2 Cases of Bullosis Diabeticorum following Long-Distance Journeys by Road: A Report of 2 Cases

Abstract

Background. Bullosis diabeticorum is a distinct, spontaneous, noninflammatory, and blistering condition of acral skin that is unique to diabetics. It is rare. Exact aetiopathogenesis is not known, but many attributed peripheral neuropathy as a potent risk factor, others hypothesized the role of trauma, UV light, and nephropathy. Aim. To present cases of bullosis diabeticorum following long-distance journeys by road. Methods. History and physical examinations were done on 2 diabetics who presented with bilateral feet bullae following a long journey. Biopsy of a circumferential area of the bullae including adjoining apparently normal skin was done. Results. Features of peripheral neuropathy were noted. One developed digital gangrene without features of peripheral vascular disease. Culture of aspirate from a bullae yielded Staphylococcus aureus. Tissue biopsy showed hyperkeratotic focally acanthotic pigmented epidermis with subcorneal separation of the granular layer of the epidermis by aggregates of viable and nonviable polymorphs and lymphocytes. There is mild acantholysis of the epidermis, and a fibrocollagenous dermis which is moderately infiltrated by lymphocytes. Conclusion. Long journeys by road is a strong factor in the aetiopathogenesis of bullosis diabeticorum on a background of peripheral neuropathy. Diabetics especially those with peripheral neuropathy should be cautious while traveling long journeys by road.

Pruritic Vesicular Eruption on the Lower Legs in a Diabetic Female

“…The sensation in our case was still intact. In concordance with our case, blisters in some studies were intraepidermal in location [6, 7, 10, 11] while in majority of cases, blisters were subepidermal [8, 9]. Bullosis diabeticorum develops usually without inflammatory base, though in our case, lesions were mildly inflamed even in the untouched or unscratched new lesions.…”

Bullosis Diabeticorum involving an unusual site- a diagnostic dilemma; managed successfully with antidiabetic drugs: A case report

“…The common findings of these blisters are that they vary in size from a few milimeter (0.5cm) to several centimeters (10cm), tense, nontender, arising on normal skin, containing clear fluid, involving the acral and distal extremities.They resolve within 2-5 weeks without scarring and most of the cases have recurrences [1,5,6]. Though feet and distal extremites are often effected, blisters can occur rarely on trunk [3,6,7]. In this case, there was non acral presentation which was rare.…”

Bullosis Diabeticorum: A Rare Presentation with Immunoglobulin G (IgG) Deposition Related Vasculopathy. Case Report and Focused Review

“…For example, among diabetics and non-diabetics, patients with known history of diabetes are shown to have a lower threshold for occurrence of blister due to suction. Other factors could be vibration, high temperature, and long-standing pressure on the proximal lower extremities [ 8 , 9 ]. In individuals with nephropathy, UV exposure might contribute to the underlying mechanism of blister development [ 10 ].…”