Diabetes-associated dermatological manifestations in primary care and their association with vascular complications

Abstract

Introduction Although type 2 diabetes mellitus (DM) is a global public health problem, the diabetes-associated dermatological (non-infectious) manifestations (DADM) remain poorly understood and under-diagnosed. We aimed to evaluate the prevalence of 7 known DADM in a primary care setting, and their association macro/microvascular complications. Methods Cross-sectionnal study included patients consulting in general practice for DM-follow up, from November 2016 to January 2017. Patients aged <18 years old or consulting for other reason than DM follow up were excluded. Each patient were screened for diabetic dermopathy (DD), Huntley's papules (HP), necrobiosis lipoidica diabeticorum (NL), acanthosis nigricans (AN), cheiroarthropathy (CA, or stiff hand syndrom), scleredema adultorum of Buschke (SB) and bullosis diabeticorum (BD). Results 213 diabetic patients were included over a period of 3 months. We found a prevalence of 17.8% (38 patients) for DD, 8.5% (18) for HP, 2.8% (6) for NL, 2.3% (5) for AN, 1.9% (4) for CA, 1.4% (3) for SB and 1.4% (3) for BD. DADM seems to be a risk factor for vascular complications (OR 1.97, p ≤ 0.001). Association with vascular involvement was stronger with DD and macroangiopathy (OR 1.86, p ≤ 0.001), and with NL and microangiopathy (OR 9.7, p ≤ 0.001). Conclusion In primary care, DM-associated dermatological manifestations present similar prevalence rates to a tertiary care setting, based on litterature. Complete dermatological examination of diabetic patients is essential and could lead to a better overall management of the pathology, as diabetic cutaneous manifestations appear as a sign of vascular involvement.

Cutaneous Manifestations Associated with Diabetes Mellitus—A Retrospective Study

“…In addition, in diabetes, loss of sensory innervation of the skin occurs, predisposing patients to infection and lesions [ 27 ]. Loss of neuroinflammatory signaling cells plays a determining role in the lack of healing of lower extremity ulcers [ 28 , 33 , 34 , 35 , 36 ].…”

“…The lesions strongly associated with diabetes mellitus were analyzed, with a predominance of diabetic foot (19 patients), followed by necrobiosis lipoidica—7 patients, with bullosis diabeticorum and acanthosis nigricans occurring in 6 and 5 patients respectively out of 103. A study conducted by Trihan et al [ 33 ], which included 213 patients with DM shows a similar number of patients with necrobiosis lipoidica—5 patients, 4 with acanthosis nigricans and 3 with bullosis diabeticorum.…”

“…This has changed dramatically with improved blood glucose control and antibiotic use. Despite these improvements, certain infections, such as otitis externa, necrotic infections and mucormycosis, occur more frequently in patients with diabetes [ 2 , 28 , 33 , 34 ]. A study conducted by Niaz et al [ 34 ] found a predominance of bacterial infec-tions (26%), followed by fungal infections (22%), and we can correlate it with our study where bacterial infections also predominated (in 33% of patients) followed by fungal infections (31%).…”

Acanthosis Nigricans: Pointer of Endocrine Entities

“…et al found a prevalence of AN of 2.3%, which corresponded to the estimated prevalence for AN among Caucasian populations. Moreover, according to the authors, in diabetic patients, AN could be an indicator of macrovascular complications, such as coronary or carotid artery disease (OR= 2.57, p < 0.05) [ 107 ].…”

Indurated plaque on the nape

“…Scleroedema, a cutaneous mucinosis, can occur secondary to acute streptococcal throat infection, paraproteinaemia, or diabetes mellitus. The last of these, termed scleroedema diabeticorum, is thought to be due to glycosylation of collagen in the dermis leading to an excessive accumulation of collagen and mucin 12. This patient, who had a raised haemoglobin A 1c concentration of 8.9% and serum protein electrophoresis within reference limits, was treated with metformin for glycaemic control.…”