Skin disorders in diabetes mellitus: an epidemiology and physiopathology review

Abstract

Skin disorders, usually neglected and frequently underdiagnosed among diabetic patients, are common complications and encounter a broad spectrum of disorders in both type 1 and type 2 diabetes mellitus (DM)—e.g. cutaneous infection, dry skin, pruritus. Skin disorders are highly associated with increased risk of important outcomes, such as skin lesions, ulcerations and diabetic foot, which can lead to major complications and revolve around multifactorial factors besides hyperglycemia and advanced glycation end products. Although diabetic’s skin disorders are consistent in the literature, there is limited data regarding early-stage skin disorders in DM patients. Disease control, early-stage treatment (e.g. skin hydration, orthotic devices) and awareness can reduce morbidity of DM patients. Thus, better understanding of the burden of skin disorders in DM patients may raise awareness on prevention and management. Therefore, the aim of this study is to perform a literature review to evaluate the main clinical characteristics and complications of skin disorders in diabetic’s patients. Additionally, physiopathology early-stage skin disorders and dermocosmetic management were also reviewed.

Optical and structural properties of biological tissues under diabetes mellitus

“…The formation of advanced glycation end products reduces the elasticity and solubility of collagen, enhances its stiffness [58,178]. The results presented in Ref.…”

“…For example, in Refs. [58,156] it was concluded that the glycation of collagen under diabetes mellitus facilitates the development of fibrosis. In turn, the structural changes of tissue proteins lead to the change of their optical properties.…”

“…In turn, the damage of nerve fibers (neuropathy) can lead to a neuropathic foot ulcer, the most severe skin injure arising when the reduced recovery capability of diabetic skin gives rise to infection, formation of gangrene, and, finally, leads to the amputation of lower extremities [58,59]. The authors of Ref.…”

“…These symptoms are manifestations of diabetes mellitus complications related to the hyperglycemia and glycation of proteins. There are many skin diseases facilitated by diabetes mellitus [19,58,59]. With age, structural changes occur in the skin, such as enlargement of pores, thinning of dermis, loss of bulk collagen, atrophy of blood vessels and flattening of dermis-epidermis junction [167].…”

“…In this connection, many papers are aimed at determining the concentration of free glucose in blood, interstitial fluid, and other fluids of the body [20][21][22][23][24][25][26][27][28][29][30], revealing the morphological changes in vital organs [10, 12, One third of all patients with diabetes mellitus have complications in the form of skin lesions, the most severe of them being the chronic ulcers that recover very slowly, thus increasing the risk of infection [19,[57][58][59]. Diabetes mellitus increases the risk of cardiovascular diseases, retinopathy that leads to blindness, neuropathy and nephropathy [8-13, 19, 31, 60-64].…”