Acta Diabetologica

, Volume 31, Issue 2, pp 73–77 | Cite as

Association between “diabetic thick skin syndrome” and neurological disorders in diabetes mellitus

  • T. Forst
  • P. Kann
  • A. Pfützner
  • R. Lobmann
  • H. Schäfer
  • J. Beyer
Originals

Abstract

Skin thickness on the extremities of patients with diabetes mellitus has been described controversially. Using high resolution ultrasonography, we were able to show a significant increase in skin thickness at the forearm (P<0.05), thigh (P<0.001) and lower limb (P<0.05) of diabetic patients, most prominent at the thigh. No difference in skin thickness was found at the dorsum of the foot. In addition, skin thickness was not related to the duration of diabetes, age or HbA1. A close association was found between diabetic neuropathy and increasing skin thickness. Diabetic patients with neurological disorders had a significant increase in skin thickness versus diabetic patients without neuropathy. The present findings suggest that diabetic neuropathy and abnormalities of connective tissue have a common etiological link in their development or that both are time-dependent processes. Whether changes in capillary blood flow, increase of nonenzymatic glycosylation, polyol accumulation or other metabolic disorders are responsible for these findings remains still to be established.

Key words

Diabetes mellitus Skin thickness Diabetic neuropathy 

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References

  1. 1.
    Arthur C, Huntley RM, Quantitative determination of skin thickness in diabetes mellitus. Relationship to disease parameters. J. Med 21:257–264, 1990Google Scholar
  2. 2.
    Collier A, Patrick AW, Bell D, Matthews DM, Mc Intyre CCA, Ewing DJ, Clarke BF, Relationship of skin thickness to duration of diabetes, glycemic control and diabetes complications in male IDDM patients. Diabetes Care 12:309–312, 1989Google Scholar
  3. 3.
    Collier A, Matthews DM, Kelett HA, Clarke BF, Change in skin thickness associated with cheiroarthropathy in insulin dependent diabetes mellitus. BMJ 292:936, 1986Google Scholar
  4. 4.
    Hanna WBC, Friesen DM, Bombardier C, Gladman D, Hanna ABC, Pathologic features of diabetic thick skin. J Am Acad Dermatol 16:546–553, 1987Google Scholar
  5. 5.
    Malik RA, Metcalfe J, Sharma AK, Day JL, Rayman G, Skin epidermal thickness and vascular density in type 1 Diabetes. Diabetic Med 9:263–267, 1992Google Scholar
  6. 6.
    Kluge A, Loch EG, Sachse G, Die Hauttrophik bei peripherer diabetischer Neuropathie, bestimmt mit 20 MHz-Ultrasehall. Diabetes und Stoffwechsel Sonderheft 1:183, 1992Google Scholar
  7. 7.
    Brincat M, Moniz CJ, Studd JWW, Darby A, Magos A, Emburey G, Versi E, Long term effects of the menopause and sex hormones on skin thickness. Br J Obstet Gynaecol 92:256–259, 1985Google Scholar
  8. 8.
    Delbridge L, Ctercteko G, Fowler C, Reeve T, Le Quense L, The aetiology of diabetic neuropathic ulceration of the foot Br J Surg 72:1–6, 1985Google Scholar
  9. 9.
    Eaton RP, Sibbitt WL, Harsh A, The effect of an aldose reductase inhibiting agent on limited joint mobility in diabetes mellitus. JAMA 253:1437–1441, 1985Google Scholar
  10. 10.
    Eaton RP, The collagen hydration hypothesis: a new paradigm for the secondary complications of diabetes mellitus. J Chronic Dis 39:763–766, 1986Google Scholar
  11. 11.
    Boulton AJM, Scarpello JHB, Ward JD, Venous oxygenation in the diabetic neuropathic foot. Diabetologia 19:558–559, 1980Google Scholar
  12. 12.
    Corbin DOC, Young RJ, Morrison DC, Hoskins P, McDicken WN, Housley E, Clarke BF, Blood flow in the foot, polyneuropathy and foot ulceration in diabetes mellitus. Diabetologia 30:468–473, 1987Google Scholar
  13. 13.
    Cronenwett JL, Lindenaur SM, Direct measurement of arteriovenous blood flow after sympathectomy. Surgery 82:82–89, 1977Google Scholar
  14. 14.
    Bazex A, Montastruc P, Bazex J, Zemp J-P, Acropathie ulceromultilante. Bull Soc Fr Syphligr 82:288–290, 1975Google Scholar
  15. 15.
    Harold A, Miller DL, Determining skin thickness with pulsed ultrasound. J Invest Dermatol 72:17–19, 1979Google Scholar
  16. 16.
    Tan CY, Sratham B, Marks R, Skin thickness measurement by pulsed ultrasound: its reproductibility, validation and variability. Br J Dermatol 106:657–667, 1982Google Scholar
  17. 17.
    Ryder REJ, Kennedy RL, Newrick PG, Autonomic denervation may be a prerequisite of diabetic neuropathic foot ulceration. Diabetic Med 7:726–730, 1990Google Scholar
  18. 18.
    Ryder REJ, Kennedy RL, Newrick PG, Acetylcholine sweatspot test for autonomic denervation. Lancet 2:1303–1305, 1988Google Scholar
  19. 19.
    Coon JM, Rothmann S, The sweat response to drugs with nicotine like action. J Pharmacol 73:1–11, 1941Google Scholar
  20. 20.
    Lofgren L, Reappearence of sweet secretion in denervated areas after sympathectomy, a sign of regeneration of the sympathethic nervous system. Ann Chir Gynaecol Fenn, 39:105–125, 1950Google Scholar
  21. 21.
    Low PA, Quantification of autonomic responses. Peripheral neuropathy. Saunders, London, pp 1139–1165, 1984Google Scholar
  22. 22.
    Ziegler D, Laux G, Dannehl K, Spüler M, Mühlen H, Mayer P, Gries FA, Assesment of cardiovascular autonomic function: age related normal ranges and reproducibility of spectral analysis, vector analysis and standard tests of heart rate variation and blood pressure responses. Diabetic Med 9:166–175, 1992Google Scholar
  23. 23.
    Deanfield JE, Dagget PR, Harrison MJG, The role of autonomic neuropathy in diabetic foot ulceration. J Neurol Sci 47:203–210, 1980Google Scholar
  24. 24.
    Linger C, Albeanu A, Bloise D, Assal JP, The tuning fork revisted. Diabetic Med 7:859–864, 1990Google Scholar
  25. 25.
    Marks R, Measurement of biological ageing in human epidermis. Br J Dermatol 104:627–633, 1981Google Scholar
  26. 26.
    Sherman JL, Normal arteriovenous anastomosis. Medicine 42:247–267, 1963Google Scholar
  27. 27.
    Mescon H, Hurlley HJ, Moretti G, The anatomy and histochemistry of arteriovenous anastomosis in human digital skin. J Invest Dermatol 27:133–145, 1956Google Scholar
  28. 28.
    Partsch H, Neuropathies of ulceromutilating types. Clinical aspects, classification, circulating measurements. Vasa (Suppl), 1–48Google Scholar
  29. 29.
    Luckner H, Die Funktion der arteriovenösen Anastomosen. In: Bartelheimer H, Kuchmeister H (eds), Kapillaren und Interstitium. Thieme, Stuttgart, pp 78–90Google Scholar
  30. 30.
    Green DA, Lattimer SA, Sima AAF, Sorbitol, phosphoinositides and sodium-potassium ATPase in the pathogenesis of diabetic complications. N Engl J Med 316:599–606, 1987Google Scholar
  31. 31.
    Stribling D, Perkins CM, Aldose reductase inhibitor. In: Nattras M (eds) Recent advances in diabetes, 2. Churchill Livingstone, Edinburgh, pp 169–176, 1986Google Scholar
  32. 32.
    Schuster S, Black NM, McVitie E, The influence of age and sex on skin thickness, skin collagen and density. Br J Dermatol 93:639–643, 1975Google Scholar
  33. 33.
    Delbridge L, Ellis CE, Le Quesne LP, Non-enzymatic glycosylation of keratin from the diabetic foot. Br J Surg 24:282–285, 1983Google Scholar
  34. 34.
    Schnider SL, Kohn RR, Glycosylation of human collagen in ageing and diabetes mellitus. J Clin Invest 66:1179–1181, 1980Google Scholar
  35. 35.
    Rosenbloom AL, Silverstein HJ, Lezotte DC, Richardson K, McCallum M, Limited joint mobility in childhood in diabetes mellitus indicates increased risk for microvascular disease. N Engl J Med 305:191–194, 1981Google Scholar
  36. 36.
    Hamlin CR, Kohn PR, Luschin JH, Apparent accelerated ageing of human collagen in diabetes mellitus. Diabetes 24:902–904, 1975Google Scholar
  37. 37.
    Perier C, Baril A, Bayle JJ, Janin J, Frey J, Consequences of diabetes mellitus or liver cirrhosis on total collagen in human skin biopsies. Biomed Pharmacother 38:110–114, 1984Google Scholar

Copyright information

© Springer-Verlag 1994

Authors and Affiliations

  • T. Forst
    • 1
  • P. Kann
    • 1
  • A. Pfützner
    • 1
  • R. Lobmann
    • 1
  • H. Schäfer
    • 1
  • J. Beyer
    • 1
  1. 1.Department for Internal Medicine and EndocrinologyUniversity Hospital MainzMainzGermany

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