Cutaneous Manifestations of Diabetes Mellitus
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Transcript of Cutaneous Manifestations of Diabetes Mellitus
Cutaneous Manifestations of Diabetes Mellitus
Dr Noreen CowleyMD FRCP
Consultant Dermatologist
Cutaneous
No Pathonomonic Skin lesion in Diabetes
Cutaneous Manifestations of Diabetes
30% incidence cutaneous disorders ADA70% during course of illness
15% ulceration
Cutaneous Manifestations of DiabetesHyperglycaemia
Neuropathy
Impaired host response
Microvascular angiopathies with failure of the microcircutation to meet the metabolic requirements of the skin
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
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
Skin Infection
20-50% (Type 2) poor glycaemic control Poor micro and macro-circulation NeuropathyAltered immune response
Dermatoses “portal of entry”
Skin Infection
Staphylococcus folliculitisSuperficial fungal infectionCellulitis and erysipelasOral and genital candida
Non pathogenic organisms mucormycosis by phycomycetes and anaerobic cellulitis by clostridium species
Erythrasma
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
Necrobiosis Lipoidica
Necrobiosis Lipoidica
Necrobiosis Lipoidica
Aetiology
Microangiopathy –---collagen degradation with release cytokines from inflammatory cells – destruction collagenous matrix
Little evidence correlation retinopathy/nephropathy
Necrobiosis Lipoidica
0.3-0.7%
Differential Diagnosis
Generalized Granuloma Annulare
Diabetic Dermopathy
“Shin Spots”
Shemer et al 40%
Men – 50yrs
Diabetic Dermopathy
Severe microvascular complications
Retinopathy,neuropathy,nephropathy
Closely linked to glycosylated Hb
High risk of accelerated diabetes complications
Bullosis Diabeticorum
Bullosis DiabeticorumType 1 Diabetes
0.5%
Men
Longstanding Disease
Peripheral Neuropathy
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
Eruptive Xanthomas
Scleredema of Buschke
Scleredema of Buschke
Type 2ObeseTherapy resistantCardiovascularRetinopathy
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
Acanthosis Nigricans
8 types
Obesity – Acanthosis Nigricans
Kahn 1975 association with insulin resistance
Acanthosis Nigricans
Mechanism?
High insulin concentrations stimulate insulin–like growth factor receptors on keratinocytes promoting epidermal cell proliferation
HAIR-AN Syndrome
• HyperAndrogenism• Insulin Resistance• Acanthosis Nigricans
HAIR-AN SyndromeType A I RMutation gene that encodes the
insulin receptor
Tall black young females
Severe acanthosis nigricansbegins infancy and early childhood
Alopecia
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
Auto-Immune DisordersVitiligo1-7% in diabetes0.2-1% non-diabetic
Lichen Sclerosis et Atrophicus
Lichen Sclerosis et Atrophicus
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
Cutaneous effects of Therapy
• Insulin• Oral hypoglycaemic agents
MetforminPsoriasiform drug eruptionErythema MultiformeLeucocytoclastic Vasculitis
Lipoatrophy/hypertrophyLipoatrophyThighs/arms children and young women
LipohypertrophyMalesSubcutaneous deposition fat at injection sitesInsulin –induced stimulation of adipose tissue growth
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
Perforating Collagenosis
Perforating Collagenosis
Elimination of focally damaged collagen through the epidermis
Necrolytic Migratory Erythema
StomatitisWeight LossDiabetes 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
Thankyou
Any Questions?