VOLUME 10 NUMBER 2 • JUNE 2013
51
SA JOURNAL OF DIABETES & VASCULAR DISEASE
REVIEW
Correspondence to:
Dr SM Kannenberg
Dermatologist (Private Practice, Kuils River,
Cape Town), Sessional Consultant Dermatologist,
Tygerberg Academic Hospital and Stellenbosch
University
PO Box 5659, Tygervalley, 7536
e-mail:
Dr WI Visser
Consultant Dermatologist, Head of Division of
Dermatology, Tygerberg Academic Hospital and
Stellenbosch University
S Afr J Diabetes Vasc Dis
2013;
10
: 51–53
Diabetes mellitus and the skin
SM Kannenberg, WI Visser
Abstract
The skin may provide vital clues for the diagnosis of diabetes
mellitus (DM). Certain skin signs may even portend advanced
disease. Skin complications associated with DM may lead to
severe impairment in the quality of life. Recognising various
skin signs is critical in the diagnosis and management of
patients with DM. This review will aim to overview the
diagnosis and management of some of the important skin
conditions associated with DM.
Introduction
Diabetes Mellitus and the skin may be associated in various ways:
the skin signs may provide the initial clue to the diagnosis of DM,
the skin may be affected by long term pathophysiological changes
caused by DM and the skin may be affected by diabetic medications.
Moreover, DM found in combination with specific skin signs may be
diagnostic of certain syndromes (e.g. necrolytic migratory erythema
in glucagonoma syndrome). Some skin findings may bemore specific
to the diagnosis of DM (e.g. necrobiosis lipoidica) and others less so
(e.g. periungual telangiectasias). The skin lesions can arbitrarily be
classified into either early or late associations (Table 1), where ‘early’
would include conditions commonly preceding the diagnosis of and
aiding in the diagnosis of DM; and ‘late’ those conditions found
in a known diabetic patient, often with end-organ involvement.
Certain conditions are more common in, although not exclusive
to, type 1 DM such as necrobiosis lipoidica and vitiligo. Others are
more common in type 2 DM, such as diabetic cheiroarthropathy
and eruptive xanthomas (Table 2). This review will aim to give an
overview of the diagnosis and management of some of the skin
conditions associated with DM.
Acanthosis nigricans
Acanthosis nigricans presents as velvety, hyperpigmented plaques
especially in the flexures. The pathogenesis is thought to be related
to high levels of circulating insulin, which binds to insulin-like growth
factor receptors. If asymptomatic, no treatment is required. Weight
reduction and exercise may reduce insulin resistance and thereby
improve the acanthosis nigricans. Ointments containing salicylic
acid or urea may reduce thicker lesions in areas of maceration. This
may decrease malodor and relieve discomfort.
Acrochordons (Skin tags)
Skin tags are soft pedunculated lesions occurring on the axillae,
neck and eyelids. In a large study of patients with skin tags, more
than 25% had diabetes and 8% had impaired glucose tolerance. If
treatment is required, skin tags can be removed with small scissors,
cryotherapy, or electrodessication.
Submitted 2/5/2013, accepted 23/5/2013
Table 1.
Skin conditions associated with Diabetes Mellitus
Early
Acanthosis nigricans
Acrochordons (skin tags)
Necrobiosis lipoidica
Diabetic dermopathy
Eruptive xanthomas
Infections such as erythrasma, cellulitis and necrotizing fasciitis
Late
Diabetic cheiroarthropathy
Scleredema diabeticorum of Buschke
Diabetic bullae
Lower leg ulcers (neuropathic, arterial or venous)
Acquired perforating disorder
Infections such as mucor, malignant otitis externa
Secondary infections of other diabetes mellitus complications
Diabetic foot
Controversial associations
Granuloma annulare and Lichen planus
Medication related
Lipoatrophy at insulin injection site
Photosensitivity
Lichenoid drug reactions
Erythema multiforme
Syndromes
Polycystic Ovarian Syndrome/Hyperandrogenism Insulin Resistance Acanthosis
Nigricans Syndrome – DM with hirsutism
Glucagonoma syndrome – DM with necrolytic migratory erythema
Polyglandular Autoimmune Syndrome Type II – DM with vitiligo
Table 2.
Skin conditions more commonly associated with type 1 and type 2 DM
Type 1 DM
Periungual telangiectasia
Necrobiosis lipoidica
Diabetic bullae
Vitiligo
Lichen planus
Type 2 DM
Diabetic cheiroarthropathy
Skin tags
Acanthosis nigricans
Diabetic dermopathy
Acquired perforating dermatoses
Eruptive xanthomas
Granuloma annulare
