Skin lesions in diabetes mellitus: prevalence and clinical correlations

doi:10.1016/S0168-8227(97)00119-8

Diabetes Research and Clinical Practice

Volume 39, Issue 2, February 1998, Pages 101-106

https://doi.org/10.1016/S0168-8227(97)00119-8 Get rights and content

Abstract

With the aim to assess the prevalence and the main clinical correlations of skin lesions in diabetes mellitus, 457 diabetic subjects consecutively attending an outpatient clinic underwent a dermatological examination. Neurovascular foot lesions were excluded. Thirty-five of 64 IDDM patients (54%) had skin alterations mainly consisting of vitiligo (9% of all patients), psoriasis (9%) and eczema (8%). The most frequent skin lesions observed in 240/393 NIDDM subjects (61%) were represented by infections (20% of all patients) and diabetic dermopathy (12.5%), while other lesions were not common. NIDDM patients with skin infections had a worse metabolic control, and those with diabetic dermopathy had a greater prevalence of neuropathy and large vessel disease than patients without skin lesions. These data show that the prevalence of skin diseases in a large, unselected diabetic population is higher than expected and indicate that, in most cases, a careful dermatological examination and a better metabolic control are needed in order to improve quality of life in these patients.

Introduction

Skin lesions are frequently observed in diabetic patients and it is generally stated that about 30% of these patients have cutaneous disorders 1, 2, 3. According to a recent review [4], cutaneous manifestations of diabetes mellitus can be classified in four categories: skin diseases with strong to weak association with diabetes (necrobiosis lipoidica, diabetic dermopathy, diabetic bullae, yellow skin, eruptive xanthomas, perforating disorders, acanthosis nigricans, oral leucoplakia, lichen planus), infections (bacterial, fungal), cutaneous manifestations of diabetic complications (microangiopathy, macroangiopathy, neuropathy) and skin reactions to diabetic treatment (sulphonylureas or insulin).

The frequency of skin lesions in diabetes is not well known; some cutaneous disorders are clearly more frequent in diabetes, but it is difficult to understand the exact nature of this association; moreover data concerning the epidemiology of these lesions come from former studies 1, 5, 6and no recent reports are available.

Aim of this study was to evaluate the prevalence and the main clinical characteristics of skin disorders in a large, unselected population attending an outpatient diabetes clinic.

Section snippets

Subjects and methods

Four hundred and fifty-seven patients, consecutively attending the outpatient diabetes clinic at the University of Messina Medical School Hospital, underwent a complete dermatological examination. Only patients with types of diabetes other than insulin-dependent (IDDM) or non-insulin-dependent (NIDDM) were excluded from the study. According to WHO criteria [7], 64 patients had IDDM (38 males, mean age 22±8 years, mean diabetes duration 10±4 years) and 393 had NIDDM (170 males, mean age 59±16

Results

In the whole diabetic population 276/457 (60%) patients had skin disorders; the prevalence did not differ between IDDM (35/64 patients, i.e. 55%) and NIDDM (240/393 patients, i.e. 61%) but the kinds of lesions were clearly different. Skin lesions observed in IDDM patients are reported in Table 1; the most frequent were vitiligo and psoriasis, followed by xerosis, warts, eczema and candida infections, without differences among patients with good, fair or poor metabolic control.

In NIDDM patients

Discussion

These data demonstrate that the prevalence of skin lesions in a large, unselected diabetic population is greater than generally reported, since 60% of our patients show cutaneous diseases. This high prevalence equally affects IDDM and NIDDM patients but the nature of skin lesions is very different in the two types of diabetes. In NIDDM patients the most frequent skin disease is represented by skin infections, especially dermatophytosis and candidosis, which were observed in more than 20% of all

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Skin lesions in diabetes mellitus: prevalence and clinical correlations

Abstract

Introduction

Section snippets

Subjects and methods

Results

Discussion

Med. Clin. North Am.

J. Am. Acad. Dermatol.

J. Am. Acad. Dermatol.

J. Am. Acad. Dermatol.

The skin and diabetes mellitus

Int. J. Dermatol.