Cutaneous manifestations of diabetes mellitus

87 patients including 64 males and 24 females with diabetes mellitus and skin diseases were studied. The skin manifestations were common during the fifth decade of life. Maturity onset diabetes had increased incidence of skin disease. Incidence of skin disease was common in early diabetes. Infections both bacterial and fungal were seen in majority of patients. Specific cutaneous markers and metabolic changes were rare and seen in long standing diabetes. Infections were the common problems which recurred subsequently.     

Cutaneous manifestations of diabetes mellitus

Diabetes is a common disease with many cutaneous manifestations encountered by dermatologists. Diabetes and the skin may be linked by association (e.g., necrobiosis lipoidica); infection; diabetic complication (e.g., neuropathic ulcer); or treatment reaction. Review of recent studies and reports focuses on pathogenesis and treatment of these many diabetic cutaneous changes.     

Cutaneous manifestations of diabetes mellitus

Diabetes mellitus is a common condition, and persons who have this ailment are commonly encountered by dermatologists and primary care physicians. Because glucose attaches to long-lived proteins, it may have a profound effect on the tertiary structure of the protein. Chronic hyperglycemia may be responsible for the pathogenesis of many diabetic complications. It has been suggested that increased cross-linking of collagen in diabetic patients is responsible for the fact that their skin is generally thicker than that of nondiabetics. Advanced glycosylation end-products are probably responsible for yellowing of skin and nails. Increased viscosity of blood caused by stiff red blood cell membranes results in engorgement of the postcapillary venules in the papillary dermis, which is detected as erythema of the face or as periungual erythema. It is suggested that these skin changes may eventually be used as a reflection of the patient's current (as well as past) metabolic status.     

Cutaneous manifestations of diabetes mellitus: a case series

Diabetes mellitus (DM) is a common disorder with a broad spectrum of cutaneous manifestations. Our purpose was to evaluate the prevalence and main clinical presentation of skin disorders in patients with DM. For a period of 6 months, all of the patients with DM attending the outpatient dermatology and diabetes clinics of the Hamedan University of Medical Sciences, Iran, were clinically examined for cutaneous manifestations of DM. Patients also were evaluated for glycemic control and evidence of other diabetes-related complications. Diabetic skin manifestations were detected in 110 of 155 (71%) patients with DM. The most common skin lesions in both patients with type 1 and type 2 DM were infectious in origin (72%). No statistically significant differences in cutaneous manifestations were observed between the 2 types of DM. In the outpatient population with DM there is a high prevalence of skin lesions mainly represented by cutaneous infections.     

Cutaneous manifestations of diabetes mellitus and the metabolic syndrome

Metabolic diseases are commonly encountered in the Western world. Cutaneous manifestations are common in metabolic disorders, such as diabetes mellitus (DM) and the metabolic syndrome (MetS), and metabolic diseases may manifest with specific skin findings. MetS and DM share a common mechanism in their etiopathogenesis. As a result, the skin findings associated with these two diseases partially overlap. Several skin findings in DM and MetS may be the first clinical features of the disease, and early diagnosis facilitates treatment, thereby helping in preventing long-term complications. In this review, MetS and skin manifestations associated with DM are discussed.     

Cutaneous manifestation of fungal infection

A 50-year-old patient with an aplastic syndrome developed disseminated purpuric, necrotic lesions on his skin. Histological examination revealed fungal sepsis. The clinical appearance, the course of the disease are described and the importance of histological examination is pointed out.     

Cutaneous manifestation of Crohn disease

In a 20-year-old women having suffered from Crohn's disease for many years, we found granulomatous fistular ulcerations on her right distal lower leg. After histological verification of the clinical diagnosis, she was orally treated with metronidazole for 6 weeks with excellent results: The cutaneous lesions healed completely.     

Lyme borreliosis. Cutaneous manifestation

Lyme borreliosis is a tick transmitted infectious disease caused by different genospecies of Borrelia burgdorferi sensu lato. In USA only one species B. burgdorferi sensu stricto is prevalent, whereas in Europe at least 5 different pathogenic species could be identified. The most prevalent species are B. afzelii and B. garinii. Infection is not always causing disease. In early infection, a localized skin inflammation, called erythema migrans, occurs around the tick bite, hematogenous dissemination of Borrelia causes flu like symptoms up to meningitis and multiple erythemata migrantia on the skin. In late stage multiple organ systems can be affected, in Europe especially the skin with various forms of acrodermatitis chronica atrophicans, the central and peripheral nervous system, joints and heartmuscle. Lyme borreliosis can be diagnosed by the typical history, the clinical symptoms and the elevated Borrelia specific IgM- and IgG-antibodies in serum and CSF according to the MIQ guidelines, in special cases B. burgdorferi can be cultivated or DNA detected by PCR. Therapy of choice for early infection is oral antibiotics like doxycycline, amoxicillin and cefuroxime for at least 10 days up to 21 days. Late stage infections should be treated for 3-4 weeks. Patients with neurological symptoms should be treated intravenously with ceftriaxone or penicillin G.     

Cutaneous manifestation of left atrial myxoma

A 53-year-old woman had a left hemiplegia with suspicion of cerebral metastases. Thoracic and abdominal computed tomography revealed renal and splenic infarction features and she presented violaceous papulosis on her fingers corresponding to thrombosis of dermal vessels. Echocardiography showed a left atrial tumor evoking myxoma. The clinical features of left atrial myxomas are intracardiac obstruction, extracardiac embolism and general symptoms. Cutaneous manifestations are frequently reported and can correspond to cutaneous manifestations of emboli, symptoms related to auto-immune disorders and specific cutaneous findings that suggest atrial myxoma as part of more complex syndromes.     

Cutaneous signs as a presenting manifestation of alcohol excess

We describe three patients who presented with a total of four episodes of an inflammatory dermatosis associated with alcohol abuse. In each case, the rash had similar characteristic features. The patients responded promptly to emollients and topical steroids but not to zinc replacement therapy. Other nutrient deficiencies were not identified. In addition, long-term remission seemed to be dependent on a reduction in alcohol consumption. We postulate that this is a separate cutaneous manifestation of chronic alcohol misuse and that this syndrome may be more common than previously thought.     

Cutaneous granulomas as the first manifestation of Hodgkin's disease

We report the case of a 64-year-old male in whom fever, cutaneous rash and hepatomegaly were the first manifestations of Hodgkin disease (HD). Histologically a dense lymphohistiocytic infiltrate with a granulomatous pattern was found in the skin infiltrate. A computed tomography scan revealed hepatosplenomegaly and a small retroperitoneal lymphadenopathy. An hepatic percutaneous biopsy showed a granulomatous infiltration with typical Reed-Sternberg cells. Cutaneous manifestations of HD are briefly reviewed. The authors underline that granulomatous infiltration of the skin as the first manifestation of lymphoma is a very rare feature. We also discuss the possible pathogenic mechanisms of skin granulomas.     

Castleman病皮损特点与治疗方法——附3例分析

目的探讨Castleman病的皮肤损害及临床特点和治疗。方法对3例Castleman病患者的诊断和治疗经过进行回顾性分析。结果3例患者均以皮肤损害为首发症状,均有不同程度的发热,多发性淋巴结肿大、肝或脾肿大、贫血、血沉加快、γ球蛋白水平升高等。淋巴结病理示淋巴滤泡间成熟浆细胞浸润。糖皮质激素联合沙力度胺治疗,3例患者病情稳定。结论Castleman病的皮肤损害呈多样性,糖皮质激素联合沙力度胺治疗有效。临床医生应加强对Castleman病皮肤损害的认识。