Skip to main content

Cutaneous Manifestations of Diabetes Mellitus: A Review

American Journal of Clinical Dermatology volume 18, pages 541–553 (2017)Cite this article

Abstract

Diabetes mellitus is a widespread endocrine disease with severe impact on health systems worldwide. Increased serum glucose causes damage to a wide range of cell types, including endothelial cells, neurons, and renal cells, but also keratinocytes and fibroblasts. Skin disorders can be found in about one third of all people with diabetes and frequently occur before the diagnosis, thus playing an important role in the initial recognition of underlying disease. Noninfectious as well as infectious diseases have been described as dermatologic manifestations of diabetes mellitus. Moreover, diabetic neuropathy and angiopathy may also affect the skin. Pruritus, necrobiosis lipoidica, scleredema adultorum of Buschke, and granuloma annulare are examples of frequent noninfectious skin diseases. Bacterial and fungal skin infections are more frequent in people with diabetes. Diabetic neuropathy and angiopathy are responsible for diabetic foot syndrome and diabetic dermopathy. Furthermore, antidiabetic therapies may provoke dermatologic adverse events. Treatment with insulin may evoke local reactions like lipohypertrophy, lipoatrophy and both instant and delayed type allergy. Erythema multiforme, leukocytoclastic vasculitis, drug eruptions, and photosensitivity have been described as adverse reactions to oral antidiabetics. The identification of lesions may be crucial for the first diagnosis and for proper therapy of diabetes.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 49.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

References

  1. Jaacks LM, Siegel KR, Gujral UP, Narayan KM. Type 2 diabetes: a 21st century epidemic. Best Pract Res Clin Endocrinol Metab. 2016;30(3):331–43. doi:10.1016/j.beem.2016.05.003.

    Article  PubMed  Google Scholar 

  2. Perez MI, Kohn SR. Cutaneous manifestations of diabetes mellitus. J Am Acad Dermatol. 1994;30(4):519–31; quiz 32-4.

  3. International Diabetes Foundation (IDF) Diabetes Atlas [database on the Internet]. 2015. Available from: http://www.diabetesatlas.org/.

  4. Centers for disease control and prevention. National diabetes statistics report: estimates of diabetes and its burden in the United States, 2014. Atlanta, GA: US Department of Health and Human Services; 2014. http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf. Accessed 19 Oct 2016.

  5. American Diabetes A. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2004;27(Suppl 1):S5–10.

    Google Scholar 

  6. Atkinson MA, Eisenbarth GS, Michels AW. Type 1 diabetes. Lancet. 2014;383(9911):69–82. doi:10.1016/S0140-6736(13)60591-7.

    Article  PubMed  Google Scholar 

  7. Eisenbarth GS. Update in type 1 diabetes. J Clin Endocrinol Metab. 2007;92(7):2403–7. doi:10.1210/jc.2007-0339.

    Article  CAS  PubMed  Google Scholar 

  8. Horenstein RB, Shuldiner AR. Genetics of diabetes. Rev Endocr Metab Disord. 2004;5(1):25–36. doi:10.1023/B:REMD.0000016122.84105.75.

    Article  CAS  PubMed  Google Scholar 

  9. DeFronzo RA. Pathogenesis of type 2 diabetes mellitus. Med Clin North Am. 2004;88(4):787–835, ix. doi:10.1016/j.mcna.2004.04.013.

  10. Gonzalez EL, Johansson S, Wallander MA, Rodriguez LA. Trends in the prevalence and incidence of diabetes in the UK: 1996–2005. J Epidemiol Community Health. 2009;63(4):332–6. doi:10.1136/jech.2008.080382.

    Article  PubMed  Google Scholar 

  11. Jallut D, Golay A, Munger R, Frascarolo P, Schutz Y, Jequier E, et al. Impaired glucose tolerance and diabetes in obesity: a 6-year follow-up study of glucose metabolism. Metabolism. 1990;39(10):1068–75.

    Article  CAS  PubMed  Google Scholar 

  12. Bastard JP, Maachi M, Lagathu C, Kim MJ, Caron M, Vidal H, et al. Recent advances in the relationship between obesity, inflammation, and insulin resistance. Eur Cytokine Netw. 2006;17(1):4–12.

    CAS  PubMed  Google Scholar 

  13. Metzger BE, Coustan DR. Summary and recommendations of the Fourth International Workshop-Conference on Gestational Diabetes Mellitus. The Organizing Committee. Diabetes Care. 1998;21(Suppl 2):B161–7.

    PubMed  Google Scholar 

  14. Baz B, Riveline JP, Gautier JF. ENDOCRINOLOGY OF PREGNANCY: gestational diabetes mellitus: definition, aetiological and clinical aspects. Eur J Endocrinol. 2016;174(2):R43–51. doi:10.1530/EJE-15-0378.

    Article  CAS  PubMed  Google Scholar 

  15. Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet. 2009;373(9677):1773–9. doi:10.1016/S0140-6736(09)60731-5.

    Article  CAS  PubMed  Google Scholar 

  16. Catalano PM, Tyzbir ED, Wolfe RR, Calles J, Roman NM, Amini SB, et al. Carbohydrate metabolism during pregnancy in control subjects and women with gestational diabetes. Am J Physiol. 1993;264(1 Pt 1):E60–7.

    CAS  PubMed  Google Scholar 

  17. Amed S, Oram R. Maturity-onset diabetes of the young (MODY): making the right diagnosis to optimize treatment. Can J Diabetes. 2016;. doi:10.1016/j.jcjd.2016.03.002.

    PubMed  Google Scholar 

  18. Fajans SS, Bell GI. MODY: history, genetics, pathophysiology, and clinical decision making. Diabetes Care. 2011;34(8):1878–84. doi:10.2337/dc11-0035.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Laugesen E, Østergaard JA, Leslie RD, Danish Diabetes Academy Workshop and Workshop Speakers. Latent autoimmune diabetes of the adult: current knowledge and uncertainty. Diabet Med. 2015;32(7):843–52. doi:10.1111/dme.12700.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. WHO. Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia: report of a WHO/IDF consultation. Geneva: WHO; 2006.

    Google Scholar 

  21. ADA. Standards of medical care in diabetes—2010. Diabetes Care. 2010;33(Suppl. 1):S11–61.

    Google Scholar 

  22. Palimeri S, Palioura E, Diamanti-Kandarakis E. Current perspectives on the health risks associated with the consumption of advanced glycation end products: recommendations for dietary management. Diabetes Metab Syndr Obes. 2015;8:415–26. doi:10.2147/DMSO.S63089.

    PubMed  PubMed Central  Google Scholar 

  23. Blakytny R, Jude EB. Altered molecular mechanisms of diabetic foot ulcers. Int J Low Extremity Wounds. 2009;8(2):95–104. doi:10.1177/1534734609337151.

    Article  Google Scholar 

  24. Obrosova IG. Increased sorbitol pathway activity generates oxidative stress in tissue sites for diabetic complications. Antioxid Redox Signal. 2005;7(11–12):1543–52. doi:10.1089/ars.2005.7.1543.

    Article  CAS  PubMed  Google Scholar 

  25. Stern D, Yan SD, Yan SF, Schmidt AM. Receptor for advanced glycation endproducts: a multiligand receptor magnifying cell stress in diverse pathologic settings. Adv Drug Deliv Rev. 2002;54(12):1615–25.

    Article  CAS  PubMed  Google Scholar 

  26. Hu H, Jiang H, Ren H, Hu X, Wang X, Han C. AGEs and chronic subclinical inflammation in diabetes: disorders of immune system. Diabetes Metab Res Rev. 2015;31(2):127–37. doi:10.1002/dmrr.2560.

    Article  PubMed  CAS  Google Scholar 

  27. Gkogkolou P, Bohm M. Advanced glycation end products: key players in skin aging? Dermatoendocrinol. 2012;4(3):259–70. doi:10.4161/derm.22028.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Ko MJ, Chiu HC, Jee SH, Hu FC, Tseng CH. Postprandial blood glucose is associated with generalized pruritus in patients with type 2 diabetes. Eur J Dermatol. 2013;23(5):688–93. doi:10.1684/ejd.2013.2100.

    PubMed  Google Scholar 

  29. Stander S, Darsow U, Mettang T, Gieler U, Maurer M, Stander H, et al. S2k guideline—chronic pruritus. J Dtsch Dermatol Ges. 2012;10(Suppl 4):S1–27. doi:10.1111/j.1610-0387.2012.08005.x.

    Article  PubMed  Google Scholar 

  30. Sun PC, Chen CS, Kuo CD, Lin HD, Chan RC, Kao MJ, et al. Impaired microvascular flow motion in subclinical diabetic feet with sudomotor dysfunction. Microvasc Res. 2012;83(2):243–8. doi:10.1016/j.mvr.2011.06.002.

    Article  PubMed  Google Scholar 

  31. Seite S, Khemis A, Rougier A, Ortonne JP. Importance of treatment of skin xerosis in diabetes. J Eur Acad Dermatol Venereol. 2011;25(5):607–9. doi:10.1111/j.1468-3083.2010.03807.x.

    Article  CAS  PubMed  Google Scholar 

  32. Lee MR, Shumack S. Prurigo nodularis: a review. Australas J Dermatol. 2005;46(4):211–18; quiz 9-20. doi:10.1111/j.1440-0960.2005.00187.x.

  33. Grundmann S, Stander S. Chronic pruritus: clinics and treatment. Ann Dermatol. 2011;23(1):1–11. doi:10.5021/ad.2011.23.1.1.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Zylicz Z, Krajnik M, Sorge AA, Costantini M. Paroxetine in the treatment of severe non-dermatological pruritus: a randomized, controlled trial. J Pain Symptom Manage. 2003;26(6):1105–12.

    Article  CAS  PubMed  Google Scholar 

  35. O’Donoghue M, Tharp MD. Antihistamines and their role as antipruritics. Dermatol Ther. 2005;18(4):333–40. doi:10.1111/j.1529-8019.2005.00034.x.

    Article  PubMed  Google Scholar 

  36. Cohen O, Yaniv R, Karasik A, Trau H. Necrobiosis lipoidica and diabetic control revisited. Med Hypotheses. 1996;46(4):348–50.

    Article  CAS  PubMed  Google Scholar 

  37. Lowitt MH, Dover JS. Necrobiosis lipoidica. J Am Acad Dermatol. 1991;25(5 Pt 1):735–48.

    Article  CAS  PubMed  Google Scholar 

  38. Sibbald C, Reid S, Alavi A. Necrobiosis lipoidica. Dermatol Clin. 2015;33(3):343–60. doi:10.1016/j.det.2015.03.003.

    Article  CAS  PubMed  Google Scholar 

  39. Jiquan S, Khalaf AT, Jinquan T, Xiaoming L. Necrobiosis lipoidica: a case with histopathological findings revealed asteroid bodies and was successfully treated with dipyridamole plus intralesional triamcinolone. J Dermatol Treat. 2008;19(1):54–7. doi:10.1080/09546630701691228.

    Article  CAS  Google Scholar 

  40. Reid SD, Ladizinski B, Lee K, Baibergenova A, Alavi A. Update on necrobiosis lipoidica: a review of etiology, diagnosis, and treatment options. J Am Acad Dermatol. 2013;69(5):783–91. doi:10.1016/j.jaad.2013.05.034.

    Article  PubMed  Google Scholar 

  41. Suarez-Amor O, Perez-Bustillo A, Ruiz-Gonzalez I, Rodriguez-Prieto MA. Necrobiosis lipoidica therapy with biologicals: an ulcerated case responding to etanercept and a review of the literature. Dermatology. 2010;221(2):117–21. doi:10.1159/000314694.

    PubMed  Google Scholar 

  42. Clayton TH, Harrison PV. Successful treatment of chronic ulcerated necrobiosis lipoidica with 0.1% topical tacrolimus ointment. Br J Dermatol. 2005;152(3):581–2. doi:10.1111/j.1365-2133.2005.06388.x.

    Article  CAS  PubMed  Google Scholar 

  43. Darvay A, Acland KM, Russell-Jones R. Persistent ulcerated necrobiosis lipoidica responding to treatment with cyclosporin. Br J Dermatol. 1999;141(4):725–7. doi:10.1046/j.1365-2133.1999.03119.x.

    Article  CAS  PubMed  Google Scholar 

  44. Erfurt-Berge C, Seitz AT, Rehse C, Wollina U, Schwede K, Renner R. Update on clinical and laboratory features in necrobiosis lipoidica: a retrospective multicentre study of 52 patients. Eur J Dermatol. 2012;22(6):770–5. doi:10.1684/ejd.2012.1839.

    CAS  PubMed  Google Scholar 

  45. Beers WH, Ince A, Moore TL. Scleredema adultorum of Buschke: a case report and review of the literature. Semin Arthritis Rheum. 2006;35(6):355–9. doi:10.1016/j.semarthrit.2006.01.004.

    Article  PubMed  Google Scholar 

  46. Angeli-Besson C, Koeppel MC, Jacquet P, Andrac L, Sayag J. Electron-beam therapy in scleredema adultorum with associated monoclonal hypergammaglobulinaemia. Br J Dermatol. 1994;130(3):394–7.

    Article  CAS  PubMed  Google Scholar 

  47. Dinato SL, Costa GL, Dinato MC, Sementilli A, Romiti N. Scleredema of Buschke associated with diabetes mellitus type 2: case report and review of the literature. Arq Bras Endocrinol Metabol. 2010;54(9):852–5.

    Article  PubMed  Google Scholar 

  48. Anand KP, Kashyap AS. Bullosis diabeticorum. Postgrad Med J. 2004;80(944):354.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Ghosh SK, Bandyopadhyay D, Chatterjee G. Bullosis diabeticorum: a distinctive blistering eruption in diabetes mellitus. Int J Diabetes Dev Ctries. 2009;29(1):41–2. doi:10.4103/0973-3930.50714.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Aye M, Masson EA. Dermatological care of the diabetic foot. Am J Clin Dermatol. 2002;3(7):463–74.

    Article  PubMed  Google Scholar 

  51. Basarab T, Munn SE, McGrath J, Russell Jones R. Bullosis diabeticorum. A case report and literature review. Clin Exp Dermatol. 1995;20(3):218–20.

    Article  CAS  PubMed  Google Scholar 

  52. Nebesio CL, Lewis C, Chuang TY. Lack of an association between granuloma annulare and type 2 diabetes mellitus. Br J Dermatol. 2002;146(1):122–4.

    Article  CAS  PubMed  Google Scholar 

  53. Goucha S, Khaled A, Kharfi M, Fazaa B, Zermani R, Ben Jilani S, et al. Granuloma annulare. G Ital Dermatol Venereol. 2008;143(6):359–63.

    CAS  PubMed  Google Scholar 

  54. Ma HJ, Zhu WY, Yue XZ. Generalized granuloma annulare associated with chronic hepatitis B virus infection. J Eur Acad Dermatol Venereol. 2006;20(2):186–9. doi:10.1111/j.1468-3083.2005.01366.x.

    Article  CAS  PubMed  Google Scholar 

  55. Li A, Hogan DJ, Sanusi ID, Smoller BR. Granuloma annulare and malignant neoplasms. Am J Dermatopathol. 2003;25(2):113–6.

    Article  PubMed  Google Scholar 

  56. Piette EW, Rosenbach M. Granuloma annulare: pathogenesis, disease associations and triggers, and therapeutic options. J Am Acad Dermatol. 2016;75(3):467–79. doi:10.1016/j.jaad.2015.03.055.

    Article  PubMed  Google Scholar 

  57. Milicic V, Ravic-Nikolic A, Jovovic-Dagovic B, Ristic G, Mitrovic S. Generalized granuloma annulare presenting as arcuate dermal erythema. Acta Dermatovenerol Alp Pannonica Adriat. 2010;19(1):25–7.

    CAS  PubMed  Google Scholar 

  58. Rubel DM, Wood G, Rosen R, Jopp-McKay A. Generalised granuloma annulare successfully treated with pentoxifylline. Australas J Dermatol. 1993;34(3):103–8.

    Article  CAS  PubMed  Google Scholar 

  59. Hermanns-Le T, Scheen A, Pierard GE. Acanthosis nigricans associated with insulin resistance: pathophysiology and management. Am J Clin Dermatol. 2004;5(3):199–203.

    Article  PubMed  Google Scholar 

  60. Stoddart ML, Blevins KS, Lee ET, Wang W, Blackett PR, Cherokee Diabetes S. Association of acanthosis nigricans with hyperinsulinemia compared with other selected risk factors for type 2 diabetes in Cherokee Indians: the Cherokee Diabetes Study. Diabetes Care. 2002;25(6):1009–14.

    Article  PubMed  Google Scholar 

  61. Kutlubay Z, Engin B, Bairamov O, Tuzun Y. Acanthosis nigricans: a fold (intertriginous) dermatosis. Clin Dermatol. 2015;33(4):466–70. doi:10.1016/j.clindermatol.2015.04.010.

    Article  PubMed  Google Scholar 

  62. Apridonidze T, Essah PA, Iuorno MJ, Nestler JE. Prevalence and characteristics of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2005;90(4):1929–35. doi:10.1210/jc.2004-1045.

    Article  CAS  PubMed  Google Scholar 

  63. Veysey E, Ratnavel R. Facial acanthosis nigricans associated with obesity. Clin Exp Dermatol. 2005;30(4):437–9. doi:10.1111/j.1365-2230.2005.01767.x.

    Article  CAS  PubMed  Google Scholar 

  64. Krause W. Skin diseases in consequence of endocrine alterations. Aging Male. 2006;9(2):81–95. doi:10.1080/13685530600708573.

    Article  CAS  PubMed  Google Scholar 

  65. Stals H, Vercammen C, Peeters C, Morren MA. Acanthosis nigricans caused by nicotinic acid: case report and review of the literature. Dermatology. 1994;189(2):203–6.

    Article  CAS  PubMed  Google Scholar 

  66. Lechleitner M, Hoppichler F, Kaser S. Autoimmune diseases in type 1 diabetes. Wien Klin Wochenschr. 2016;128(Suppl 2):S201–3. doi:10.1007/s00508-015-0929-x.

    Article  PubMed  CAS  Google Scholar 

  67. Amer AA, Gao XH. Quality of life in patients with vitiligo: an analysis of the dermatology life quality index outcome over the past two decades. Int J Dermatol. 2016;55(6):608–14. doi:10.1111/ijd.13198.

    Article  PubMed  Google Scholar 

  68. Martis J, Bhat R, Nandakishore B, Shetty JN. A clinical study of vitiligo. Indian J Dermatol Venereol Leprol. 2002;68(2):92–3.

    PubMed  Google Scholar 

  69. Whitton M, Pinart M, Batchelor JM, Leonardi-Bee J, Gonzalez U, Jiyad Z, et al. Evidence-based management of vitiligo: summary of a Cochrane systematic review. Br J Dermatol. 2016;174(5):962–9. doi:10.1111/bjd.14356.

    Article  CAS  PubMed  Google Scholar 

  70. Sudy E, Urbina F, Maliqueo M, Sir T. Screening of glucose/insulin metabolic alterations in men with multiple skin tags on the neck. J Dtsch Dermatol Ges. 2008;6(10):852-5, -6. doi:10.1111/j.1610-0387.2008.06720.x.

  71. Nikoleishvili LR, Kurashvili RB, Virsaladze DK, Khachapuridze NG, Kurashvili LR. Characteristic changes of skin and its accessories in type 2 diabetes mellitus. Georgian Med News. 2006;131:43–6.

    Google Scholar 

  72. Suzuki K, Ito Y, Nakamura S, Ochiai J, Aoki K. Relationship between serum carotenoids and hyperglycemia: a population-based cross-sectional study. J Epidemiol. 2002;12(5):357–66.

    Article  PubMed  Google Scholar 

  73. Seyhan M, Ozcan H, Sahin I, Bayram N, Karincaoglu Y. High prevalence of glucose metabolism disturbance in patients with lichen planus. Diabetes Res Clin Pract. 2007;77(2):198–202. doi:10.1016/j.diabres.2006.12.016.

    Article  CAS  PubMed  Google Scholar 

  74. Lehman JS, Tollefson MM, Gibson LE. Lichen planus. Int J Dermatol. 2009;48(7):682–94. doi:10.1111/j.1365-4632.2009.04062.x.

    Article  PubMed  Google Scholar 

  75. Manousaridis I, Manousaridis K, Peitsch WK, Schneider SW. Individualizing treatment and choice of medication in lichen planus: a step by step approach. J Dtsch Dermatol Ges. 2013;11(10):981–91. doi:10.1111/ddg.12141.

    PubMed  Google Scholar 

  76. Tsuboi H, Katsuoka K. Characteristics of acquired reactive perforating collagenosis. J Dermatol. 2007;34(9):640–4. doi:10.1111/j.1346-8138.2007.00346.x.

    Article  PubMed  Google Scholar 

  77. Ataseven A, Kayacetin S. Acquired reactive perforating collagenosis. Eurasian J Med. 2012;44(1):51–3. doi:10.5152/eajm.2012.11.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Wagner G, Sachse MM. Acquired reactive perforating dermatosis. J Dtsch Dermatol Ges. 2013;11(8):723-9, -30. doi:10.1111/ddg.12131.

  79. Yancovitz M, Johnson H, Wang N, Pomeranz MK. Perforating collagenosis. Dermatol Online J. 2008;14(10):14.

    PubMed  Google Scholar 

  80. Nebel R, Fiedler E, Danz B, Marsch WC, Kreft B. Acquired reactive perforating collagenosis associated with diabetes mellitus and renal insufficiency requiring dialysis. Dtsch Med Wochenschr. 2007;132(49):2624–6. doi:10.1055/s-2007-993108.

    Article  CAS  PubMed  Google Scholar 

  81. Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293(2):217–28. doi:10.1001/jama.293.2.217.

    Article  CAS  PubMed  Google Scholar 

  82. Behm B, Schreml S, Landthaler M, Babilas P. Skin signs in diabetes mellitus. J Eur Acad Dermatol Venereol. 2012;26(10):1203–11. doi:10.1111/j.1468-3083.2012.04475.x.

    Article  CAS  PubMed  Google Scholar 

  83. Karrer S. Diabetic foot syndrome. Hautarzt. 2011;62(7):493–503. doi:10.1007/s00105-010-2112-7.

    Article  CAS  PubMed  Google Scholar 

  84. Falanga V. Wound healing and its impairment in the diabetic foot. Lancet. 2005;366(9498):1736–43. doi:10.1016/S0140-6736(05)67700-8.

    Article  PubMed  Google Scholar 

  85. Trieb K. The Charcot foot: pathophysiology, diagnosis and classification. Bone Jt J. 2016;98-B(9):1155–9. doi:10.1302/0301-620X.98B9.37038.

    Article  CAS  Google Scholar 

  86. American Diabetes A. Peripheral arterial disease in people with diabetes. Diabetes Care. 2003;26(12):3333–41.

    Article  Google Scholar 

  87. Amin N, Doupis J. Diabetic foot disease: from the evaluation of the “foot at risk” to the novel diabetic ulcer treatment modalities. World J Diabetes. 2016;7(7):153–64. doi:10.4239/wjd.v7.i7.153.

    Article  PubMed  PubMed Central  Google Scholar 

  88. Pandey A, Usman K, Reddy H, Gutch M, Jain N, Qidwai S. Prevalence of hand disorders in type 2 diabetes mellitus and its correlation with microvascular complications. Ann Med Health Sci Res. 2013;3(3):349–54. doi:10.4103/2141-9248.117942.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  89. Loos B, Puschkin V, Horch RE. 50 years experience with Dupuytren’s contracture in the Erlangen University Hospital—a retrospective analysis of 2919 operated hands from 1956 to 2006. BMC Musculoskelet Disord. 2007;8:60. doi:10.1186/1471-2474-8-60.

    Article  PubMed  PubMed Central  Google Scholar 

  90. Perkins BA, Olaleye D, Bril V. Carpal tunnel syndrome in patients with diabetic polyneuropathy. Diabetes Care. 2002;25(3):565–9.

    Article  PubMed  Google Scholar 

  91. Al-Homood IA. Rheumatic conditions in patients with diabetes mellitus. Clin Rheumatol. 2013;32(5):527–33. doi:10.1007/s10067-012-2144-8.

    Article  PubMed  Google Scholar 

  92. Kiziltan ME, Benbir G. Clinical and nerve conduction studies in female patients with diabetic dermopathy. Acta Diabetol. 2008;45(2):97–105. doi:10.1007/s00592-008-0031-1.

    Article  CAS  PubMed  Google Scholar 

  93. Ahmed I, Goldstein B. Diabetes mellitus. Clin Dermatol. 2006;24(4):237–46. doi:10.1016/j.clindermatol.2006.04.009.

    Article  PubMed  Google Scholar 

  94. Morgan AJ, Schwartz RA. Diabetic dermopathy: a subtle sign with grave implications. J Am Acad Dermatol. 2008;58(3):447–51. doi:10.1016/j.jaad.2007.11.013.

    Article  PubMed  Google Scholar 

  95. Yosipovitch G, Tur E, Cohen O, Rusecki Y. Skin surface pH in intertriginous areas in NIDDM patients. Possible correlation to candidal intertrigo. Diabetes Care. 1993;16(4):560–3.

    Article  CAS  PubMed  Google Scholar 

  96. Suaya JA, Eisenberg DF, Fang C, Miller LG. Skin and soft tissue infections and associated complications among commercially insured patients aged 0-64 years with and without diabetes in the US. PLoS One. 2013;8(4):e60057. doi:10.1371/journal.pone.0060057.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  97. Sunderkotter C, Becker K. Frequent bacterial skin and soft tissue infections: diagnostic signs and treatment. J Dtsch Dermatol Ges. 2015;13(6):501–24; quiz 25-6. doi:10.1111/ddg.12721.

  98. Yeoh DK, Bowen AC, Carapetis JR. Impetigo and scabies—disease burden and modern treatment strategies. J Infect. 2016;72(Suppl):S61–7. doi:10.1016/j.jinf.2016.04.024.

    Article  PubMed  Google Scholar 

  99. Koning S, van der Sande R, Verhagen AP, van Suijlekom-Smit LW, Morris AD, Butler CC, et al. Interventions for impetigo. Cochrane Database Syst Rev. 2012;1:CD003261. doi:10.1002/14651858.CD003261.pub3.

    PubMed  Google Scholar 

  100. Tschachler E, Brockmeyer N, Effendy I, Geiss HK, Harder S, Hartmann M, et al. Streptococcal infections of the skin and mucous membranes. J Dtsch Dermatol Ges. 2007;5(6):527–32. doi:10.1111/j.1610-0387.2007.06287.x.

    Article  CAS  PubMed  Google Scholar 

  101. Kilburn SA, Featherstone P, Higgins B, Brindle R. Interventions for cellulitis and erysipelas. Cochrane Database Syst Rev. 2010;(6):CD004299. doi:10.1002/14651858.CD004299.pub2.

  102. Eke N. Fournier’s gangrene: a review of 1726 cases. Br J Surg. 2000;87(6):718–28. doi:10.1046/j.1365-2168.2000.01497.x.

    Article  CAS  PubMed  Google Scholar 

  103. Wong CH, Chang HC, Pasupathy S, Khin LW, Tan JL, Low CO. Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality. J Bone Jt Surg Am. 2003;85-A(8):1454–60.

    Article  Google Scholar 

  104. Oumeish OY. Skin disorders in patients with diabetes. Clin Dermatol. 2008;26(3):235–42. doi:10.1016/j.clindermatol.2007.10.015.

    Article  PubMed  Google Scholar 

  105. Rubin Grandis J, Branstetter BFT, Yu VL. The changing face of malignant (necrotising) external otitis: clinical, radiological, and anatomic correlations. Lancet Infect Dis. 2004;4(1):34–9.

    Article  PubMed  Google Scholar 

  106. Gupta AK, Konnikov N, MacDonald P, Rich P, Rodger NW, Edmonds MW, et al. Prevalence and epidemiology of toenail onychomycosis in diabetic subjects: a multicentre survey. Br J Dermatol. 1998;139(4):665–71.

    Article  CAS  PubMed  Google Scholar 

  107. Lugo-Somolinos A, Sanchez JL. Prevalence of dermatophytosis in patients with diabetes. J Am Acad Dermatol. 1992;26(3 Pt 2):408–10.

    Article  CAS  PubMed  Google Scholar 

  108. de Leon EM, Jacober SJ, Sobel JD, Foxman B. Prevalence and risk factors for vaginal Candida colonization in women with type 1 and type 2 diabetes. BMC Infect Dis. 2002;2:1.

    Article  PubMed  PubMed Central  Google Scholar 

  109. Eckhard M, Lengler A, Liersch J, Bretzel RG, Mayser P. Fungal foot infections in patients with diabetes mellitus—results of two independent investigations. Mycoses. 2007;50(Suppl 2):14–9. doi:10.1111/j.1439-0507.2007.01425.x.

    Article  PubMed  Google Scholar 

  110. Rashid M, Bari A, Majeed S, Tariq KM, Haq I, Niwaz A. Mucormycosis: a devastating fungal infection in diabetics. J Coll Physicians Surg Pak. 2005;15(1):43–5. doi:01.2005/JCPSP.4345.

  111. Rajagopalan S. Serious infections in elderly patients with diabetes mellitus. Clin Infect Dis. 2005;40(7):990–6. doi:10.1086/427690.

    Article  PubMed  Google Scholar 

  112. Prabhu RM, Patel R. Mucormycosis and entomophthoramycosis: a review of the clinical manifestations, diagnosis and treatment. Clin Microbiol Infect. 2004;10(Suppl 1):31–47.

    Article  PubMed  Google Scholar 

  113. Richardson T, Kerr D. Skin-related complications of insulin therapy: epidemiology and emerging management strategies. Am J Clin Dermatol. 2003;4(10):661–7.

    Article  PubMed  Google Scholar 

  114. Young RJ, Hannan WJ, Frier BM, Steel JM, Duncan LJ. Diabetic lipohypertrophy delays insulin absorption. Diabetes Care. 1984;7(5):479–80.

    Article  CAS  PubMed  Google Scholar 

  115. Reeves WG, Allen BR, Tattersall RB. Insulin-induced lipoatrophy: evidence for an immune pathogenesis. Br Med J. 1980;280(6230):1500–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  116. Beltrand J, Guilmin-Crepon S, Castanet M, Peuchmaur M, Czernichow P, Levy-Marchal C. Insulin allergy and extensive lipoatrophy in child with type 1 diabetes. Horm Res. 2006;65(5):253–60. doi:10.1159/000092515.

    CAS  PubMed  Google Scholar 

  117. Havel PJ. Update on adipocyte hormones: regulation of energy balance and carbohydrate/lipid metabolism. Diabetes. 2004;53(Suppl 1):S143–51.

    Article  CAS  PubMed  Google Scholar 

  118. Radermecker RP, Pierard GE, Scheen AJ. Lipodystrophy reactions to insulin: effects of continuous insulin infusion and new insulin analogs. Am J Clin Dermatol. 2007;8(1):21–8.

    Article  PubMed  Google Scholar 

  119. Scheer BG, Sitz KV. Suspected insulin anaphylaxis and literature review. J Ark Med Soc. 2001;97(9):311–3.

    CAS  PubMed  Google Scholar 

  120. Heinzerling L, Raile K, Rochlitz H, Zuberbier T, Worm M. Insulin allergy: clinical manifestations and management strategies. Allergy. 2008;63(2):148–55. doi:10.1111/j.1398-9995.2007.01567.x.

    Article  CAS  PubMed  Google Scholar 

  121. Blanco C, Castillo R, Quiralte J, Delgado J, Garcia I, de Pablos P, et al. Anaphylaxis to subcutaneous neutral protamine Hagedorn insulin with simultaneous sensitization to protamine and insulin. Allergy. 1996;51(6):421–4.

    CAS  PubMed  Google Scholar 

  122. Ben Salem C, Hmouda H, Slim R, Denguezli M, Belajouza C, Bouraoui K. Rare case of metformin-induced leukocytoclastic vasculitis. Ann Pharmacother. 2006;40(9):1685–7. doi:10.1345/aph.1H155.

    Article  PubMed  Google Scholar 

  123. Wiwanitkit V. Metformin allergy. Indian J Pharmacol. 2011;43(2):216–7. doi:10.4103/0253-7613.77379.

    Article  PubMed  PubMed Central  Google Scholar 

  124. Fujii S, Nakashima T, Kaneko T. Glibenclamide-induced photosensitivity in a diabetic patient with erythropoietic protoporphyria. Am J Hematol. 1995;50(3):223.

    Article  CAS  PubMed  Google Scholar 

  125. Noakes R. Lichenoid drug eruption as a result of the recently released sulfonylurea glimepiride. Australas J Dermatol. 2003;44(4):302–3.

    Article  PubMed  Google Scholar 

  126. Lao B, Czyzyk A, Szutowski M, Szczepanik Z. Alcohol tolerance in patients with non-insulin-dependent (type 2) diabetes treated with sulphonylurea derivatives. Arzneimittelforschung. 1994;44(6):727–34.

    CAS  PubMed  Google Scholar 

  127. Franz CB, Massullo RE, Welton WA. Lichenoid drug eruption from chlorpropamide and tolazamide. J Am Acad Dermatol. 1990;22(1):128–9.

    Article  CAS  PubMed  Google Scholar 

  128. Goh CL. Psoriasiform drug eruption due to glibenclamide. Australas J Dermatol. 1987;28(1):30–2.

    Article  CAS  PubMed  Google Scholar 

  129. Paterson AJ, Lamey PJ, Lewis MA, Nolan A, Rademaker M. Pemphigus vulgaris precipitated by glibenclamide therapy. J Oral Pathol Med. 1993;22(2):92–5.

    Article  CAS  PubMed  Google Scholar 

  130. Goldberg I, Sasson A, Gat A, Srebrnik A, Brenner S. Pemphigus vulgaris triggered by glibenclamide and cilazapril. Acta Dermatovenerol Croat. 2005;13(3):153–5.

    PubMed  Google Scholar 

  131. Koca R, Altinyazar HC, Yenidunya S, Tekin NS. Psoriasiform drug eruption associated with metformin hydrochloride: a case report. Dermatol Online J. 2003;9(3):11.

    PubMed  Google Scholar 

  132. Kono T, Hayami M, Kobayashi H, Ishii M, Taniguchi S. Acarbose-induced generalised erythema multiforme. Lancet. 1999;354(9176):396–7. doi:10.1016/S0140-6736(99)02135-2.

    Article  CAS  PubMed  Google Scholar 

  133. Wu CS, Chang WY, Lan CC, Chen GS, Chiu HH. Acute generalized exanthematous pustulosis possibly induced by acarbose. Int J Dermatol. 2008;47(12):1313–5. doi:10.1111/j.1365-4632.2008.03668.x.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Dermatology, University Hospital Jena, Erfurter Straße 35, 07740, Jena, Germany

    Ana Luiza Lima, Tanja Illing, Sibylle Schliemann & Peter Elsner

Authors
  1. Ana Luiza Lima
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tanja Illing
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sibylle Schliemann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Peter Elsner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Peter Elsner.

Ethics declarations

Conflict of interest

A. L. Lima, T. Illing, S. Schliemann, and P. Elsner declare that they have no conflicts of interest.

Funding

No funding was received for the preparation of this manuscript.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Lima, A.L., Illing, T., Schliemann, S. et al. Cutaneous Manifestations of Diabetes Mellitus: A Review. Am J Clin Dermatol 18, 541–553 (2017). https://doi.org/10.1007/s40257-017-0275-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40257-017-0275-z

Keywords

  • Carpal Tunnel Syndrome
  • Lichen Planus
  • Bullous Pemphigoid
  • Continuous Subcutaneous Insulin Infusion
  • Pimecrolimus