Bullosis diabeticorum E14.65

Kramer (first description of the clinical picture), 1930; Cantwell and Martz (naming), 1967

Rare spontaneous or recurrent blistering of the lower legs and/or feet that occurs in diabetics. After 2-6 weeks healing with the development of brownish pigmentation.

Remark: The entity is disputed by some authors

w:m=2:1; average age of onset is 55 years (17-84 years).

Unclear; microtraumas and an underlying microangiopathy are discussed.

Mostly occurring in long-term diabetes mellitus (equally in insulin-dependent and insulin-independent diabetes mellitus), especially in patients with polyneuropathy, retinopathy and renal involvement. It is observed in 0.5%-1.0% of diabetics.

soles of feet, palms of hands, extensor sides of lower legs, extensor sides of forearms

Spontaneous blistering of a few millimetres up to several centimetres in the area of the distal extremities, especially the feet. A previous trauma is usually not remembered, although the localizations suggest it. Slight burning sensation.

Clinically important is the association of bullosis diabeticorum with diabetic retinopathy, nephropathy and polyneuropathy. There is no association with insulin dependence.

2 types are described:

• Non-scarring type with intraepidermal cleft or blister formation without acantholysis.
• Scarring type with subepidermal cleft formation.

Other blistering dermatoses, especially porphyria cutanea tarda; mechanical blistering; pseudoporphyria in dialysis patients; bullous pemphigoid; epidermolysis bullosa acquisita.

Suction of the bladder contents, dressings with polyvidon-iodine ointments R204 or gauze (e.g. Braunovidon wound gauze), fusidic acid ointments (e.g. Fucidine ointment). Additional baths with polihexanide (Prontosan W) or aqueous quinolinol solution(e.g. Chinosol 1:1000), R042.

Setting the diabetes mellitus.

1. Aye M et al (2002) Dermatological care of the diabetic foot. Am J Clin Dermatol 3: 463-474
2. Bernstein JE et al (1983) Reduced threshold to suction-induced blister formation in insulin-dependent diabetics. J Am Acad Dermatol 8: 790-791
3. Cantwell AR Jr et al (1967) Idiopathic bullae in diabetics. Bullous diabeticorum. Arch Dermatol 96: 42-44
4. Kramer DW (1930) Early or warning signs of impeding gangrene in diabetes. Med J Rec 132: 338-342
5. Lipsky BA et al (2000) Diabetic bullae: 12 cases of a purportedly rare cutaneous disorder. Int J Dermatol 39: 196-200
6. Ragunatha S et al(2011) Cutaneous disorders in 500 diabetic patients attending diabetic clinic. Indian J Dermatol 56:160-164
7. Richardson T, Kerr D (2003) Skin-related complications of insulin therapy: epidemiology and emerging management strategies. At J Clin Dermatol 4: 661-667