78例糖尿病皮肤病变临床分析

糖尿病皮肤病变近年来国内外已有一些报道[1～4],皮肤病变比较直观可为糖尿病早期诊断提供线索。现对我们见到的78例糖尿病皮肤病变分析报告如下。临床资料　本组患者为本院内分泌科和皮肤科门诊及住院病人,糖尿病诊断符合ＷＨＯ1981年诊断标准。其中男49例,女29例,年龄30～89岁,平均59.5岁。皮肤病变发病时糖尿病病程<5年37例,5～9年20例,10～14年8例,≥15年13例。皮损表现　见附表。78例中真菌感染发病率最高,占19.23%,女性多见,多为白念珠菌感染。大疱症均在有严重并发症时发生,5例中2例死亡。　　讨论　本组中真菌感染发病率最高,与陈锡…     

糖尿病患者并发带状疱疹56例临床分析

带状疱疹是一种常见的病毒性皮肤病,临床报道较多,糖尿病患者并发带状疱疹与单独患带状疱疹其临床特点有所不同,现将笔者收治的56例糖尿病患者并发带状疱疹报道如下: 1 临床资料 1.1 一般资料 56例患者均为符合世界卫生组织(WHO) 1999年制定的糖尿病诊断标准的糖尿病患者,其中男30例,女26例,年龄最小48岁,最大76岁,患糖尿病病程最短5个月,最长34年.其中:Ⅰ型糖尿病3例,Ⅱ型糖尿病53例.     

196例糖尿病患者皮肤病的临床浅析

皮肤损害不仅是皮肤病主要临床表现,也是一些全身性疾病的外在反映。就糖尿病而言,皮肤损害为多种多样。我们在1989年3月—1990年3月,对196例临床确诊为糖尿病的患者进行了皮肤病学检查及有关资料的收集,现报告如下:     

非糖尿病性类脂质渐进性坏死1例

类脂质渐进性坏死是一种代谢障碍性疾病,由于多伴发糖尿病,故又称为糖尿病性类脂质渐进性坏死,而非糖尿病性类脂质渐进性坏死病例十分少见,我们于2007年4月诊治1例,获得显著疗效,报告如下。     

Kyrle病一例

患者女,58岁,因全身皮疹伴痒1年余,渐加重就诊。患者12年前诊为Ⅰ型糖尿病;9年前并发冠心病,脑梗死;约2年前进入糖尿病肾病-尿毒症期,约1年前前从四肢开始出现散在丘疹,皮疹数目,体积及颜色随病情逐渐增多,增大及加深,以背部为甚,瘙痒,无融合。     

287例糖尿病病人甲真菌病流行病学调查

目的:了解糖尿病人群甲真菌病患病率、临床分型、菌种构成的现况。方法:选取广州医学院附属第二医院内分泌专科2006年7-8月门诊就诊糖尿病患者287例,进行病史询问和临床检查,对有甲形态异常者作甲真菌培养,根据临床表现及甲真菌培养阳性诊断甲真菌病,统计分析糖尿病病人甲真菌病的患病率以及临床分型、菌种构成等指标。结果:287例糖尿病病人甲真菌病的患病率为8.7%;不同病程组糖尿病患者甲真菌病患病率的差异无统计学意义(2=1.054,P>0.05);临床分型主要为远端侧位甲下型(40.0%),其次为全营养不良型(36.0%),浅表白色型和近端甲下型分别为8.0%和16.0%;分离菌种皮肤癣菌和酵母菌各占44.0%,霉菌为8.0%,混合感染4.0%。结论:糖尿病患者甲真菌病的患病率高于一般人群的平均发病率,糖尿病患者甲真菌病的临床分型以远端侧位甲下型多见,病原菌主要是皮肤癣菌和酵母菌。     

老年糖尿病溃疡10例治疗体会

我们在 1995年 1月～ 2 0 0 1年 7月对老年糖尿病性皮肤溃疡 10例进行治疗 ,取得了良好的效果 ,现报告如下。临床资料　本组男 7例 ,女 3例。年龄 65～ 78岁 ,平均 71岁。溃疡病程 2个月～ 5年 ,平均 7个月。患者均按ＷＨＯ1982年修订的糖尿病诊断标准确诊。其中既往已确诊糖尿病出现溃疡 5例 ,外伤或挤压破溃后 ,伤口经久不愈确诊糖尿病4例 ,无诱因发生溃疡确诊糖尿病 1例。10例糖尿病性皮肤溃疡中 ,足部溃疡 4例 ,骶尾部溃疡 2例 ,小腿溃疡 4例。溃疡面积 2～ 10ｃｍ2 。治疗方法　 10例患者均在内分泌科指导下给予胰岛素或口服降糖药物控…     

糖尿病性大疱病一例

糖尿病性大疱病为糖尿病皮肤病变之一,现将我院收治的一例报告如下: 患者女,40岁,有糖尿病史15年,以糖尿病性肾病,糖尿病Ⅱ型合并周围神经炎、内脏神经炎、视网膜病变、心动过速、上呼吸道感染,于1989年12月15日再次住我院内科。入院后检查;T 38.5℃,P 110次/分,R18次/分、BP 12.4/8 KPa,体质消瘦,心率110次/分,心尖区可闻及Ⅲ级收缩期杂音,双下肢轻度凹陷性水肿,双足发凉、痛、温觉减退、膝腱反射减弱至消失,右足跟可见3×2cm溃疡。眼底检查:视乳突边界清楚,A:     

获得性反应性穿通性胶原病1例

患者男,61岁。双下肢丘疹结节4个月。患者有糖尿病病史10年余,有糖尿病肾病病史3年余。皮肤镜检查示:结节中央可见棕褐色栓塞物,直径为5mm。皮损组织病理示:表皮杯状凹陷,凹陷周围表皮向下增生,可见胶原纤维自凹陷底部向外排出。诊断:获得性反应性穿通性胶原病。     

坏疽性脓皮病合并肾脏肿瘤转移1例

正坏疽性脓皮病是一种反应性炎症性皮肤溃疡,为副肿瘤性皮肤损害,伴发肿瘤多为血液系统肿瘤、淋巴瘤,实体性肿瘤少见,我院2017年11月诊治1例疑诊为糖尿病手感染的坏疽性脓皮病合并肾脏肿瘤远处转移的病例,报道如下。1病历摘要患者男,60岁,因"口渴多饮8年,消瘦4个月,右手背部溃烂15 d"于2017年11月21日入住内分泌科。患者于8年前明确诊断为Ⅱ型糖尿病,血     

Links Between Granuloma Annulare,Necrobiosis Lipoidica Diabeticorum and Childhood Diabetes: A Matter of Time?

Abstract: Diabetes mellitus is associated with a range of dermatologic presentations, including granuloma annulare and necrobiosis lipoidica diabeticorum. Granuloma annulare occurs earlier than necrobiosis lipoidica diabeticorum and the association with diabetes mellitus is much weaker. We describe two children with diabetes who both developed granuloma annulare and later, necrobiosis lipoidica diabeticorum. We postulate that the early onset and transient nature of granuloma annulare, compared with the later onset and persistence of necrobiosis lipoidica diabeticorum, might account for the different apparent rates of association with diabetes mellitus.     

Necrobiosis lipoidica diabeticorum with cholesterol clefts in the differential diagnosis of necrobiotic xanthogranuloma

The histopathologic findings in 331 cases of necrobiosis lipoidica diabeticorum seen during a 50-year period were reviewed. Three cases showing cholesterol cleft formation were found. All 3 cases were associated with severe diabetes mellitus. The differential diagnosis of importance is necrobiotic xanthogranuloma. Common features included extensive hyaline necrobiosis and foreign-body giant cells. Atypical and Touton-type giant cells are more common in necrobiotic xanthogranuloma. Vascular changes in necrobiotic xanthogranuloma may include granulomatous involvement of muscular walls with thrombosis. Explanations for cholesterol cleft formation are offered. When cholesterol clefts are seen in biopsy specimens of necrobiosis, necrobiotic xanthogranuloma must be ruled out. In addition, when found in necrobiosis lipoidica diabeticorum, these clefts may imply diabetes mellitus with complications.     

Necrobiosis lipoidica diabeticorum: a clinicopathologic study

Necrobiosis lipoidica diabeticorum is an unusual dermatologic condition with a characteristic clinical appearance and a clear association with diabetes mellitus. There is currently no treatment that reverses the atrophic changes associated with this lesion. We have carried out a clinicopathologic study on 15 subjects and, in addition, have reviewed 10 further biopsy specimens of necrobiosis lipoidica diabeticorum. We found a frequent association of necrobiosis lipoidica diabeticorum with other chronic complications of diabetes mellitus, including limited joint mobility. It is possible that nonenzymatic glucosylation or other changes in collagen may be important in the etiology of necrobiosis lipoidica diabeticorum and the limited joint mobility. We confirmed that cutaneous anesthesia is usually present in the necrobiosis lipoidica diabeticorum lesions. With the use of an antibody to S100 protein and an immunohistochemical method, there was an apparent decreased number of nerves in the skin lesions. We suggest that sensory loss results from local destruction of cutaneous nerves by the inflammatory process. Finally, in six elliptical biopsies extending into clinically normal skin, we demonstrated that the inflammatory infiltrate of necrobiosis lipoidica diabeticorum extended from the lesion into apparently normal skin surrounding clinically active lesions. Thus, intradermal steroids might be administered to perilesional areas surrounding active lesions in the hope of halting progression.     

Necrobiotic xanthogranuloma: a case without paraproteinemia but with transepithelial elimination

We report a female patient, now aged 60, followed for 20 years for lesions originally diagnosed as necrobiosis lipoidica diabeticorum. In fact, the anatomical and clinical features of her disorder correspond to the new entity described as necrobiotic xanthogranuloma. Two elements distinguish this from earlier cases: 1) two examinations failed to reveal paraproteinemia; 2) there was transepithelial elimination of cholesterol crystals and degenerated xanthomatous cell debris via hair follicles. This demonstrates the characteristic histology of the disorder and indicates that the diagnosis of necrobiotic xanthogranuloma should be considered even in the absence of paraproteinemia.     

Perforating necrobiosis lipoidica in a girl with type 1 diabetes mellitus: a new case reported

Necrobiosis lipoidica is an idiopathic dermatological condition that is strongly associated with diabetes mellitus. It is more commonly seen in women than men. The average age of onset is 30-40 years. Necrobiosis Lipoidica diabeticorum is an extremely rare finding in childhood diabetes. We describe the case of a 13-year-old girl who has had type 1 diabetes mellitus since she was 8 years old. The patient presented with 2 well-defined, persistent plaques with a depressed central area and elevated purple peripheral ring, one on the right thigh and the other over the lateral left leg. Histopathologic evaluation of the patient's biopsy confirmed the diagnosis of necrobiosis lipoidica with transfollicular elimination. Our patient is the second pediatric case described with perforating necrobiosis lipoidica. We review the literature and discuss clinical features, several complications, and the most recent treatment options for necrobiosis lipoidica in diabetic children.     

Case for diagnosis

We present a case of bullosis diabeticorum. It is a rare disorder, probably underdiagnosed, associated with long-term diabetes mellitus. Its etiology remains unclear. It is characterized by tense blisters, with serous content, recurrent and spontaneous on normal skin especially in the acral regions. Displays self-limiting course. No specific laboratory tests for diagnosis of this bullous disease exist. Clinical and conservative management to prevent secondary infection reduces morbidity in diabetic patients.     

Scleredema diabeticorum successfully treated with ultraviolet A1 phototherapy

Scleredema diabeticorum is an uncommon condition. It is one of the cutaneous manifestations in diabetes mellitus that mainly occurs in obese middle-aged men with insulin-resistant diabetes. This condition is generally recalcitrant to therapy. Various treatments have been tried with inconsistent results. Here, we describe two cases of scleredema diabeticorum with substantial clinical improvement from a course of medium dose (60 J/cm2) ultraviolet A1 radiation therapy.     

Necrobiosis lipoidica diabeticorum: platelet survival and response to platelet inhibitors

Results of an open trial of platelet inhibitor treatment for necrobiosis lipoidica diabeticorum suggest the possible importance of abnormal platelet function in this disease. In ten female patients with necrobiosis lipoidica diabeticorum (six who were diabetic and four who were not) platelet survival times were measured before and after treatment with aspirin and dipyridamole. Pretreatment platelet survival time was considerably shortened in 50 percent of the diabetic and nondiabetic patients. Platelet-inhibitor treatment prolonged platelet survival time toward normal in most of these patients. The clinical response to treatment varied from healing to no noticeable effect.     

Scleredema diabeticorum: successful treatment with UVA-1 phototherapy

Scleredema adultorum is characterized by induration of the skin on the neck, shoulders and upper back caused by increased accumulation of collagen and aminoglycans in the dermis. The induration may progress and lead to pronounced restriction of mobility. Scleredema diabeticorum is one type of scleredema adultorum associated with diabetes mellitus. Multiple therapies have been tried, but most of them have not proven to be consistently effective. We report two cases of scleredema diabeticorum treated successfully with UVA-1- as well as physiotherapy and topical corticosteroids; this approach led to improvement in skin changes and mobility.     

Sarcoidosis with leg ulcers and annular facial lesions

A patient with unusually severe sarcoid skin lesions illustrates the difficulty and therapeutic importance of differentiating these lesions from those of necrobiosis lipoidica diabeticorum.