Diabetes mellitus skin changes E10-E14 + Hauterkrankung

Last updated on: 29.10.2020

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Synonym(s)

Diabetes Skin changes; Diabetogenic skin diseases; Skin and diabetes mellitus; skin changes in diabetes mellitus, dermatoses in diabetes mellitus; Skin diseases with diabetes mellitus

Definition
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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 overlaid by diabetogenically induced organ diseases (nephropathy, neuropathy, retinopathy, macro- and microangiopathy).

The diabetic skin alterations are partly associated with significantly increased morbidity and mortality.

4 types of diabetes are distinguished:

  • Type 1 diabetes (special form of 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).

Classification
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  • Skin changes occur both in manifest diabetes and in the pre-diabetic stage. The listed percentages refer to several publications with larger collectives.
  • Skin changes in diabetes mellitus can be assigned to 5 disease groups:
    1. Skin infections
    2. Skin diseases with a frequent association to diabetes mellitus
    3. Skin diseases due to diabetic complications
    4. Skin diseases due to diabetogenic organ diseases and their secondary effects on the skin (e.g. effects of diabetic nephropathy)
    5. Reactions to antidiabetic therapy (ADR).

skin infections:

Skin diseases with frequent association to diabetes mellitus:

Skin diseases caused by diabetic complications:

Skin diseases through antidiabetic therapy:

Occurrence/Epidemiology
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Prevalence of diabetes mellitus: 6% of the population. About one third of all diabetics develop skin symptoms during the course of the disease.

Etiopathogenesis
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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.

Literature
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  1. 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
  2. Guardiano RA et al (2003) Generalized granuloma annulare in a patient with adult onset diabetes mellitus. J Drugs Dermatol 2: 666-668
  3. 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.
  4. Lima AL et al (2017) Cutaneous Manifestations of Diabetes Mellitus: A Review. At J Clin Dermatol 18:541-553.
  5. Noakes R (2003) Lichenoid drug eruption as a result of the recently released sulfonylurea glimepiride. Australas J Dermatol 44: 302-303
  6. Quondamatteo F (2014) Skin and diabetes mellitus: what do we know?
    Cell Tissue Res 355: 1-21.

  7. Schmults CA (2003) Scleroderma. Dermatol Online J 9: 11

  8. Ragunatha S et al(2011) Cutaneous disorders in 500 diabetic patients attending diabetic clinic. Indian J Dermatol 56:160-164
  9. Richardson T, Kerr D (2003) Skin-related complications of insulin therapy: epidemiology and emerging management strategies. At J Clin Dermatol 4: 661-667
  10. Romero MA et al (2002) Prevalence of diabetes mellitus among oral lichen planus patients. Clinical and pathological characteristics. Med Oral 7: 121-129
  11. Schneider JB, Norman RA (2004) Cutaneous manifestations of endocrine-metabolic disease and nutritional deficiency in the elderly. Dermatol Clin North Am 22: 23-31
  12. Sipetic S et al (2004) The belgrade childhood diabetes study: association of infections and vaccinations on diabetes in childhood. Ann Epidemiol 13: 645-51
  13. Yosipovitch G et al (2003) Medical pearl: Scleroderma-like skin changes in patients with diabetes mellitus. J Am Acad 49: 109-111

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

Last updated on: 29.10.2020