Cutaneous Manifestations of Diabetes Mellitus

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Cutaneous Manifestations of Diabetes Mellitus

• Dr Noreen Cowley
• MD FRCP
• Consultant Dermatologist

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(No Transcript)
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Cutaneous

• No Pathonomonic Skin lesion in Diabetes

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Cutaneous Manifestations of Diabetes

• 30 incidence cutaneous disorders ADA
• 70 during course of illness
• 15 ulceration

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Cutaneous Manifestations of Diabetes

• Hyperglycaemia
• Neuropathy
• Impaired host response
• Microvascular angiopathies with failure of the
  microcircutation to meet the metabolic
  requirements of the skin

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Cutaneous Manifestations of Diabetes

• Common disorders that affect non-diabetes
• Those classically associated with diabetes /
  reflect microangiopathy
• Lesions indicating poor control
• Effect of insulin resistance
• Adverse effects of therapy for diabetes
• Skin changes as a result complications of
  diabetes
• Other associated autoimmune disorders

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Cutaneous Manifestations of Diabetes

• Common disorders that affect non-diabetics
• Those classically associated with diabetes /
  reflect microangiopathy
• Lesions indicating poor control
• Effect of insulin resistance
• Adverse effects of therapy for diabetes
• Skin changes as a result complications of
  diabetes
• Other associated autoimmune disorders

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Skin Infection

• 20-50 (Type 2) poor glycaemic control
• Poor micro and macro-circulation
• Neuropathy
• Altered immune response
• Dermatoses portal of entry

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Skin Infection

• Staphylococcus folliculitis
• Superficial fungal infection
• Cellulitis and erysipelas
• Oral and genital candida
• Non pathogenic organisms
• mucormycosis by phycomycetes
• and anaerobic cellulitis by clostridium species

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Erythrasma
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Cutaneous Manifestations of Diabetes

• Common disorders that affect non-diabetes
• Those classically associated with diabetes /
  reflect microangiopathy
• Lesions indicating poor control
• Effect of insulin resistance
• Adverse effects of therapy for diabetes
• Skin changes as a result complications of
  diabetes
• Other associated autoimmune disorders

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Necrobiosis Lipoidica
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Necrobiosis Lipoidica
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Necrobiosis Lipoidica
Aetiology Microangiopathy ---collagen
degradation with release cytokines from
inflammatory cells destruction collagenous
matrix Little evidence correlation
retinopathy/nephropathy
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Necrobiosis Lipoidica
0.3-0.7
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Differential Diagnosis
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Generalized Granuloma Annulare
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Diabetic Dermopathy
Shin Spots Shemer et al 40 Men 50yrs
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Diabetic Dermopathy
Severe microvascular complications Retinopathy,ne
uropathy,nephropathy Closely linked to
glycosylated Hb High risk of accelerated
diabetes complications
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Bullosis Diabeticorum
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Bullosis Diabeticorum
Type 1 Diabetes 0.5 Men Longstanding
Disease Peripheral Neuropathy
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Cutaneous Manifestations of Diabetes

• Common disorders that affect non-diabetes
• Those classically associated with diabetes /
  reflect microangiopathy
• Lesions indicating poor control
• Effect of insulin resistance
• Adverse effects of therapy for diabetes
• Skin changes as a result complications of
  diabetes
• Other associated autoimmune disorders

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Eruptive Xanthomas
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Scleredema of Buschke
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Scleredema of Buschke
Type 2 Obese Therapy resistant Cardiovascular Reti
nopathy
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Cutaneous Manifestations of Diabetes

• Common disorders that affect non-diabetes
• Those classically associated with diabetes /
  reflect microangiopathy
• Lesions indicating poor control
• Effects of insulin resistance
• Adverse effects of therapy for diabetes
• Skin changes as a result complications of
  diabetes
• Other associated autoimmune disorders

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Acanthosis Nigricans
8 types Obesity Acanthosis Nigricans Kahn
1975 association with insulin resistance
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Acanthosis Nigricans
Mechanism? High insulin concentrations stimulate
insulinlike growth factor receptors on
keratinocytes promoting epidermal cell
proliferation
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HAIR-AN Syndrome

• HyperAndrogenism
• Insulin Resistance
• Acanthosis Nigricans

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HAIR-AN Syndrome

• Type A I R
• Mutation gene that encodes the insulin receptor
• Tall black young females
• Severe acanthosis nigricans
• begins infancy and early childhood
• Alopecia

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Cutaneous Manifestations of Diabetes

• Common disorders that affect non-diabetes
• Those classically associated with diabetes /
  reflect microangiopathy
• Lesions indicating poor control
• Effect of insulin resistance
• Adverse effects of therapy for diabetes
• Skin changes as a result complications of
  diabetes
• Other associated autoimmune disorders

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Auto-Immune Disorders

• Vitiligo
• 1-7 in diabetes
• 0.2-1 non-diabetic

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Lichen Sclerosis et Atrophicus
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Lichen Sclerosis et Atrophicus
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Cutaneous Manifestations of Diabetes

• Common disorders that affect non-diabetes
• Those classically associated with diabetes /
  reflect microangiopathy
• Lesions indicating poor control
• Effect of insulin resistance
• Adverse effects of therapy for diabetes
• Skin changes as a result complications of
  diabetes
• Other associated autoimmune disorders

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Cutaneous effects of Therapy

• Insulin
• Oral hypoglycaemic agents
• Metformin
• Psoriasiform drug eruption
• Erythema Multiforme
• Leucocytoclastic Vasculitis

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Lipoatrophy/hypertrophy

• Lipoatrophy
• Thighs/arms children and young women
• Lipohypertrophy
• Males
• Subcutaneous deposition fat at injection sites
• Insulin induced stimulation of adipose tissue
  growth

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Cutaneous Manifestations of Diabetes

• Common disorders that affect non-diabetes
• Those classically associated with diabetes /
  reflect microangiopathy
• Lesions indicating poor control
• Effect of insulin resistance
• Adverse effects of therapy for diabetes
• Skin changes as a result complications of
  diabetes
• Other associated autoimmune disorders

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Perforating Collagenosis
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Perforating Collagenosis
Elimination of focally damaged collagen through
the epidermis
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Necrolytic Migratory Erythema
Stomatitis Weight Loss Diabetes Mellitus
Glucagon-secreting tumour of the pancreatic
islet cells
Mechanism? Sustained gluconeogenesis from high
glucagon levels leads to amino acid
deficiency,epidermal protein deficiency and
necrolysis
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Thankyou

• Any Questions?