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Skin diseases commonly seen in diabetic patients

Skin diseases commonly seen in diabetic patients. Dr. Au Tak Shing MBBS (HK), MRCP (UK), FHKCP, FHKAM (Medicine), FRCP (Edin), Dip Derm (Lond), Dip GUM (LSA), DCH (Lond), DFM (CUHK), Specialist in Dermatology and Venereology. Skin disease and DM. Skin manifestations of DM

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Skin diseases commonly seen in diabetic patients

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  1. Skin diseases commonly seen in diabetic patients Dr. Au Tak Shing MBBS (HK), MRCP (UK), FHKCP, FHKAM (Medicine), FRCP (Edin), Dip Derm (Lond), Dip GUM (LSA), DCH (Lond), DFM (CUHK), Specialist in Dermatology and Venereology

  2. Skin disease and DM • Skin manifestations of DM • Skin disease as side effects of treatment for DM • Treatment of skin disease resulting in DM

  3. Dermatophyte infection • Tinea is common in DM patients • May not be more common than general population • Need for treatment is even stronger • Watch out for secondary bacterial infection

  4. Infection or not? • Distribution is a very important clue

  5. Fungal infection is usually asymmetrical Dermatitis is usually symmetrical or corresponding to the primary cause Distribution

  6. Distribution is a very important clue Morphology of an individual lesion Infection or not?

  7. Candidiasis • More common in DM patients • Vulvo-vaginitis • Balano-posthitis • Can be the first sign of DM

  8. Diabetic dermopathy • Quite common • Multiple, asymptomatic, irregularly shaped, discrete, atrophic, brown macules resembling scars • Shins • Intimal thickening and deposition of PAS-positive fibrillary material in vessel walls • Microangiopathy elsewhere

  9. Acanthosis nigricans • Velvety hyperpigmentation of intertriginous areas • Less often on extensor surfaces • Commonly associated with insulin resistance • Obesity, darkly-pigmented patients

  10. Diabetic bullae • Bullous diabeticorum • Non-inflammatory bullae on lower extremities • Pathology uncertain

  11. Bullous pemphigoid • Autoimmune process that affects the dermo-epidermal junction • Elderly • Multiple intact bullae • Investigation: skin biopsy for histology and immunofluorescence study • Treatment: oral steroid +/- other immuno-suppressants

  12. Necrobiosis lipoidica • Yellow atrophic patches often on shins • Erythematous border • Ulceration • Not always associated with DM

  13. Disseminated granuloma annulare • Annular lesions composed of papules • Usually smooth surface • Controversy about relation with DM

  14. Neuropathic ulcers • Non-painful ulcers at feet • Pressure points

  15. Acral dry gangrene • Due to vascular disease

  16. Eruptive xanthomas • Reddish yellow papules • Developing over weeks to months • Elevated serum triglycerides in patients with poorly controlled DM • Good control of DM leads to resolution

  17. Contact • Dr. Au Tak Shing • Unit 502, Hing Wai Building, 36 Queen’s Road Central, HK (tel: 28100680) • 香港中環皇后大道中36號興瑋大廈5樓502室（星期一、三、五） • Unit 922, Argyle Centre Phase One, 688 Nathan Road, Mongkok (tel: 23926006) • 九龍旺角彌敦道688號旺角中心第一座9樓922室（星期二、四、六） • Email: auts123@yahoo.com.hk

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