Cutaneous Manifestations in Diabetes Mellitus

  • Karen Regina Rosso SchonsEmail author


Diabetes mellitus is a metabolic disorder of great importance. The corresponding pathomechanisms of this disease lead to repercussions in every organ system including the skin. Cutaneous manifestations as a consequence of diabetes are numerous and may even precede its diagnosis. Skin signs may also develop at any time over the course of the disease, helping physicians to identify previously undiagnosed diabetes cases. Despite prior investigations, the exact mechanisms of many cutaneous markers remain not fully explained. While some of these skin markers are indolent others can result in great morbidity, occasionally affecting patients’ quality of life or leading to hospitalizations and life-threatening conditions. This chapter covers the clinical presentation, etiopathogenesis, and current therapeutic approach to the most common dermatologic manifestations specifically associated with diabetes mellitus such as diabetic dermopathy, necrobiosis lipoidica, acanthosis nigricans, granuloma annulare, diabetic bullae, scleredema diabeticorum, and Kyrle’s disease. Skin conditions not specifically related to diabetes and skin complications directly related to diabetes are also discussed.


Diabetes mellitus Skin Diabetic dermopathy Necrobiosis lipoidica Acanthosis nigricans Diabetic bullae Scleredema diabeticorum Kyrle’s disease Diabetic hand syndrome Diabetic foot syndrome 




Hyperplasia of the squamous epithelium.

Acanthosis Nigricans

Dark pigmentation with a velvety texture in large skin folds.


Benign pedunculated skin growths usually occurring on the eyelids, neck, and axillae.

Charcot foot

Complication in diabetes that is characterized by severe deformity of the foot and/or the ankle that when not detected early may result in secondary ulceration, infection, and amputation.

Diabetic dermopathy

Also known as “shin spots,” a specific skin condition associated with diabetes mellitus.


Redness of the skin together with a sensation of local warmth or burning.

Koebner reaction

A phenomenon where new lesions appear along a site of trauma or irritation of the skin can. Examples: lichen planus, psoriasis.

lichen planus

Inflammatory chronic skin condition of flat-topped erythematous to violaceous papules caused by an autoimmune process,


A change in the color of the skin that is neither raised nor depressed, up to 1 cm in diameter.


Pigment cells responsible for producing melanin. In the human skin they are found in the basal layer of the epidermis and hair follicles.


Gradual degeneration and death of a cell.

Necrobiosis lipoidica

Skin disease marked by one or more tender yellowish brown patches often associated with diabetes mellitus.


An autoimmune skin condition that changes the life cycle of skin cells. The majority of patients presents lesions as clearly defined red and scaly plaques.


A dermatologic disorder characterized by hardening and thickening of the skin. When associated with diabetes mellitus is called “scleredema diabeticorum.”


An acquired pigmentary disorder of unknown origin characterized by portions of the skin losing their pigment.


Yellow pigmentation of the skin.


Commonly known as “dry skin,” results from a defect in the stratum corneum.


  1. 1.
    Ragunatha S, Anitha B, Inamadar AC, Palit A, Devarmani SS. Cutaneous disorders in 500 diabetic patients attending diabetic clinic. Indian J Dermatol. 2011;56(2):160–4. Epub 2011/07/01.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Pierard GE, Seite S, Hermanns-Le T, Delvenne P, Scheen A, Pierard-Franchimont C. The skin landscape in diabetes mellitus. Focus on dermocosmetic management. Clin Cosmet Investig Dermatol. 2013;6:127–35. Epub 2013/05/23.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Baselga Torres E, Torres-Pradilla M. Cutaneous manifestations in children with diabetes mellitus and obesity. Actas Dermosifiliogr. 2014;105(6):546–57. Epub 2014/04/05.PubMedCrossRefGoogle Scholar
  4. 4.
    IDF diabetes atlas, 7th edition. Available at: Accessed 25th May 2015.
  5. 5.
    Urrets-Zavalia JA, Esposito E, Garay I, Monti R, Ruiz-Lascano A, Correa L, et al. The eye and the skin in endocrine metabolic diseases. Clin Dermatol. 2016;34(2):151–65. Epub 2016/02/24.PubMedCrossRefGoogle Scholar
  6. 6.
    Murphy-Chutorian B, Han G, Cohen SR. Dermatologic manifestations of diabetes mellitus: a review. Endocrinol Metab Clin N Am. 2013;42(4):869–98. Epub 2013/11/30.CrossRefGoogle Scholar
  7. 7.
    Duff M, Demidova O, Blackburn S, Shubrook J. Cutaneous manifestations of diabetes mellitus. Clin Diabetes: Publ Am Diabetes Assoc. 2015;33(1):40–8. Epub 2015/02/06.CrossRefGoogle Scholar
  8. 8.
    Behm B, Schreml S, Landthaler M, Babilas P. Skin signs in diabetes mellitus. J Eur Acad Dermatol Venereol (JEADV). 2012;26(10):1203–11. Epub 2012/02/22.CrossRefGoogle Scholar
  9. 9.
    Gkogkolou P, Bohm M. Skin disorders in diabetes mellitus. J Dtsch Dermatol Ges J Ger Soc Dermatol (JDDG). 2014;12(10):847–63. quiz 64–5. Epub 2014/09/30. Hauterkrankungen bei Diabetes mellitus.Google Scholar
  10. 10.
    Demirseren DD, Emre S, Akoglu G, Arpaci D, Arman A, Metin A, et al. Relationship between skin diseases and extracutaneous complications of diabetes mellitus: clinical analysis of 750 patients. Am J Clin Dermatol. 2014;15(1):65–70. Epub 2013/10/19.PubMedCrossRefGoogle Scholar
  11. 11.
    Bristow I. Non-ulcerative skin pathologies of the diabetic foot. Diabetes Metab Res Rev. 2008;24(Suppl 1):S84–9. Epub 2008/03/22.PubMedCrossRefGoogle Scholar
  12. 12.
    Sibbald C, Reid S, Alavi A. Necrobiosis lipoidica. Dermatol Clin. 2015;33(3):343–60. Epub 2015/07/06.PubMedCrossRefGoogle Scholar
  13. 13.
    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. Epub 2013/08/24.PubMedCrossRefGoogle Scholar
  14. 14.
    Minelli LB, Nonino A, Cantarelli J, Neme L, Marcondes M. Diabetes mellitus and cutaneous affections. An Bras Dermatol. 2003;78(6):735–47.CrossRefGoogle Scholar
  15. 15.
    Feily A, Mehraban S. Treatment modalities of necrobiosis lipoidica: a concise systematic review. Dermatol Rep. 2015;7(2):5749. Epub 2015/08/04.CrossRefGoogle Scholar
  16. 16.
    Grillo E, Rodriguez-Munoz D, Gonzalez-Garcia A, Jaen P. Necrobiosis lipoidica. Aust Fam Physician. 2014;43(3):129–30. Epub 2014/03/07.PubMedGoogle Scholar
  17. 17.
    Basaria S, Braga-Basaria M. Necrobiosis lipoidica diabeticorum: response to pentoxiphylline. J Endocrinol Investig. 2003;26(10):1037–40. Epub 2004/02/05.CrossRefGoogle Scholar
  18. 18.
    Wee E, Kelly R. Pentoxifylline: an effective therapy for necrobiosis lipoidica. Australas J Dermatol. 2015. Epub 2015/11/13.Google Scholar
  19. 19.
    Kovich O, Burgin S. Generalized granuloma annulare. Dermatol Online J. 2005;11(4):23. Epub 2006/01/13.PubMedGoogle Scholar
  20. 20.
    Lukacs J, Schliemann S, Elsner P. Treatment of generalized granuloma annulare – a systematic review. J Eur Acad Dermatol Venereol (JEADV). 2015;29(8):1467–80. Epub 2015/02/05.Google Scholar
  21. 21.
    Hsu S, Le EH, Khoshevis MR. Differential diagnosis of annular lesions. Am Fam Physician. 2001;64(2):289–96. Epub 2001/07/31.PubMedGoogle Scholar
  22. 22.
    Cyr PR. Diagnosis and management of granuloma annulare. Am Fam Physician. 2006;74(10):1729–34. Epub 2006/12/02.PubMedGoogle Scholar
  23. 23.
    Keimig EL. Granuloma annulare. Dermatol Clin. 2015;33(3):315–29. Epub 2015/07/06.PubMedCrossRefGoogle Scholar
  24. 24.
    Barbato MT, Criado PR, Silva AK, Averbeck E, Guerine MB, Sa NB. Association of acanthosis nigricans and skin tags with insulin resistance. An Bras Dermatol. 2012;87(1):97–104. Epub 2012/04/07.PubMedCrossRefGoogle Scholar
  25. 25.
    Ahmed I, Goldstein B. Diabetes mellitus. Clin Dermatol. 2006;24(4):237–46. Epub 2006/07/11.PubMedCrossRefGoogle Scholar
  26. 26.
    Brodell JD Jr, Cannella JD, Helms SE. Case report: acanthosis nigricans resulting from repetitive same-site insulin injections. J Drugs Dermatol (JDD). 2012;11(12):e85–7. Epub 2013/02/05.Google Scholar
  27. 27.
    Kutlubay Z, Engin B, Bairamov O, Tuzun Y. Acanthosis nigricans: a fold (intertriginous) dermatosis. Clin Dermatol. 2015;33(4):466–70. Epub 2015/06/09.PubMedCrossRefGoogle Scholar
  28. 28.
    Higgins SP, Freemark M, Prose NS. Acanthosis nigricans: a practical approach to evaluation and management. Dermatol Online J. 2008;14(9):2. Epub 2008/12/09.PubMedGoogle Scholar
  29. 29.
    Ramirez-Amador V, Esquivel-Pedraza L, Caballero-Mendoza E, Berumen-Campos J, Orozco-Topete R, Angeles-Angeles A. Oral manifestations as a hallmark of malignant acanthosis nigricans. J Oral Pathol Med: Off Publ Int Assoc Oral Pathol Am Acad Oral Pathol. 1999;28(6):278–81. Epub 1999/07/30.CrossRefGoogle Scholar
  30. 30.
    Thiers BH, Sahn RE, Callen JP. Cutaneous manifestations of internal malignancy. CA Cancer J Clin. 2009;59(2):73–98. Epub 2009/03/05.PubMedCrossRefGoogle Scholar
  31. 31.
    Levy L, Zeichner JA. Dermatologic manifestation of diabetes. J Diabetes. 2012;4(1):68–76. Epub 2011/08/19.PubMedCrossRefGoogle Scholar
  32. 32.
    Larsen K, Jensen T, Karlsmark T, Holstein PE. Incidence of bullosis diabeticorum – a controversial cause of chronic foot ulceration. Int Wound J. 2008;5(4):591–6. Epub 2008/11/14.Google Scholar
  33. 33.
    Handa S, Sharma R, Kumar B. Bullosis diabeticorum. Indian J Dermatol Venereol Leprology. 1995;61(1):62–3. Epub 1995/01/01.Google Scholar
  34. 34.
    Derighetti M, Hohl D, Krayenbuhl BH, Panizzon RG. Bullosis diabeticorum in a newly discovered type 2 diabetes mellitus. Dermatology. 2000;200(4):366–7. Epub 2000/07/15.PubMedCrossRefGoogle Scholar
  35. 35.
    Mota AN, Nery NS, Barcaui CB. Case for diagnosis: bullosis diabeticorum. An Bras Dermatol. 2013;88(4):652–4. Epub 2013/09/27.PubMedPubMedCentralCrossRefGoogle Scholar
  36. 36.
    Mohamed M, Belhadjali H, Bechir AB, Moussa A, Zili J. Scleredema adultorum of Buschke with prominent periorbital edema in a Tunisian patient with diabetes mellitus: a case report. Int J Dermatol. 2016;55(2):e100–2. Epub 2015/11/05.PubMedCrossRefGoogle Scholar
  37. 37.
    Tran K, Boyd KP, Robinson MR, Whitlow M. Scleredema diabeticorum. Dermatol Online J. 2013;19(12):20718. Epub 2013/12/25.PubMedGoogle Scholar
  38. 38.
    Kurihara Y, Kokuba H, Furue M. Case of diabetic scleredema: diagnostic value of magnetic resonance imaging. J Dermatol. 2011;38(7):693–6. Epub 2011/07/07.PubMedCrossRefGoogle Scholar
  39. 39.
    Lee SJ, Jang JW, Lee WC, Kim DW, Jun JB, Bae HI, et al. Perforating disorder caused by salt-water application and its experimental induction. Int J Dermatol. 2005;44(3):210–4. Epub 2005/04/06.PubMedCrossRefGoogle Scholar
  40. 40.
    Saray Y, Seckin D, Bilezikci B. Acquired perforating dermatosis: clinicopathological features in twenty-two cases. J Eur Acad Dermatol Venereol (JEADV). 2006;20(6):679–88. Epub 2006/07/14.CrossRefGoogle Scholar
  41. 41.
    Nair PA, Jivani NB, Diwan NG. Kyrle’s disease in a patient of diabetes mellitus and chronic renal failure on dialysis. J Family Med Prim Care. 2015;4(2):284–6. Epub 2015/05/08.PubMedPubMedCentralCrossRefGoogle Scholar
  42. 42.
    Viswanathan S, Narurkar SD, Rajpal A, Nagpur NG, Avasare SS. Rare presentation of Kyrle’s disease in siblings. Indian J Dermatol. 2008;53(2):85–7. Epub 2008/01/01.PubMedPubMedCentralCrossRefGoogle Scholar
  43. 43.
    Sehgal VN, Jain S, Thappa DM, Bhattacharya SN, Logani K. Perforating dermatoses: a review and report of four cases. J Dermatol. 1993;20(6):329–40. Epub 1993/06/01.PubMedCrossRefGoogle Scholar
  44. 44.
    Ataseven A, Ozturk P, Kucukosmanoglu I, Kurtipek GS. Kyrle’s disease. BMJ Case Rep. 2014;2014. Epub 2014/01/17.Google Scholar
  45. 45.
    Gambichler T, Altmeyer P, Kreuter A. Treatment of acquired perforating dermatosis with narrowband ultraviolet B. J Am Acad Dermatol. 2005;52(2):363–4. Epub 2005/02/05.PubMedCrossRefGoogle Scholar
  46. 46.
    Verma R, Vasudevan B, Kakkar S, Mishra P, Pragasam V, Dabbas D. Kyrle’s disease presenting in an extensive distribution along lines of Blaschko. Indian J Dermatol. 2015;60(4):423. Epub 2015/08/20.PubMedPubMedCentralCrossRefGoogle Scholar
  47. 47.
    Wali V, Wali VV. Assessment of various biochemical parameters and BMI in patients with skin tags. J Clin Diagn Res: JCDR. 2016;10(1):BC09–11. Epub 2016/02/20.PubMedGoogle Scholar
  48. 48.
    Vahora R, Thakkar S, Marfatia Y. Skin, a mirror reflecting diabetes mellitus: a longitudinal study in a tertiary care hospital in Gujarat. Indian J Endocrinol Metab. 2013;17(4):659–64. Epub 2013/08/21.PubMedPubMedCentralCrossRefGoogle Scholar
  49. 49.
    Schilling WH, Crook MA. Cutaneous stigmata associated with insulin resistance and increased cardiovascular risk. Int J Dermatol. 2014;53(9):1062–9. Epub 2014/04/05.PubMedCrossRefGoogle Scholar
  50. 50.
    Gupta S, Aggarwal R, Arora SK. Human papillomavirus and skin tags: is there any association? Indian J Dermatol Venereol Leprology. 2008;74(3):222–5. Epub 2008/06/28.CrossRefGoogle Scholar
  51. 51.
    Dianzani C, Calvieri S, Pierangeli A, Imperi M, Bucci M, Degener AM. The detection of human papillomavirus DNA in skin tags. Br J Dermatol. 1998;138(4):649–51. Epub 1998/06/26.PubMedCrossRefGoogle Scholar
  52. 52.
    Gorgulu T, Torun M, Guler R, Olgun A, Kargi E. Fast and painless skin tag excision with ethyl chloride. Aesthet Plast Surg. 2015;39(4):644–5. Epub 2015/06/06.CrossRefGoogle Scholar
  53. 53.
    Allegue F, Fachal C, Perez-Perez L. Friction induced skin tags. Dermatol Online J. 2008;14(3):18. Epub 2008/07/17.PubMedGoogle Scholar
  54. 54.
    Namazi MR, Jorizzo JL, Fallahzadeh MK. Rubeosis faciei diabeticorum: a common, but often unnoticed, clinical manifestation of diabetes mellitus. Sci World J. 2010;10:70–1. Epub 2010/01/12.CrossRefGoogle Scholar
  55. 55.
    Julka S, Jamdagni N, Verma S, Goyal R. Yellow palms and soles: a rare skin manifestation in diabetes mellitus. Indian J Endocrinol Metab. 2013;17(Suppl 1):S299–300. Epub 2013/11/20.PubMedPubMedCentralCrossRefGoogle Scholar
  56. 56.
    Lin JN. Images in clinical medicine. Yellow palms and soles in diabetes mellitus. N Engl J Med. 2006;355(14):1486. Epub 2006/10/06.PubMedCrossRefGoogle Scholar
  57. 57.
    Silverberg NB, Lee-Wong M. Generalized yellow discoloration of the skin. The diagnosis: carotenemia. Cutis. 2014;93(5):E11–2. Epub 2014/06/05.PubMedGoogle Scholar
  58. 58.
    Uhoda E, Debatisse B, Paquet P, Pierard-Franchimont C, Pierard GE. The so-called dry skin of the diabetic patient. Rev Med Liege. 2005;60(5–6):560–3. Epub 2005/07/23. La peau dite seche du patient diabetique.PubMedGoogle Scholar
  59. 59.
    Yoon HS, Baik SH, Oh CH. Quantitative measurement of desquamation and skin elasticity in diabetic patients. Skin Res Technol. 2002;8(4):250–4. Epub 2002/11/09.PubMedCrossRefGoogle Scholar
  60. 60.
    Tarikci N, Kocaturk E, Gungor S, Topal IO, Can PU, Singer R. Pruritus in systemic diseases: a review of etiological factors and new treatment modalities. Sci World J. 2015;2015:803752. Epub 2015/08/05.CrossRefGoogle Scholar
  61. 61.
    Yamaoka H, Sasaki H, Yamasaki H, Ogawa K, Ohta T, Furuta H, et al. Truncal pruritus of unknown origin may be a symptom of diabetic polyneuropathy. Diabetes Care. 2010;33(1):150–5. Epub 2009/12/31.PubMedPubMedCentralCrossRefGoogle Scholar
  62. 62.
    Dorfman D, George MC, Tamler R, Lushing J, Nmashie A, Simpson DM. Pruritus induced self injury behavior: an overlooked risk factor for amputation in diabetic neuropathy? Diabetes Res Clin Pract. 2014;103(3):e47–8. Epub 2014/01/23.PubMedCrossRefGoogle Scholar
  63. 63.
    Vinik AI. Barely scratching the surface. Diabetes Care. 2010;33(1):210–2. Epub 2009/12/31.PubMedPubMedCentralCrossRefGoogle Scholar
  64. 64.
    Tseng HW, Ger LP, Liang CK, Liou HH, Lam HC. High prevalence of cutaneous manifestations in the elderly with diabetes mellitus: an institution-based cross-sectional study in Taiwan. J Eur Acad Dermatol Venereol (JEADV). 2015;29(8):1631–5. Epub 2014/09/03.CrossRefGoogle Scholar
  65. 65.
    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 (EJD). 2013;23(5):688–93. Epub 2013/09/05.Google Scholar
  66. 66.
    Machado-Pinto J, Diniz Mdos S, Bavoso NC. Psoriasis: new comorbidities. An Bras Dermatol. 2016;91(1):8–14. Epub 2016/03/18.PubMedPubMedCentralCrossRefGoogle Scholar
  67. 67.
    Azfar RS, Seminara NM, Shin DB, Troxel AB, Margolis DJ, Gelfand JM. Increased risk of diabetes mellitus and likelihood of receiving diabetes mellitus treatment in patients with psoriasis. Arch Dermatol. 2012;148(9):995–1000. Epub 2012/06/20.PubMedPubMedCentralCrossRefGoogle Scholar
  68. 68.
    Li W, Han J, Hu FB, Curhan GC, Qureshi AA. Psoriasis and risk of type 2 diabetes among women and men in the United States: a population-based cohort study. J Invest Dermatol. 2012;132(2):291–8. Epub 2011/10/14.PubMedCrossRefGoogle Scholar
  69. 69.
    Boehncke WH, Schon MP. Psoriasis. Lancet. 2015;386(9997):983–94. Epub 2015/05/31.PubMedCrossRefGoogle Scholar
  70. 70.
    Griffiths CE, Barker JN. Pathogenesis and clinical features of psoriasis. Lancet. 2007;370(9583):263–71. Epub 2007/07/31.PubMedCrossRefGoogle Scholar
  71. 71.
    Wu JJ, Lynde CW, Kleyn CE, Iversen L, van der Walt JM, Carvalho A, et al. Identification of key research needs for topical therapy treatment of psoriasis – a consensus paper by the International Psoriasis Council. J Eur Acad Dermatol Venereol (JEADV). 2016. Epub 2016/03/13.Google Scholar
  72. 72.
    Ezzedine K, Eleftheriadou V, Whitton M, van Geel N. Vitiligo. Lancet. 2015;386(9988):74–84. Epub 2015/01/19.PubMedCrossRefGoogle Scholar
  73. 73.
    Gopal KV, Rao GR, Kumar YH. Increased prevalence of thyroid dysfunction and diabetes mellitus in Indian vitiligo patients: a case-control study. Indian Dermatol Online J. 2014;5(4):456–60. Epub 2014/11/15.PubMedPubMedCentralCrossRefGoogle Scholar
  74. 74.
    Iannella G, Greco A, Didona D, Didona B, Granata G, Manno A, et al. Vitiligo: pathogenesis, clinical variants and treatment approaches. Autoimmun Rev. 2016;15(4):335–43. Epub 2016/01/03.PubMedCrossRefGoogle Scholar
  75. 75.
    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. Epub 2007/02/06.PubMedCrossRefGoogle Scholar
  76. 76.
    Albrecht M, Banoczy J, Dinya E, Tamas G Jr. Occurrence of oral leukoplakia and lichen planus in diabetes mellitus. J Oral Pathol Med: Off Publ Int Assoc Oral Pathol Am Acad Oral Pathol. 1992;21(8):364–6. Epub 1992/09/11.CrossRefGoogle Scholar
  77. 77.
    Le Cleach L, Chosidow O. Clinical practice. Lichen planus. N Engl J Med. 2012;366(8):723–32. Epub 2012/02/24.PubMedCrossRefGoogle Scholar
  78. 78.
    Li X, Xu G, Chen J. Tissue engineered skin for diabetic foot ulcers: a meta-analysis. Int J Clin Exp Med. 2015;8(10):18191–6. Epub 2016/01/16.PubMedPubMedCentralGoogle Scholar
  79. 79.
    Blanes JI. Consensus document on treatment of infections in diabetic foot. Rev Esp Quimioterapia: Publ Off Soc Esp Quimioterapia. 2011;24(4):233–62. Epub 2011/12/17.Google Scholar
  80. 80.
    Apelqvist J, Bakker K, van Houtum WH, Nabuurs-Franssen MH, Schaper NC. International consensus and practical guidelines on the management and the prevention of the diabetic foot. International Working Group on the Diabetic Foot. Diabetes Metab Res Rev. 2000;16(Suppl 1):S84–92. Epub 2000/10/31.PubMedCrossRefGoogle Scholar
  81. 81.
    O’Loughlin A, McIntosh C, Dinneen SF, O’Brien T. Review paper: basic concepts to novel therapies: a review of the diabetic foot. Int J Lower Extrem Wounds. 2010;9(2):90–102. Epub 2010/05/21.CrossRefGoogle Scholar
  82. 82.
    Benkhadoura M, Alswehly M, Elbarsha A. Clinical profile and surgical management of diabetic foot in Benghazi, Libya. Foot Ankle Surg: Off J Eur Soc Foot Ankle Surg. 2016;22(1):55–8. Epub 2016/02/13.CrossRefGoogle Scholar
  83. 83.
    do Amaral Junior AH, do Amaral LA, Bastos MG, do Nascimento LC, Alves MJ, de Andrade MA. Prevention of lower-limb lesions and reduction of morbidity in diabetic patients. Rev Bras Ortop. 2014;49(5):482–7. Epub 2015/08/01.PubMedPubMedCentralCrossRefGoogle Scholar
  84. 84.
    Varma AK. Charcot neuroarthropathy of the foot and ankle: a review. J Foot Ankle Surg: Off Publ Am Coll Foot Ankle Surg. 2013;52(6):740–9. Epub 2013/08/24.CrossRefGoogle Scholar
  85. 85.
    Fernando ME, Seneviratne RM, Tan YM, Lazzarini PA, Sangla KS, Cunningham M, et al. Intensive versus conventional glycaemic control for treating diabetic foot ulcers. Cochrane Database Syst Rev. 2016;1:CD010764. Epub 2016/01/14.Google Scholar
  86. 86.
    Elraiyah T, Domecq JP, Prutsky G, Tsapas A, Nabhan M, Frykberg RG, et al. A systematic review and meta-analysis of debridement methods for chronic diabetic foot ulcers. J Vasc Surg. 2016;63(2 Suppl):37S–45S. e2. Epub 2016/01/26.PubMedCrossRefGoogle Scholar
  87. 87.
    Elraiyah T, Tsapas A, Prutsky G, Domecq JP, Hasan R, Firwana B, et al. A systematic review and meta-analysis of adjunctive therapies in diabetic foot ulcers. J Vasc Surg. 2016;63(2 Suppl):46S–58S. e2. Epub 2016/01/26.PubMedCrossRefGoogle Scholar
  88. 88.
    Schade VL, Andersen CA. A literature-based guide to the conservative and surgical management of the acute Charcot foot and ankle. Diabet Foot Ankle. 2015;6:26627. Epub 2015/03/22.PubMedCrossRefGoogle Scholar
  89. 89.
    La Fontaine J, Lavery L, Jude E. Current concepts of Charcot foot in diabetic patients. Foot (Edinb). 2015;26:7–14. Epub 2016/01/24.CrossRefGoogle Scholar
  90. 90.
    Sommer TC, Lee TH. Charcot foot: the diagnostic dilemma. Am Fam Physician. 2001;64(9):1591–8. Epub 2001/12/04.PubMedGoogle Scholar
  91. 91.
    Petrova NL, Edmonds ME. Acute Charcot neuro-osteoarthropathy. Diabetes Metab Res Rev. 2016;32(Suppl 1):281–6. Epub 2015/10/10.PubMedCrossRefGoogle Scholar
  92. 92.
    Ameen M, Lear JT, Madan V, Mohd Mustapa MF, Richardson M. British Association of Dermatologists’ guidelines for the management of onychomycosis 2014. Br J Dermatol. 2014;171(5):937–58. Epub 2014/11/21.PubMedCrossRefGoogle Scholar
  93. 93.
    Long B, Koyfman A. Mucormycosis: what emergency physicians need to know? Am J Emerg Med. 2015;33(12):1823–5. Epub 2015/10/11.PubMedCrossRefGoogle Scholar
  94. 94.
    Papanas N, Maltezos E. The diabetic hand: a forgotten complication? J Diabetes Complicat. 2010;24(3):154–62. Epub 2009/02/17.PubMedCrossRefGoogle Scholar
  95. 95.
    Cherqaoui R, McKenzie S, Nunlee-Bland G. Diabetic cheiroarthropathy: a case report and review of the literature. Case Rep Endocrinol. 2013;2013:257028. Epub 2013/06/14.PubMedPubMedCentralGoogle Scholar
  96. 96.
    Gerrits EG, Landman GW, Nijenhuis-Rosien L, Bilo HJ. Limited joint mobility syndrome in diabetes mellitus: a minireview. World J Diabetes. 2015;6(9):1108–12. Epub 2015/08/13.PubMedPubMedCentralCrossRefGoogle Scholar
  97. 97.
    Silva MB, Skare TL. Musculoskeletal disorders in diabetes mellitus. Rev Bras Reumatol. 2012;52(4):601–9. Epub 2012/08/14.PubMedCrossRefGoogle Scholar
  98. 98.
    Abbas ZG, Archibald LK. Tropical diabetic hand syndrome. Epidemiology, pathogenesis, and management. Am J Clin Dermatol. 2005;6(1):21–8. Epub 2005/01/29.PubMedCrossRefGoogle Scholar
  99. 99.
    Ince B, Dadaci M, Arslan A, Altuntas Z, Evrenos MK, Fatih Karsli M. Factors determining poor prognostic outcomes following diabetic hand infections. Pak J Med Sci. 2015;31(3):532–7. Epub 2015/07/08.PubMedPubMedCentralGoogle Scholar
  100. 100.
    Coppini DV, Best C. A case of hand ulceration in the diabetic foot clinic – a reminder of hand neuropathy in ‘at risk’ patients. Diabet Med: J Br Diabet Assoc. 2000;17(9):682–3. Epub 2000/10/29.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2018

Authors and Affiliations

  1. 1.Hospital da Cidade de Passo Fundo, (Medicine Faculty of University of Passo Fundo)Passo FundoBrazil

Personalised recommendations