cutaneous manifestations of diabetes mellitus
DESCRIPTION
Cutaneous Manifestations of Diabetes Mellitus. Dr Noreen Cowley MD FRCP Consultant Dermatologist. Cutaneous . No Pathonomonic Skin lesion in Diabetes. Cutaneous Manifestations of Diabetes. 30% incidence cutaneous disorders ADA 70% during course of illness 15% ulceration. - PowerPoint PPT PresentationTRANSCRIPT
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Cutaneous Manifestations of Diabetes Mellitus
Dr Noreen CowleyMD FRCP
Consultant Dermatologist
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Cutaneous
No Pathonomonic Skin lesion in Diabetes
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Cutaneous Manifestations of Diabetes
30% incidence cutaneous disorders ADA70% during course of illness
15% ulceration
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Cutaneous Manifestations of DiabetesHyperglycaemia
Neuropathy
Impaired host response
Microvascular angiopathies with failure of the microcircutation to meet the metabolic requirements of the skin
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Cutaneous Manifestations of Diabetes
• Common disorders that affect non-diabetes• Those classically associated with diabetes / reflect
microangiopathy• Lesions indicating poor control • Effect of insulin resistance• Adverse effects of therapy for diabetes• Skin changes as a result complications of diabetes• Other associated autoimmune disorders
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Cutaneous Manifestations of Diabetes
• Common disorders that affect non-diabetics• Those classically associated with diabetes / reflect
microangiopathy• Lesions indicating poor control • Effect of insulin resistance• Adverse effects of therapy for diabetes• Skin changes as a result complications of diabetes• Other associated autoimmune disorders
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Skin Infection
20-50% (Type 2) poor glycaemic control Poor micro and macro-circulation NeuropathyAltered immune response
Dermatoses “portal of entry”
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Skin Infection
Staphylococcus folliculitisSuperficial fungal infectionCellulitis and erysipelasOral and genital candida
Non pathogenic organisms mucormycosis by phycomycetes and anaerobic cellulitis by clostridium species
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Erythrasma
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Cutaneous Manifestations of Diabetes
• Common disorders that affect non-diabetes• Those classically associated with diabetes / reflect
microangiopathy• Lesions indicating poor control • Effect of insulin resistance• Adverse effects of therapy for diabetes• Skin changes as a result complications of diabetes• Other associated autoimmune disorders
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Necrobiosis Lipoidica
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Necrobiosis Lipoidica
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Necrobiosis Lipoidica
Aetiology
Microangiopathy –---collagen degradation with release cytokines from inflammatory cells – destruction collagenous matrix
Little evidence correlation retinopathy/nephropathy
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Necrobiosis Lipoidica
0.3-0.7%
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Differential Diagnosis
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Generalized Granuloma Annulare
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Diabetic Dermopathy
“Shin Spots”
Shemer et al 40%
Men – 50yrs
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Diabetic Dermopathy
Severe microvascular complications
Retinopathy,neuropathy,nephropathy
Closely linked to glycosylated Hb
High risk of accelerated diabetes complications
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Bullosis Diabeticorum
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Bullosis DiabeticorumType 1 Diabetes
0.5%
Men
Longstanding Disease
Peripheral Neuropathy
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Cutaneous Manifestations of Diabetes
• Common disorders that affect non-diabetes• Those classically associated with diabetes / reflect
microangiopathy• Lesions indicating poor control • Effect of insulin resistance• Adverse effects of therapy for diabetes• Skin changes as a result complications of diabetes• Other associated autoimmune disorders
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Eruptive Xanthomas
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Scleredema of Buschke
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Scleredema of Buschke
Type 2ObeseTherapy resistantCardiovascularRetinopathy
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Cutaneous Manifestations of Diabetes
• Common disorders that affect non-diabetes• Those classically associated with diabetes / reflect
microangiopathy• Lesions indicating poor control • Effects of insulin resistance• Adverse effects of therapy for diabetes• Skin changes as a result complications of diabetes• Other associated autoimmune disorders
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Acanthosis Nigricans
8 types
Obesity – Acanthosis Nigricans
Kahn 1975 association with insulin resistance
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Acanthosis Nigricans
Mechanism?
High insulin concentrations stimulate insulin–like growth factor receptors on keratinocytes promoting epidermal cell proliferation
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HAIR-AN Syndrome
• HyperAndrogenism• Insulin Resistance• Acanthosis Nigricans
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HAIR-AN SyndromeType A I RMutation gene that encodes the
insulin receptor
Tall black young females
Severe acanthosis nigricansbegins infancy and early childhood
Alopecia
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Cutaneous Manifestations of Diabetes
• Common disorders that affect non-diabetes• Those classically associated with diabetes / reflect
microangiopathy• Lesions indicating poor control • Effect of insulin resistance• Adverse effects of therapy for diabetes• Skin changes as a result complications of diabetes• Other associated autoimmune disorders
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Auto-Immune DisordersVitiligo1-7% in diabetes0.2-1% non-diabetic
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Lichen Sclerosis et Atrophicus
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Lichen Sclerosis et Atrophicus
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Cutaneous Manifestations of Diabetes
• Common disorders that affect non-diabetes• Those classically associated with diabetes / reflect
microangiopathy• Lesions indicating poor control • Effect of insulin resistance• Adverse effects of therapy for diabetes• Skin changes as a result complications of diabetes• Other associated autoimmune disorders
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Cutaneous effects of Therapy
• Insulin• Oral hypoglycaemic agents
MetforminPsoriasiform drug eruptionErythema MultiformeLeucocytoclastic Vasculitis
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Lipoatrophy/hypertrophyLipoatrophyThighs/arms children and young women
LipohypertrophyMalesSubcutaneous deposition fat at injection sitesInsulin –induced stimulation of adipose tissue growth
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Cutaneous Manifestations of Diabetes
• Common disorders that affect non-diabetes• Those classically associated with diabetes / reflect
microangiopathy• Lesions indicating poor control • Effect of insulin resistance• Adverse effects of therapy for diabetes• Skin changes as a result complications of diabetes• Other associated autoimmune disorders
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Perforating Collagenosis
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Perforating Collagenosis
Elimination of focally damaged collagen through the epidermis
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Necrolytic Migratory Erythema
StomatitisWeight LossDiabetes Mellitus
Glucagon-secreting tumour of the pancreatic islet cells
Mechanism? Sustained gluconeogenesis from high glucagon levels leads to amino acid deficiency,epidermal protein deficiency and necrolysis
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Thankyou
Any Questions?