Dermatologic Manifestations of Diabetes Mellitus: A Review

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Key points

  • •

    Primer on dermatologic conditions that may serve as markers of impaired glucose metabolism, emphasizing their role in the early identification and management of diabetes mellitus.

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    Understand the epidemiology, pathogenesis and treatment of diabetes-associated skin disorders.

Necrobiosis Lipoidica Diabeticorum

Necrobiosis lipoidica (NL) is a chronic, necrotizing, granulomatous skin disease that occurs primarily in individuals with diabetes. It is one of the most disfiguring, disabling, and refractory cutaneous complications of diabetes.7 NL lesions begin as small, firm, erythematous papules that gradually evolve and enlarge. Typical lesions are well-demarcated, indurated, annular plaques that contain characteristic yellow-brown atrophic centers studded with prominent ectatic vessels, and delimited by

Acrochordons (Skin Tags)

Skin tags are soft fibromas that are particularly common in people with diabetes. These benign, asymptomatic, exophytic growths are observed on the eyelids, neck, axilla, and other skin folds. They may be flesh-colored or, less often, hyperpigmented, and can range from small papules to pedunculated polyps, typically 1 to 6 mm in diameter, with smooth or irregular surfaces.94, 95, 96, 97 There is a slight female predilection, and prevalence increases with age.39 Although characteristically

Skin Manifestations of Diabetic Vascular Disease

Diabetes mellitus causes both large and small blood vessel disease. Atherosclerosis of vessels in diabetic patients often leads to ischemic changes of the lower extremities that result in classic findings: shiny, hairless, atrophic skin with cold toes and dystrophic nails, pallor on elevation, and mottling on dependence.39 Large vessel disease contributes to poor wound healing and the frequency and recurrence of cutaneous infections in persons with diabetes, causing increased risk of gangrene

Psoriasis

Psoriasis is a relatively common chronic inflammatory skin disease with systemic manifestations. The worldwide prevalence of psoriasis is estimated to be 1% to 3%.141 Inflammatory pathways and genetic susceptibility seem to be at the core of the pathologic mechanism. Many risk factors have been associated with psoriasis, including smoking, hypertension, obesity, and insulin resistance.142 The condition is more frequent and severe in obese patients.143

Patients with psoriasis are believed to have

Cutaneous infections

Skin infections are common in those with diabetes mellitus, especially type 2 diabetes. The impaired microcirculation, sensory and autonomic neuropathy, acid-base imbalances, and impaired immune response of diabetes mellitus and its complications predispose diabetic patients to bacterial and fungal infections of the skin that may run an unusually prolonged or recurrent course. Many studies have shown the incidence of cutaneous infections is higher in people with diabetes than in the general

Insulin

The advent of recombinant insulin preparations has largely done away with once common insulin allergies.10 Insulin allergy is now seen in less than 1% of patients injecting insulin. Delayed hypersensitivity reactions have been the most common type of allergic reaction, but immediate-local, generalized, and biphasic reactions have also occurred. Treatment options for insulin allergies include antihistamines, the addition of steroid to insulin, desensitization therapy, rotating the injection

Summary

The wide range of dermatologic conditions related to impaired glucose metabolism is important across multiple medical specialties to identify undiagnosed diabetes as early as possible and to better manage patients with known disease. Despite numerous investigations, the exact causes of many cutaneous complications of diabetes remain elusive, due in part to inherent challenges of research in diabetes, a heterogeneous group of conditions affecting patients of widely ranging demographics and often

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