Skin diseases commonly seen in diabetic patients

1
Skin diseases commonly seen in diabetic patients

• Dr. Au Tak Shing
• MBBS (HK), MRCP (UK),
• FHKCP, FHKAM (Medicine), FRCP (Edin),
• Dip Derm (Lond), Dip GUM (LSA),
• DCH (Lond), DFM (CUHK),
• Specialist in Dermatology and Venereology

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Skin disease and DM

• Skin manifestations of DM
• Skin disease as side effects of treatment for DM
• Treatment of skin disease resulting in DM

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Dermatophyte infection

• Tinea is common in DM patients
• May not be more common than general population
• Need for treatment is even stronger
• Watch out for secondary bacterial infection

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Infection or not?

• Distribution is a very important clue

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Distribution

• Fungal infection is usually asymmetrical

• Dermatitis is usually symmetrical or
  corresponding to the primary cause

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Infection or not?

• Distribution is a very important clue
• Morphology of an individual lesion

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Candidiasis

• More common in DM patients
• Vulvo-vaginitis
• Balano-posthitis
• Can be the first sign of DM

8
Diabetic dermopathy

• Quite common
• Multiple, asymptomatic, irregularly shaped,
  discrete, atrophic, brown macules resembling
  scars
• Shins
• Intimal thickening and deposition of PAS-positive
  fibrillary material in vessel walls
• Microangiopathy elsewhere

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Acanthosis nigricans

• Velvety hyperpigmentation of intertriginous areas
• Less often on extensor surfaces
• Commonly associated with insulin resistance
• Obesity, darkly-pigmented patients

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Diabetic bullae

• Bullous diabeticorum
• Non-inflammatory bullae on lower extremities
• Pathology uncertain

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Bullous pemphigoid

• Autoimmune process that affects the
  dermo-epidermal junction
• Elderly
• Multiple intact bullae
• Investigation skin biopsy for histology and
  immunofluorescence study
• Treatment oral steroid /- other
  immuno-suppressants

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Necrobiosis lipoidica

• Yellow atrophic patches often on shins
• Erythematous border
• Ulceration
• Not always associated with DM

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Disseminated granuloma annulare

• Annular lesions composed of papules
• Usually smooth surface
• Controversy about relation with DM

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Neuropathic ulcers

• Non-painful ulcers at feet
• Pressure points

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Acral dry gangrene

• Due to vascular disease

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Eruptive xanthomas

• Reddish yellow papules
• Developing over weeks to months
• Elevated serum triglycerides in patients with
  poorly controlled DM
• Good control of DM leads to resolution

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Contact

• Dr. Au Tak Shing
• Unit 502, Hing Wai Building, 36 Queens Road
  Central, HK (tel [phone])
• ?????????36?????5?502?(???????)
• Unit 922, Argyle Centre Phase One, 688 Nathan
  Road, Mongkok (tel [phone])
• ???????688????????9?922?(???????)
• Email auts123_at_yahoo.com.hk