Skin Manifestations Of Diabetes Mellitus
by Dr. Sharmila Patil, M.D.

DEFINITION
State of relative or complete insulin deficiency
Leading to disturbance of Carbohydrate, Fat & Protein metabolism
Characterized by elevated fasting & post – prandial blood glucose levels
Associated with complications mainly in the blood vessels, eye, kidney, nervous system & integument

INTRODUCTION
30% of patients with diabetes have a cutaneous manifestation
In several cases, the skin lesions may be a clue to the diagnosis of diabetes

SKIN & INSULIN
Skin depends on insulin & circulating fuels for metabolic & biosynthetic activity
Insulin regulates glucose disposition in epidermal cells & is required for their growth & differentiation
Dermal fibroblasts in diabetes produce more fibronectin with decrease in acid soluble collagen, more cross-linking and more glycosylation

CLASSIFICATION OF CUTANEOUS MANIFESTATIONS

1.CUTANEOUS CONDITIONS ASSOCIATED WITH DM
Diabetic Vascular Abnormalities
Necrobiosis Lipoidica Diabeticorum
Granuloma Annulare
Bullosis Diabeticirum
Acanthosis Nigricans
Acquired Perforating Dermatosis
Diabetic Thick Skin
Xanthomatosis
Carotenosis
Pruritus
Skin Tags
Vitiligo
Lichen Planus

2. CUTANEOUS INFECTIONS IN DM
Bacterial Infections
Fungal Infections

3. NAILS & DIABETES

4. CUTANEOUS MANIFESTATIONS OF DIABETIC COMPLICATION
Diabetic Foot
Neuropathy in Diabetes
Neuropathic Ulcer
Vascular Ulcer
Charcot’s Arthropathy

5.COMPLICATIONS OF TREATMENT
Reactions to Insulin
Reactions to Oral Hypoglycemic Agents

DIABETIC VASCULAR ABNORMALITIES
Diabetic Microangiopathy
Erysipelas – Like Erythema
Wet Gangrene Of Foot
Diabetic Rubeosis
Diabetic Dermopathy (Diabetic Shin Spots)
Diabetic Dermopathy Contd
Large-Vessel Disease

NAILS & DIABETES

CUTANEOUS MANIFESTATIONS OF DIABETIC COMPLICATIONS

DIABETIC FOOT
Infection, neuropathy, Underlying anatomical abnormalities and peripheral vascular disease together cause “Diabetic Foot”

COMPLICATIONS OF TREATMENT – REACTIONS TO INSULIN
Allergic Cutaneous
At start of Rx
Wheal and flare: early occurrence
Indurated lesions: late occurrence
Biphasic lesions
Allergic Systemic
With interrupted treatment
Preceded by increasingly severe local reactions
Urticaria, angioedema anaphylaxis

COMPLICATIONS OF TREATMENT- REACTIONS TO INSULIN
Lipoatrophy
Young & females
Arms, thighs
Depression in normal skin
Less common with human insulin
? Immunological mechanism
Lipohypertrophy
Males
No specific area
Subcutaneous fat deposition
Not related to type of insulin
Insulin induced stimulation of fat

COMPLICATIONS OF TREATMENT – REACTIONS TO OHA
Phototoxic Reaction – Sulphonylureas (Chlorpropamide, Tolbutamide)
Drug Reaction - Maculo-Papular Rash
Erythema Nodosum
Steven Johnson
Syndrome
Erythema Multiforme
Purpura
Porphyria Cutanea Tarda
Urticaria
Flushing Reaction – Antabuse like reaction with Chlorpropamide if alcohol is consumed