Diabetes Mellitus and Glucagonoma
- Diabetis Mellitus
Diabetic dermopathy is the most common skin disease in diabetes; it is present in nearly half of diabetic patients older than 50 years. It is caused by diabetic microangiopathy, polyneuropathy and infections frequently associated with retinopathy or nephropathy. The typical lesions are flat scars ulcers and bullae mainly at the legs. Fifteen percent of individuals with diabetes develop a foot ulcer during their lifetime- a risk factor for subsequent amputations. Treatment mainly means prevention of ulcers. Correct foot care is mandatory.
Skin reaction to insulin therapy occur in 5-10% of patients. There are local and systemic allergic reactions including erythema, itching, urticae and infiltrated plaques, urticaria and anaphylactic shock. A special feature is lipoatrophy occurring at the injection sites. Treatment depends on the severity of the phenomena. Frequent change of injection site is advisable. Antihistamines may suppress the itching. In lipatropy, treatment with glucocorticoids has been useful.
Necrobiosis lipoidica diabeticorum is a slowly progressing, granulomatous disorder of unknown etiology, usually occurring on the pretibial areas. The skin is atrophic and yellowish-brown, enlarged vessels may be seen through the translucent skin. Histopathologically, large areas of necrobiosis in the dermis are seen, surrounded by infiltrates of epithelioid cells, lymphocytes and multinucleate giant cells. A great variety of regimen has been proposed. It appears that NLD is associated with poor glucose control.
Scleredema adultorum is associated with diabetes mellitus, but association with paraproteinemias and myeloma has also been reported. The skin is tight, thickened and hardened, involving neck, chest, shoulders, and the upper back. The patients report limitation of motion in the joints. Histopathological, the dermis is thickened, the collagen fibres appear to be swollen and separated by wide spaces (dermal fenestration). For treatment, physiotherapy as well as with antibiotics, glucocorticoids, immunosuppressants, and photopheresis were applied. Photochemotherapy appears to be the treatment of choice.
- Glucagonoma Syndrome
Necrolytic migratory erythema as the skin manifestation of glucagonoma syndrome is the first symptom of glucagonoma in roughly 79% of patients, its first symptoms being macules, bullae and crusted plaques. Later the central part of the lesions heals leaving postinflammatory hyperpigmentation, giving the lesions an annular appearance. Histopathologically, the epidermis shows clefts in the upper spinous cell layer and a diffuse epidermal pallor. Treatment requires surgical exstirpation of the underlying tumour. Skin lesions then clear within a week.
KeywordsHuman Insulin Insulin Lispro Insulin Detemir Tinea Pedis Acanthosis Nigricans
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