|
ORIGINAL ARTICLE |
|
| Year : 2010 | Volume
: 55
| Issue : 1 | Page : 39-41 |
|
| Pattern of cutaneous manifestations in diabetes mellitus |
|
|
Abhishek Goyal1, Sujeet Raina1, Satinder S Kaushal1, Vikram Mahajan2, Nand Lal Sharma2
1 Department of Medicine, Indira Gandhi Medical College, Shimla - 171 001, India
2 Department of Dermatology, Indira Gandhi Medical College, Shimla - 171 001, HP, India
| Date of Web Publication | 4-Mar-2010 |
Correspondence Address:
Sujeet Raina
Fire Officers Building, Stokes Place, Shimla (H.P) 171 002
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0019-5154.60349
|
|
 Abstract | | |
Background: Diabetes mellitus affects individuals of all ages and socioeconomic status. Skin is affected by the acute metabolic derangements as well as by chronic degenerative complications of diabetes. Aims: To evaluate the prevalence of skin manifestations in patients with diabetes mellitus. To analyze the prevalence and pattern of skin disorders among diabetic patients from this region of Western Himalayas. Materials and Methods: One hundred consecutive patients with the diagnosis of diabetes mellitus and having skin lesions, either attending the diabetic clinic or admitted in medical wards were included in this study. Results: The common skin disorders were: x0 erosis (44%), diabetic dermopathy (36%), skin tags (32%), cutaneous infections (31%), and seborrheic keratosis (30%). Conclusion: Skin is involved in diabetes quite often and the manifestations are numerous. High prevalence of xerosis in our diabetic population is perhaps due to cold and dry climatic conditions in the region for most of the time in the year.
Keywords: Diabetes mellitus, skin lesions, Western Himalayas
How to cite this article:
Goyal A, Raina S, Kaushal SS, Mahajan V, Sharma NL. Pattern of cutaneous manifestations in diabetes mellitus. Indian J Dermatol 2010;55:39-41 |
How to cite this URL:
Goyal A, Raina S, Kaushal SS, Mahajan V, Sharma NL. Pattern of cutaneous manifestations in diabetes mellitus. Indian J Dermatol [serial online] 2010 [cited 2023 Dec 7];55:39-41. Available from: https://www.e-ijd.org/text.asp?2010/55/1/39/60349 |
| Introduction | |  |
Diabetes mellitus affects individuals of all ages and in all socio-economic segments of the population. Global presence of type 2 diabetics in the year 2000 was 171 million which is likely to be 366 million in the year 2030. [1] The International Diabetes Federation (IDF) estimates the total number of diabetic subjects to be around 40.9 million in India and this is further set to raise to 69.9 million by the year 2025. [2] Estimates by WHO suggest that the number of diabetic subjects would increase to 80 million by the year 2030 in India. [1] Skin lesions are frequently observed in diabetic patients and about 30% of diabetics have cutaneous disorders. [3] The skin is affected by the acute metabolic derangements and the chronic degenerative complications of diabetes. Although the mechanism for many diabetes-associated skin conditions remains unknown, the pathogenesis of others is linked to abnormal carbohydrate metabolism, other altered metabolic pathways, atherosclerosis, microangiopathy, neuron degeneration, and impaired host mechanisms. [4] Only a few epidemiologic studies have been done on the prevalence of skin disorders in patients with diabetes mellitus. [3],[5] There are no epidemiologic data related to skin disorders in diabetics reported from the Northern state of Himachal Pradesh, India. This study was designed to analyze the prevalence and pattern of skin disorders among diabetic patients from this region of Western Himalayas.
| Materials and Methods | | |
The study was conducted in the Departments of Medicine and Dermatology of IGMC, Shimla. One hundred consecutive patients with the diagnosis of diabetes mellitus and having skin lesions, either attending the diabetic clinic or admitted in medical wards constituted the study population. Clinical details regarding age, sex, duration of diabetes mellitus, and treatment modalities were noted. All the patients underwent a detailed dermatological examination. Relevant microbiological and histopathological investigations to confirm the diagnosis were carried out.
| Results | | |
The study comprised of 100 consecutive patients of diabetes mellitus with skin lesions. There were 54 males and 46 females (M:F = 1.7:1). The youngest patient was 28 years and oldest was 80 years with a mean age of 57.44 ± 10.37 years. The duration of diabetes was <10 years in 60 patients. Thirty four patients had 11-20 years of diabetes, and six had >20 years of diabetes. Ten patients were newly diagnosed as diabetics.
Various types of skin lesions and duration of diabetes mellitus observed are presented in [Table 1]. Various types of skin infections observed are shown in [Table 2]. Majority of patients (80%) had combination of more than one type of skin lesions. Twenty patients had two types of skin lesions, 12 had three types, sixteen had four types, and another 16 had five types. Six types of skin lesions were observed in another 14 patients and only two patients presented with a maximum of seven. Twenty patients had only a single type of skin lesion.
| Discussion | | |
Cutaneous signs of diabetes mellitus are extremely valuable to the clinician. They generally appear after the primary disease has developed but may signal or appear coincidentally with its onset, or even precede diabetes by many years.
Cutaneous manifestations of diabetes are classified into four categories: s0 kin lesions with strong-to-weak association with diabetes (necrobiosis lipiodica, diabetic dermopathy, diabetic bullae, yellow skin, eruptive xanthomas, perforating disorders, acanthosis nigricans, oral leucoplakia, lichen planus), infections (bacterial, fungal), cutaneous manifestations of diabetic complications (microangiopathy, macroangiopathy, neuropathy), and skin reactions to diabetic treatment (sulphonylureas or insulin). [3] Most documented studies have shown the incidence of cutaneous disorders associated with diabetes to be between 30 and 71%. [3],[6] In our study, the most common six skin disorders were: x0 erosis (44%), diabetic dermopathy (36%), skin tags (32%), cutaneous infections (31%), and pruritis and seborrheic keratosis -30% each, respectively. Xerosis accounted for the most common skin manifestation in our study and 44% patients had xerosis although various studies on cutaneous lesions in diabetic patients do not comment on the prevalence of xerosis. The reason for high prevalence of xerosis in our diabetic population is perhaps due to cold and dry climatic conditions in the region for most of the time in the year. Diabetic dermopathy, in the form of small, atrophic, brown-scar-like macules on both chins were seen in 36% of the patients. Diabetic dermopathy may develop from the factors that lead to the development of vascular complications of diabetes and it may serve as a clinical sign of an increased likelihood of vascular complications in diabetic patients.
Skin tags were seen in 32% of patients. Skin tags may serve as a marker for diabetes mellitus as was concluded by Thappa et al. [7] Cutaneous infections were seen in 31% of patients. Fungal infections were seen in 16% of the patients (9% had candidal and 7% had dermatophytosis). Bacterial infections were seen in 15% of the patients. It is widely believed that diabetic patients have an increased risk for infectious diseases, although there is little documented evidence to support it. This risk seems to be higher in poorly controlled patients, but it is often difficult to understand whether poor metabolic control is the cause or the consequence of the concurrent infections. [4] None of the patients had viral infections, wet gangrene, scleroderma diabeticorum, trophic ulcer, granuloma annulare, necrobiosis lipiodica, lichen planus, reactive perforating collagenosis, or drug reactions to oral hypoglycemics in this study, although these are usually associated with diabetes mellitus.
From the foregoing account, we conclude that the skin is involved in diabetes quite often. The manifestations are numerous and varied and many a times they can serve as diagnostic marker for underlying diabetes. Whenever patients present with multiple skin manifestations, their diabetic status should be checked. The recognition of these skin findings is the key to treatment and prevention.
| References | | |
| 1. | Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes, estimates for the year 2000 and projection for 2030. Diabetes Care 2004;27:1047-53.  [PUBMED] [FULLTEXT] |
| 2. | Sicree R, Shaw J, Zimmet P. Diabetes and impaired glucose tolerance. In: Gan D, editor. Diabetes atlas. International diabetes federation. 3 rd ed. Belgium: International Diabetes Federation; 2006. p. 15-103. |
| 3. | Romano G, Moretti G, Di Benedetto A, Giofre C, Di Cesare E, Russo G, et al. Skin lesions in diabetes mellitus: Prevalence and clinical correlations. Diabetes Res Clin Pract 1998;39:101-6. |
| 4. | Bhat YJ, Gupta V, Kudyar RP. Cutaneous manifestations of diabetes mellitus. Int J Diab Dev Ctries 2006;26:152-5.  |
| 5. | Sasmaz S, Buyukbese MA, Cetinkaya A, Celik M, Arican O. The prevalence of skin disorders in type-2 diabetic patients. Int J Dermatol 2005;3:1. |
| 6. | Mahajan S, Koranne RV, Sharma SK. Cutaneous manifestation of diabetes melitus. Indian J Dermatol Venereol Leprol 2003;69:105-8. [PUBMED] |
| 7. | Thappa DM. Skin tags as markers of diabetes mellitus: An epidemiological study in India. J Dermatol 1995;22:729-31. |
[Table 1], [Table 2] |
|
| This article has been cited by | | 1 |
Cutaneous Manifestations Associated with Diabetes Mellitus—A Retrospective Study |
|
| Dan Vâ?a, Diana-Elena Stanciu, Doini?a Temelie-Olinici, Elena Porumb-Andrese, Bogdan-Marian Tarcau, Vasile-Bogdan Grecu, Laura Gheuca-Solovastru | | Diseases. 2023; 11(3): 106 | | [Pubmed] | [DOI] | | | 2 |
Cutaneous Manifestation of Diabetes Mellitus in an Unsheltered Male Leading to Emergent Hospitalization |
|
| Taha F Rasul, Alana Moore, Daniel R Bergholz, Kavan Mulloy, Armen Henderson | | Cureus. 2022; | | [Pubmed] | [DOI] | | | 3 |
Improvement of Quality of Life in Dialysis and Diabetic Patients by Skin Dryness and Pruritus Management with an Ecobiological Dermo-Cosmetic Product |
|
| Helena Polena, Marlène Chavagnac-Bonneville, Michèle Sayag | | Clinical, Cosmetic and Investigational Dermatology. 2022; Volume 15: 2143 | | [Pubmed] | [DOI] | | | 4 |
Different patterns of cutaneous manifestation of diabetes mellitus type-2 observed in tertiary care centre of South West Rajasthan |
|
| Kalpana Gupta, Anurag Bareth, Charul Agrawal | | IP Indian Journal of Clinical and Experimental Dermatology. 2021; 7(4): 341 | | [Pubmed] | [DOI] | | | 5 |
A Tertiary Care Hospital-based Study of Various Skin Manifestations in Diabetes Mellitus Patients: Skin as a Clinical Marker of Diabetes Mellitus |
|
| Purshottam L Gupta, Kishor Singh, Ganpat Devpura | | Journal of Mahatma Gandhi University of Medical Sciences and Technology. 2021; 6(1): 10 | | [Pubmed] | [DOI] | | | 6 |
Cutaneous Manifestations of Diabetes |
|
| Alex Hines, Afsaneh Alavi, Mark D.P. Davis | | Medical Clinics of North America. 2021; 105(4): 681 | | [Pubmed] | [DOI] | | | 7 |
Evaluation of skin lesions in diabetic patients: a systematic review and meta-analysis |
|
| Nader Salari, Amin Hosseinian-Far, Melika Hosseinian-Far, Hossein Kavoussi, Rostam Jalali, Aliakbar Vaisi-Raygani, Shabnam Rasoulpoor, Shna Rasoulpoor, Masoud Mohammadi, Shervin Shabani | | Journal of Diabetes & Metabolic Disorders. 2020; 19(2): 1909 | | [Pubmed] | [DOI] | | | 8 |
The combination of common neuroosteoarthropathy and diabetic dermatopathy in type 2 diabetes mellitus |
|
| Alla Yu. Tokmakova, Ekaterina S. Gracheva, Ekaterina L. Zaitseva, Alexandr V. Vorontsov | | Diabetes mellitus. 2020; 23(2): 201 | | [Pubmed] | [DOI] | | | 9 |
Manifestaciones dermatológicas de la diabetes: clasificación y diagnóstico |
|
| Diana Patricia Crizón-Díaz, Camilo Andrés Morales-Cardona | | Iatreia. 2020; 33(3): 239 | | [Pubmed] | [DOI] | | | 10 |
Dermatoses Associated with Diabetes Mellitus |
|
| Lyubomir Dourmishev, Joana Pozharashka | | Journal of Skin and Stem Cell. 2020; 6(4) | | [Pubmed] | [DOI] | | | 11 |
Cutaneous manifestations in patients with type 2 diabetes mellitus and normal controls |
|
| Sangeetha Roslind, Kunnummal Muhammed, K. G. Sajeeth Kumar | | Journal of Skin and Sexually Transmitted Diseases. 2020; 2: 26 | | [Pubmed] | [DOI] | | | 12 |
CUTANEOUS INFECTIONS IN TYPE II DIABETES MELLITUS |
|
| Shashikant Balkrishna Dhumale | | Journal of Evidence Based Medicine and Healthcare. 2018; 5(19): 1507 | | [Pubmed] | [DOI] | | | 13 |
Metabolic Associations with Skin Tags |
|
| AH Maluki | | International Journal of Dermatology and Clinical Research. 2016; : 003 | | [Pubmed] | [DOI] | | | 14 |
Cutaneous Manifestations of Diabetes Mellitus |
|
| Michelle Duff, Olga Demidova, Stephanie Blackburn, Jay Shubrook | | Clinical Diabetes. 2015; 33(1): 40 | | [Pubmed] | [DOI] | | | 15 |
Leptin and c-reactive protein are implicated in the pathogenesis of skin tags |
|
| Sahar K Hegazy,Nahla E El-Ashmawy | | Journal of Diabetes Research and Clinical Metabolism. 2013; 2(1): 13 | | [Pubmed] | [DOI] | | | 16 |
Relationship Between Skin Diseases and Extracutaneous Complications of Diabetes Mellitus: Clinical Analysis of 750 Patients |
|
| Duriye Deniz Demirseren,Selma Emre,Gulsen Akoglu,Dilek Arpaci,Aysegul Arman,Ahmet Metin,Bekir Cakir | | American Journal of Clinical Dermatology. 2013; | | [Pubmed] | [DOI] | | | 17 |
Evolution assessment of head and neck infections in diabetic patients – A case control study |
|
| Mihai Juncar,Amorin R. Popa,Mihaela F. Baciut,Raluca Iulia Juncar,Florin Onisor-Gligor,Simion Bran,Grigore Baciut | | Journal of Cranio-Maxillofacial Surgery. 2013; | | [Pubmed] | [DOI] | | | 18 |
Prevalence of vitiligo among type 2 diabetic patients in an Iranian population |
|
| Mohammad Afkhami-Ardekani,Akram Ghadiri-Anari,Mohammad Ebrahimzadeh-Ardakani,Neda Zaji | | International Journal of Dermatology. 2013; : n/a | | [Pubmed] | [DOI] | | | 19 |
The diabetic foot and leg: Combined He-Ne and infrared low-intensity lasers improve skin blood perfusion and prevent potential complications. A prospective study on 30 Egyptian patients |
|
| Saied, G.M., Kamel, R.M., Labib, A.M., Said, M.T., Mohamed, A.Z. | | Lasers in Medical Science. 2011; 26(5): 627-632 | | [Pubmed] | |
|
|
|
|
|
|
|
|
|
|
|
| Article Access Statistics | | | Viewed | 10091 | | | Printed | 336 | | | Emailed | 3 | | | PDF Downloaded | 586 | | | Comments | [Add] | | | Cited by others | 19 | | |
|
|
