Bullous eruption of diabetes mellitus. Bullosis diabeticorum

Recurrent Blister Formation in Setting of Poorly Managed Diabetes Mellitus

“…Reported blisters have a significant variance in size, from 0.5 to 10 cm [4,10]. They tend to have a self-limited evolution, with reepithelization of the blister floor occurring rapidly within a few days [12] and most resolving in 2-6 weeks without scarring [2,4,5,8,9,11,13,14]. However, most cases will reoccur [3,7,8,9,13,14].…”

“…At the present time, the etiology remains unclear [2,3,4,8,14]. The most common presenting comorbidities are diabetic peripheral neuropathy [3,8], followed by vasculopathy [3,5,10].…”

“…The most common presenting comorbidities are diabetic peripheral neuropathy [3,8], followed by vasculopathy [3,5,10]. Other less commonly presenting comorbidities include nephropathy [13,17], microangiopathy [4,18], or disorders of metabolism of calcium, magnesium, and carbohydrates [2,5,14,19]. One observation is that, in cases that were properly documented, the patients appear to have poor glucose control at the time of the blisters' eruptions [4,5,11,15].…”

“…Findings may range from subepidermal blisters with sparse perivascular infiltrate to intraepidermal with surrounding spongiosis [4,10]. Both direct and indirect immunofluorescence will be negative [8,14], excluding conditions like bullous pemphigoid that would otherwise appear similar clinically and histologically [2,8,11].…”

Incidence of bullosis diabeticorum – a controversial cause of chronic foot ulceration

“…One paper reported a patient with immunoglobulin M , complement and fibrinogen in the wall of the dermal blood vessels (6), but others have found no evidence of deposition of complements or immunoglobulins. Direct fluorescence microscopy of the perilesional skin has been found to be normal (2,6,18). Thus, no specific pathology has been found.…”