The Prevalence of Cutaneous Manifestations in Young Patients With Type 1 Diabetes

Abstract

OBJECTIVE -The aim of the study was to assess the prevalence of cutaneous disorders and their relation to disease duration, metabolic control, and microvascular complications in children and adolescents with type 1 diabetes.RESEARCH DESIGN AND METHODS -The presence and frequency of skin manifestations were examined and compared in 212 unselected type 1 diabetic patients (aged 2-22 years, diabetes duration 1-15 years) and 196 healthy sex-and age-matched control subjects.Logistic regression was used to analyze the relation of cutaneous disorders with diabetes duration, glycemic control, and microvascular complications.RESULTS -One hundred forty-two (68%) type 1 diabetic patients had at least one cutaneous disorder vs. 52 (26.5%) control subjects (P Ͻ 0.01). Diabetes-associated skin lesions were found in 81 (38%) patients. Acquired ichthyosis, rubeosis faciei, diabetic hand, and necrobiosis lipoidica were seen in 22 vs. 3%, 7.1 vs. 0%, 2.3 vs. 0%, and 2.3 vs. 0% of type 1 diabetic and control subjects, respectively. The frequency of cutaneous reactions to insulin therapy was low (-2.7%). The prevalence of fungal infections in patients and control subjects was 4.7% and 1.5%, respectively. Keratosis pilaris affected 12% of our patients vs. 1.5% of control subjects. Diabetic hand was strongly (odds ratio 1.42 [95% CI 1.11-1.81]; P Ͻ 0.001), and rubeosis faciei weakly (1.22 [1.04 -1.43]; P ϭ 0.0087), associated with diabetes duration. Significant association was also found between acquired ichthyosis and keratosis pilaris (1.53 [1.09 -1.79]; P Ͻ 0.001).CONCLUSIONS -Cutaneous manifestations are common in type 1 diabetic patients, and some of them, like acquired ichthyosis and keratosis pilaris, develop early in the course of the disease. Diabetic hand and rubeosis faciei are related to disease duration. Diabetes Care 30:1964-1967, 2007T hough it is well known that diabetes is associated with a number of cutaneous manifestations (1-3), there is a relative paucity of studies looking at the prevalence of skin changes in young patients with type 1 diabetes. Cutaneous manifestations generally appear subsequent to the development of diabetes but may be the first presenting sign or even precede the diagnosis by many years. The cutaneous findings can be classified into four major groups: 1) skin diseases associated with diabetes, such as scleroderma-like changes of the hand, necrobiosis lipoidica, and diabetic dermopathy; 2) cutaneous infections; 3) cutaneous manifestations of diabetes complications, such as neuropathic foot ulcers; and 4) skin reactions to diabetes treatment (1).To understand the development of skin lesions and their relationship to diabetes complications, a useful approach would be a long-term follow-up of type 1 diabetic patients and/or surveys of cutaneous disorders in younger type 1 diabetic subjects. Available data suggest that skin dryness and scleroderma-like changes of the hand represent the most common cutaneous manifestations of type 1 diabetes seen in up to 49% of the patients (3). They are interrel...

Relation between cutaneous and extracutaneous complications in pediatric patients with type 1 diabetes

“…The prevalence of rubeosis faciei in our patients with type 1 diabetes was rather high (8.75%), a similar high prevalence was noticed by Pavlovi'c et al.. 2 It is presumed that venular dilation in the cheeks of patients with diabetes underlies rubeosis faciei and is caused by hyperglycemia-induced sluggish microcirculation. 20 …”

“…identified xerosis in 22% of studied diabetic cohort. 2 Stepwise logistic regression highlighted the strong influence of glycemic control on xerosis. Similarly, Zakharov et al.…”

“…There they postulated that xerosis plays a significant role in the development of keratosis pilaris. 2 …”

“…2 DM affects the skin through several mechanisms. Reaching pathological high levels of glucose strongly affects skin homeostasis by inhibiting keratinocyte proliferation and migration, protein biosynthesis, inducing endothelial cell apoptosis, decreasing nitric oxide synthesis and impairing phagocytosis and chemotaxis from several cells.…”

“…1 The frequency of dermatological disorders during the course of diabetes has been reported to range from 30.0 to 91.2%. 2-4 …”