisading granuloma, like that of necrobiosis lipoidica. Lesions tend to go away over the course of a year or two. Stubborn ones respond to intra-lesional triamcinolone injections. 3. Diabetic dermopathy ~ 50% of Type I diabetics, multiple small (0.51 cm in diameter) slightly sunken brownish scars can be found on the limbs, most obviously over the shins. 4. Diabetic sclerodactyly or cheiroarthropathy Stiff thick skin on the fingers and hands Demonstrated by the prayer sign in which the fingers and palms cannot be opposed properly. 5. Eruptive xanthomas (Lipid metabolic disorders) 6. Atherosclerosis with ischaemia or gangrene of feet. 7. Hypertrichosis (hair) - periumbilical, scapular and dorsal flexion of toe 8. Neuropathic foot ulcers. 9. Scleredema adultorum - thick brawny induration of the nape and neck (Fig. ) 10. Acanthosis nigricans - associated with insulin resistance and hyperinsulinaemia

Efi. Gelerstein 2011

More skin manifestation: Dehydration Itchy-pruritus Obesity Diabetes Thickened waxy skin Collagen Candidal infections degeneration Staphylococcal infections Mucin deposition Skin Tags soft fibromas Palisade granuloma Yellow skin- increased levels of carotene Vascular disorders Micro-and macro-angiopathy 1. Acral erythema 2. Rubeosis diabeticoum 3. Bullosis diabeticorum 4. Necrobiosis lipoidica diabeticorum 5. Eruptive xanthomas 6. Leg ulcers, gangrena (moist), malum perforans pedis

Diagnosis Necrobiosis Granuloma lipoidica annulare + Diffuse Local + + + + -

Skin symptoms in DM Diabetic neuropathy 1. Burning feet sensation 2. Lack of sensation in the feet 3. Diabetic neurotrophic ulcers (patient thinks it is hyperkeratosis doesnt go to the doctor) Cutaneous complications of therapy 1. Insulin allergy 2. lipoatrophy or lipodystrophy due to the injection 3. Eruptive xanthomas 4. Phototoxic, photoallergic reactions due to antidiuretic drugs Skin diseases possibly associated with DM 1. Disseminated granuloma annulare 2. Pruritus / Prurigo nodularis 3. Lichen simplexchronicus / Lichen planus 4. Vitiligo 5. Fibromatoses 6. Lipodystrophy Xanthomas 1. Xanthomas: deposits of fatty material in skin and subcutaneous tissue 2. Xanthomas are in coloration with the patients triglycerides levels. If we give the patient anti lipidemic drugs xanthomas resolve.