Reduced threshold to suction-induced blister formation in insulin-dependent diabetics

Bullosis diabeticorum in a Newly Discovered Type 2 Diabetes mellitus

“…The pathogenesis of these blisters is still not clearly understood. A report documenting a reduced threshold to suction-induced blister formation in patients with insulin-dependent DM indicates a possible cause in the pathogenesis of diabetic bullae [7]. Local metabolic disturbances [2]and nephropathy have been suggested as a possible etiology [8].…”

Diabetic bullae

“…There is a lower threshold for suction-induced blister formation in the diabetic population in comparison to controls, and the distal prominence of diabetic bullae has led to speculation for the role of trauma in this group of patients. 4 However, this fails to account for the absence of these lesions in the vast majority of the diabetic population and the fact that these lesions resolve spontaneously. Some have suggested that the associated micro-angiopathy and sympathetic autonomic denervation leading to impaired microvascular perfusion, predisposes to the premature ageing of connective tissue.…”

“…5 There does not seem to be a consistent Department of Dermatology, Hull and East Yorkshire Hospitals NHS Trust and Hull York Medical School, UK REVIEW association between the occurrence of bullae and glycaemic control. Disturbances in calcium, magnesium and carbohydrate metabolism have been postulated in the literature, 4,8 and excessive exposure to ultraviolet light has also been suggested as a causative factor in a few cases. 13 …”

“…A lower threshold of suction-induced blister formation 4 has led to the theory that trauma is a possible aetiological factor. Spontaneous bullae may be the first sign of underlying impaired glycaemic control.…”

Bullosis Diabeticorum in Median Nerve Innervated Fingers Shortly After Carpal Tunnel Release: Case Report

“…Toonstra reported that skin biopsies in one patient with recurrent bullae of the fingers showed subepidermal blister formation at the level of lamina lucida on multiple 4 occasions 3 . Bernstein et al found that subjects with insulin-dependent diabetes had a reduced threshold for suction-induced blister formation at the level of lamina lucida compared to normal controls 7 .…”