Presentation on theme: "Cutaneous Manifestations Nearly all patients with diabetes eventually develop cutaneous manifestations of the disease. Can be first sign that a patient."— Presentation transcript:
Cutaneous Manifestations Nearly all patients with diabetes eventually develop cutaneous manifestations of the disease. Can be first sign that a patient has diabetes. Cutaneous signs of diabetes can be valuable to physician for diagnosis, management, and treatment.
Necrobiosis Lipoidica Diabeticorum Degenerative disease of collagen in the dermis and subcutaneous fat with an atrophic epidermis. Precedes onset of diabetes in 15-20% of patients Lesions progress to ulcers if predisposed to trauma Location: 85% anterior aspect-pretibial region of lower extremeties, 15% hands, forearms, face, scalp
Necrobiosis Lipoidica Diabeticorum Initial lesions appear as well circumscribed erythematous plaques/papules with a depressed-waxy center. Advanced, typically larger, lesions show translucency and enlargement of underlying blood vessels.
Necrobiosis Lipoidica Diabeticorum Etiology unknown: seem to occur and persist independent of hyperglycemic control Theory one: immunologic role-release of cytokines from inflammatory cells may lead to destruction of the collagen matrix. Theory two: Microvascular effects of diabetic retinopathy and neuropathy lead to a degradation of collagen. Women > Men
Necrobiosis Lipoidica Diabeticorum Treatment: Lesions can spontaneously resolve, however most do not. No standard therapy. -used to arrest progression Support stockings/rest NSAIDs Intrelesional, systemic, topical corticosteriods Aspirin and dipyridamole Tumor necrosis factor Laser surgery Excision/grafting
Diabetic Dermopathy Also known as shin spots, most common cutaneous finding in diabetics (approximately 50% of diabetics). Round to oval atrophic hyperpigmented lesions on the pretibial areas of the lower extremities. Early lesions usually raised, then flatten. Brownish hyperpigmentation due to hemosiderin deposits. Occur bilateral with asymmetrical distribution.
Diabetic Dermopathy Asymptomatic, resolve spontaneously leaving a scar usually following improved blood glucose control. Usually occurs in older diabetic patients who have had diabetes >10 years. Occurs more frequently in diabetic patients with retinopathy, neuropathy, and nephropathy. Can be indicator of poor control of blood glucose levels.
Diabetic Bullae Blisters occur spontaneously in diabetic patients, atraumatic/asymptomatic lesions on feet and legs. Patients tend to have adequate circulation in the affected extremities and peripheral neuropathy. Three types of Diabetic Bullae: -Most common: Sterile fluid containing that heal without scarring. -Hemorrhagic, heals with scarring. -Multiple nonscarring on sun exposed/tan skin.
Diabetic Bullae Usually resolve without treatment within 2-5 weeks. Therapy should be aimed at preventing ulceration and secondary infection.
Diabetic Bullae When they occur in the feet can resemble friction blisters, however usually an absence of trauma.
Eruptive Xanthomas Occur in hyperlipidemic/hyperglycemic states: uncontrolled diabetic patients. Most common in young men with Type 1 diabetes Resistance to insulin makes it difficult for the body to clear the fat from the blood.
Eruptive Xanthomas Usually asymptomatic firm, waxy, yellow papules in the skin. Enlargements can have erythematous halo, can itch. Occurs most often on the back of hands/feet, arms/legs, buttocks, face-eyes.
Eruptive Xanthomas Increase risk of developing pancreatitis. Eruptions can resolve in a few weeks with hyperlipidemic/hyperglycemic control, lipid lowering medications.
Acanthosis Nigricans Hyperpigmentation and thickening of epidermis Precedes diabetes, considered a marker for the disease, most common in overweight diabetic patients. Usually occurs in skin folds, often described as velvety Neck, back, axillae, groin region, over joints in the hands/feet.
Acanthosis Nigricans Exact mechanism is unknown, thought to be a manifestation of insulin resistance, high concentrations of insulin may stimulate growth factor receptors on keratinocytes promoting epidermal cell proliferation.
Acanthosis Nigricans Classification: 5-8 types Type 1: hereditary-benign Type 2: endocrine disorders-diabetes, benign Type 3: complication of obesity Type 4: drug induced Type 5: malignant Genetically inherited, hypothyroidism, hyperthyroidism, acromegaly, polycystic ovarian disease, cushings disease Important to rule out underlying endocrine disorders and malignancies No cure: weight loss, exercise, nutrition, creams may help
Kyrles Disease Also known as perforating dermatosis. Rare condition, except in setting of diabetes with chronic renal failure. Large papules with central keratin plugs, widespread pattern seen in patients undergoing dialysis. Itching/scratching present
Kyrles Disease Primary location: extensor surfaces of the lower extremity, but can occur on face and trunk. Seen with DM, CHF, hepatic abnormalities-alcoholic cirrhosis, renal disease Elimination of collagen and elastin throughout epidermis.
Kyrles Disease Can be difficult to treat: have to manage underlying systemic disorder Antihistamines, antipruritics, topical corticosteriods, Retinoic acid, UV light therapy, laser therapy Rapid improvement and resolution of lesions is seen once underlying disease is treated.
Conclusion Nearly all patients with diabetes eventually develop cutaneous manifestations of the disease. It is valuable to recognize for diagnosis, management, and treatment. Leads to prevention of ulcerations, infections, amputations.
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