Research indicates that 30 to 70% of individuals with diabetes experience skin manifestations related to their condition, with some cases emerging even before a diabetes diagnosis. A 2023 retrospective study sought to analyze these dermatological manifestations and compare findings with existing literature. This review highlights critical clinical observations from the study and underscores the role of podiatrists in identifying and managing these conditions, particularly in the lower extremities.
The study categorized skin disorders associated with diabetes into five groups:
- Manifestations Strongly Associated with Diabetes Mellitus
- Non-Specific Signs and Symptoms Associated with Diabetes Mellitus
- Dermatological Disorders Associated with Diabetes Mellitus
- Frequent Skin Infections Occurring in Diabetes Mellitus
- Skin Changes Associated with Diabetes Mellitus Therapy
Researchers examined the records of 427 diabetes patients treated at a dermatology clinic over five years. Of these, 103 patients presented with at least one diabetes-related dermatological issue upon initial evaluation. The cohort comprised 60 females and 43 males, with a mean age of 63.3 years (range: 32-88 years). The Chi-Square Test-Likelihood Ratio indicated no significant differences in age and sex distribution. The majority (101) had type 2 diabetes, while 2 had type 1 diabetes.
Key Findings from the Study
Manifestations Strongly Associated with Diabetes:
Diabetic foot complications were observed in 18.4% of patients.
Necrobiosis lipoidica was noted in 6.8%.
Bullous diabeticorum and acanthosis nigricans were present in 5.8% and 4.9%, respectively.
Signs and Symptoms Commonly Associated with Diabetes:
Xerosis (dry skin) was found in 42.7% of patients.
Pruritus (itching) was reported by 15.5%.
Acrochordons (skin tags) were seen in nearly 15%.
Rubeosis faciei (facial redness) affected 5.8%.
Skin and Mucosal Infections:
Bacterial infections, including erythrasma, folliculitis, and cellulitis, were prevalent in 33.9% of patients.
Tinea pedis (athlete’s foot) affected 31.1%.
Other cutaneous mycoses were noted in 27.1%.
Oral and genital candidiasis were also reported.
Other Dermatological Disorders Associated with Diabetes Mellitus:
Bullous autoimmune dermatoses (e.g., bullous pemphigoid, morphea) were present in 18.4% of patients.
Psoriasis affected 10.6%.
Lichen planus and granuloma annulare were also documented.
The study also explored skin conditions linked to diabetes therapy, including lipohypertrophy at insulin injection sites, subcutaneous nodules, lipoatrophy, and allergic reactions. Although less common, oral diabetes medications, particularly sulfonylureas, can cause drug eruptions, vasculitis, photosensitivity, and polymorphic erythema. The authors also mentioned potential metformin-related leukocytoclastic vasculitis or psoriatic eruptions.
Clinical Implications
The study emphasizes that while many dermatological conditions appear after a diabetes diagnosis, some may present earlier, potentially signaling undiagnosed diabetes. It is crucial for healthcare providers to maintain a high index of suspicion and assess diabetes risk when encountering patients with these skin manifestations. Type 2 diabetes patients were more likely to have infectious skin issues, whereas those with type 1 diabetes more frequently experienced autoimmune skin conditions. The relationship between skin changes and elevated blood glucose levels is complex, and hyperglycemia can influence dermatological manifestations.
Early recognition and management of these skin issues are essential components of comprehensive diabetes care. Addressing these conditions can enhance patient outcomes and quality of life.
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