DefinitionThis section has been translated automatically.
Diabetes mellitus is the most common metabolic disease in humans; 5 million people in Germany suffer from this disease. About 1/3 of diabetics develop skin diseases. These occur both in manifest diabetes and in the pre-diabetic stage. However, they can also be superimposed by diabetogenically induced organ diseases (nephropathy, neuropathy, retinopathy, macro- and microangiopathy).
The diabetic skin changes are sometimes associated with a significantly increased morbidity and mortality.
4 types of diabetes are distinguished:
- Type 1 diabetes (special form LADA diabetes)
- Type 2 diabetes (>90%)
- Type 3 diabetes = other specific forms of diabetes (e.g. drugs such as glucocorticoids, genetic defects in beta cell function(MODY1-14), rare immunological diseases; genetic forms)
- Type 4 diabetes = gestational diabetes (GDM).
ClassificationThis section has been translated automatically.
- Skin changes occur both in manifest diabetes and in the pre-diabetic stage. The percentages listed refer to several publications with larger collectives.
- Skin changes in diabetes mellitus can be classified into 5 disease groups:
- Skin infections
- Skin diseases with overfrequent association to diabetes mellitus
- Skin diseases due to diabetic complications
- Skin diseases due to diabetogenic organ diseases and their secondary effects on the skin (e.g. effects of a diabetic nephropathy)
- Reactions to antidiabetic therapy (ADR).
- Bacterial infections:
- Abscess, phlegmon
- Neck carbuncle
- Otitis externa (also caused by Pseudomonas aeruginosa).
- Yeast infections (gastrointestinal candidiasis as reservoir; also the dentures; cave: plastic indwelling catheters - here also non-C-albicans pathogens such as C. glabrata and C. tropicalis):
- Candidiasis (14% of diabetics)
- Candidiasis, chronic mucocutaneous
- Balanitis, vulvovaginitis
- Other infections:
- Tinea (one hand two feet syndrome)
- Scabies norvegica
Skin diseases with hyper association to diabetes mellitus:
- Granulomatous changes:
- Metabolic disorders:
- glucagonoma syndrome (erythema necrolyticum migrans)
- Hyperlipoproteinemia (eruptive xanthomas: in 0,6% of diabetics)
- Porphyria cutanea tarda
- Insulin resistance syndromes:
- Filiform fibromas of the axillae/groin regions (in 26% of diabetics)
- Acanthosis nigricans (in 5% of diabetics)
- Congenital lipodystrophy.
- Diseases of the connective tissue:
- Other diseases:
- Lipid deposition diseases, systematized
- Kyrle's disease (hyperkeratosis follicularis et parafollicularis in cutem penetrans)
- Reactive, perforating collagenosis
- Lichen planus (with oral mucosal involvement)
- Black hair tongue
- Kaposi's sarcoma
- Bullosis diabeticorum (0.4%)
- Hirsutism (diabeticorum)
- Along with Addison's disease, Hashimoto's thyroiditis in autoimmunologic polyendocrinologic syndrome.
- Deposits, discoloration:
- Eruptive xanthomas (hyperlipidemic xanthomas: 0,6%)
- Rubeosis diabeticorum
- Erythema palmare et plantare symptomaticum
- pseudoacanthosis nigricans
- pretibial pigment spots.
Skin diseases due to diabetic complications:
- Atrophy blanche
- leg ulcer
- Arteriosclerosis with pAVK
- Other chronic wounds.
Polyneuropathy (see Diabetic Polyneuropathy):
- Common pressure calluses, with incorrect pressure on the soles of the feet
- Burning-feet syndrome
- Malum perforans
- Diabetic foot syndrome
- Diabetic pruritus (In 27.5% of patients with type 2 diabetes - Ko MJ et al 2013).
- Diabetic nephropathy with dermatological complications of potentially occurring superimposed chronic kidney disease (especially in end-stage renal failure).
Skin disorders due to antidiabetic therapy:
- Allergic reactions
- Photosensitivity reactions
- Alcohol-induced flushing phenomena under sulfonylureas.
- Allergic reactions (5-10%)
- Insulin-induced lipatrophy (14%)
- Lipomatoses ( lipomatosis, benign symmetric)
- "Insulin tumors" (at insulin injection sites).
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Occurrence/EpidemiologyThis section has been translated automatically.
Prevalence of diabetes mellitus: 6% of the population. About one third of all diabetics develop skin symptoms during the course of the disease.
EtiopathogenesisThis section has been translated automatically.
It has been proven that diabetes mellitus on the one hand directly damages increased pathological glucose concentrations, on the other hand indirectly, by forming "advanced glycation end-products(AGEs)". AGEs are formed in a non-enzymatic reaction (glycation) of glucose and proteins, lipids and nucleic acid AGEs. They induce negative effects on almost all cell systems. Pathological glucose concentrations inhibit the proliferation, migration and protein biosynthesis of keratinocytes and fibroblasts. In endothelial cells they induce apoptosis and inhibit nitric oxide synthase (NOS) and thus NO synthesis. This leads to a reduced vasodilation in vivo. Pathological glucose concentrations suppress chemotaxis and phagocytosis of cell types of the innate immune defence.
AGEs interact with a number of intracellular and extracellular proteins, e.g. collagen type I, superoxide dismutase 1 or epidermal growth factor receptor and weaken their biological function. Furthermore, AGEs bind to RAGE (Receptor for AGEs). This leads to activation of the NF-κB signalling pathway with induction of proinflammatory cytokines, and both pathological glucose concentrations and AGEs lead to increased formation of intracellular oxidative stress (formation of reactive oxygen species - ROS). This is caused by a depletion of antioxidative protective enzymes such as glutathione or mitochondrial superoxide dismutase. On the other hand, ROS-generating enzymes such as nicotinamide adenine dinucleotide phosphate oxidase are induced.
LiteratureThis section has been translated automatically.
- Diris N et al (2003) Non infectious skin conditions associated with diabetes mellitus: a prospective study of 308 cases. Ann Dermatol Venereol 130: 1009-1014
- Guardiano RA et al (2003) Generalized granuloma annulare in a patient with adult onset diabetes mellitus. J Drugs Dermatol 2: 666-668
- Ko MJ et al (2013) Postprandial blood glucose is associated with generalized pruritus in patients with type 2 diabetes. Eur J Dermatol 23:688-693.
- Lima AL et al (2017) Cutaneous Manifestations of Diabetes Mellitus: A Review. At J Clin Dermatol 18:541-553.
- Noakes R (2003) Lichenoid drug eruption as a result of the recently released sulfonylurea glimepiride. Australas J Dermatol 44: 302-303
Quondamatteo F (2014) Skin and diabetes mellitus: what do we know?
Cell Tissue Res 355: 1-21.
Schmults CA (2003) Scleroderma. Dermatol Online J 9: 11
- Ragunatha S et al(2011) Cutaneous disorders in 500 diabetic patients attending diabetic clinic. Indian J Dermatol 56:160-164
- Richardson T, Kerr D (2003) Skin-related complications of insulin therapy: epidemiology and emerging management strategies. At J Clin Dermatol 4: 661-667
- Romero MA et al (2002) Prevalence of diabetes mellitus among oral lichen planus patients. Clinical and pathological characteristics. Med Oral 7: 121-129
- Schneider JB, Norman RA (2004) Cutaneous manifestations of endocrine-metabolic disease and nutritional deficiency in the elderly. Dermatol Clin North Am 22: 23-31
- Sipetic S et al (2004) The belgrade childhood diabetes study: association of infections and vaccinations on diabetes in childhood. Ann Epidemiol 13: 645-51
- Yosipovitch G et al (2003) Medical pearl: Scleroderma-like skin changes in patients with diabetes mellitus. J Am Acad 49: 109-111
Incoming links (17)Achard-thiers syndrome; Adiposity skin changes; Autoimmune diseases; Bilobed flap; Chronic mucocutaneous candidiasis; Dermatitis-arthritis syndromes; Erythema palmare et plantar symptomaticum; Erythromelalgia; Glossary; Malum perforans; ... Show all
Outgoing links (61)Acanthosis nigricans (overview); Acute paronychia; Ages; Arterial occlusive disease peripheral; Atrophie blanche; Balanitis; Bullosis diabeticorum; Burning feet syndrome; Candida glabrata; Candidoses; ... Show all
Please ask your physician for a reliable diagnosis. This website is only meant as a reference.