Cutaneous Manifestations of Diabetes Mellitus Dr Noreen Cowley MD FRCP Consultant Dermatologist.

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Cutaneous Manifestations of Diabetes Mellitus Dr Noreen Cowley MD FRCP Consultant Dermatologist

Transcript of Cutaneous Manifestations of Diabetes Mellitus Dr Noreen Cowley MD FRCP Consultant Dermatologist.

Page 1: Cutaneous Manifestations of Diabetes Mellitus Dr Noreen Cowley MD FRCP Consultant Dermatologist.

Cutaneous Manifestations of Diabetes Mellitus

Dr Noreen CowleyMD FRCP

Consultant Dermatologist

Page 2: Cutaneous Manifestations of Diabetes Mellitus Dr Noreen Cowley MD FRCP Consultant Dermatologist.
Page 3: Cutaneous Manifestations of Diabetes Mellitus Dr Noreen Cowley MD FRCP Consultant Dermatologist.

Cutaneous

No Pathonomonic Skin lesion in Diabetes

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Cutaneous Manifestations of Diabetes

30% incidence cutaneous disorders ADA70% during course of illness

15% ulceration

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Cutaneous Manifestations of DiabetesHyperglycaemia

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

Page 7: Cutaneous Manifestations of Diabetes Mellitus Dr Noreen Cowley MD FRCP Consultant Dermatologist.

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 NeuropathyAltered immune response

Dermatoses “portal of entry”

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Skin Infection

Staphylococcus folliculitisSuperficial fungal infectionCellulitis and erysipelasOral 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,neuropathy,nephropathy

Closely linked to glycosylated Hb

High risk of accelerated diabetes complications

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Bullosis Diabeticorum

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Bullosis DiabeticorumType 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 2ObeseTherapy resistantCardiovascularRetinopathy

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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 insulin–like 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 SyndromeType A I RMutation gene that encodes the

insulin receptor

Tall black young females

Severe acanthosis nigricansbegins 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 DisordersVitiligo1-7% in diabetes0.2-1% 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

MetforminPsoriasiform drug eruptionErythema MultiformeLeucocytoclastic Vasculitis

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Lipoatrophy/hypertrophyLipoatrophyThighs/arms children and young women

LipohypertrophyMalesSubcutaneous deposition fat at injection sitesInsulin –induced stimulation of adipose tissue growth

Page 39: Cutaneous Manifestations of Diabetes Mellitus Dr Noreen Cowley MD FRCP Consultant Dermatologist.

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

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

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Thankyou

Any Questions?