Bullosis Diabeticorum: A Diabetic Bullosis, Commonly Unknown

Abstract

Bullosis diabeticorum (BD) is a distinct, spontaneous, noninflammatory, and blistering lesion that develops predominantly in the acral skin of patients with diabetes mellitus (DM). BD is a rare disease that develops in patients with longterm DM and not well known to physicians and often fails to be diagnosed. The lesions are known to spontaneously heal in most patients in 2 to 6 weeks. Wound care is required to prevent secondary infection of the blisters. However, if infection develops and progresses to necrosis, surgical intervention including debridement and reconstruction may be necessary. We report a case of BD in a patient with relatively well controlled DM, whose wounds progressed to necrosis and then spontaneously healed with dressings.

Bullosis diabeticorum in a morbidly obese woman in Haiti

“…Although discovered more than 80 years ago by Professor Kramer in 1930, it took about 37 years for this condition to be described in the medical literature by Cantwell and Martz under the name by which it is known today: bullosis diabeticorum [ 4 - 6 , 10 , 11 ]. It is a very rare skin condition, with only a hundred case descriptions in the medical literature and is characterized by sudden onset bullous lesions with no history of trauma, most of whom have poorly controlled type 2 diabetes [ 2 , 11 , 12 ]. Our patient was admitted for not being followed up by a healthcare professional for her diabetes, and unfortunately HBA1C was not available at the center, and the patient could not afford to have it done elsewhere.…”

“…She self-medicated with metformin at irregular doses when she experienced discomfort, knowing that she was diabetic and obese. Kang et al reported observations of Wilson disease over 11 years, leading to the conclusion that there is a correlation between bullosis diabeticorum and uncontrolled hyperglycemia in diabetic patients [ 2 , 13 ].…”

“…No etiology has been attributed to bullosis diabeticorum. A multifactorial etiology has been proposed, along with many theories and hypotheses [ 2 , 5 , 6 , 11 ]. One hypothesis is that the underlying cause is a long-term vascular compromise characterized by the thickening of the basal membrane of capillaries, leading to tissue hypoxia, which is responsible for the formation of bullae [ 2 , 6 , 11 , 14 ].…”

“…Bullosis diabeticorum is a rare skin complication of diabetes mellitus [ 1 - 4 ] and is characterized by the spontaneous appearance of bullous, non-painful, and non-inflammatory lesions of unknown etiology [ 2 , 5 ]. With a prevalence of 0.16–0.5%, it predominantly affects men and has an acral and distal asymmetric presentation [ 1 , 2 , 6 ].…”

“…Bullosis diabeticorum is a rare skin complication of diabetes mellitus [ 1 - 4 ] and is characterized by the spontaneous appearance of bullous, non-painful, and non-inflammatory lesions of unknown etiology [ 2 , 5 ]. With a prevalence of 0.16–0.5%, it predominantly affects men and has an acral and distal asymmetric presentation [ 1 , 2 , 6 ]. At the present time, there is no known etiology of this disease; hypotheses are in favor of a multifactorial etiology whose predominant element is poor control of glycemia.…”