Cutaneous manifestations of diabetes mellitus in controlled and uncontrolled state

Cutaneous manifestations of diabetes mellitus ISSN: 2394-0026 (P)Original Research Article ISSN: 2394-0034 (O) Cutaneous manifestations of diabetesmellitus in controlled and uncontrolled stateUsha Kataria1*, Dinesh Chhillar2, Hitender Kumar3, Pankaj Chhikara41Assistant Professor, Department of Dermatology, BPS Govt. Medical College for Women, Khanpur Kalan, Sonepat, Haryana, India 2Resident, Department of Forensic Medicine, PGIMS, Rohtak, India3Assistant Professor, Department of Medicine, BPS Govt. Medical College for Women, Khanpur Kalan, Sonepat, Haryana, India 4Assistant Professor, Department of Forensic Medicine, PGIMS, Rohtak, India *Corresponding author email: [email protected] to cite this article: Usha Kataria, Dinesh Chhillar, Hitender Kumar, Pankaj Chhikara. Cutaneousmanifestations of diabetes mellitus in controlled and uncontrolled state. IAIM, 2015; 2(2): 90-93. Available online at www.iaimjournal.comReceived on: 28-01-2015 Accepted on: 02-02-2015AbstractBackground: Diabetes Mellitus can be complicated by a variety of cutaneous manifestations. Goodmetabolic control may prevent some of these manifestations and may support cure. Almost alldiabetic patients eventually develop skin complications from long term effects of Diabetes Mellituson the microcirculation and skin collagen. Cutaneous infections are more common in type 2diabetes. Patients, who had diabetes for many years, tend to develop the most devastating skinproblems.Aim: To evaluate the pattern of cutaneous manifestations in Diabetes Mellitus in controlled anduncontrolled State.Material and methods: Two hundred patients with the diagnosis of diabetes mellitus type-II (100controlled and 100 uncontrolled) attending the outpatient departments of dermatology andmedicine of B.P.S. Govt. Medical College, Khanpur Kalan, Dist. Sonepat were studied.Results: Among the cutaneous disorders commonly associated with diabetes, infections (49%) werethe most prevalent.Conclusion: One should be vigilant enough for the cutaneous manifestations as they are the windowto the systemic illness.Key wordsDiabetes Mellitus, Cutaneous manifestations, Microcirculation.International Archives of Integrated Medicine, Vol. 2, Issue 2, February, 2015. Page 90Copy right © 2015, IAIM, All Rights Reserved.

Cutaneous manifestations of diabetes mellitus ISSN: 2394-0026 (P) ISSN: 2394-0034 (O)Introduction A1C) levels were estimated in all patients toDiabetes Mellitus is a chronic disease and it assess the control of diabetes. Histo-affects multiple systems of the body including pathological examination of skin lesions andthe skin. It is the most common endocrine micro-biological investigations were carried outdisorder and it is estimated that it will affect 300 where ever necessary to confirm the diagnosis.million people worldwide by 2025 [1]. Patients with Hb A1C value less than 7 gm%Abnormalities of insulin and elevated blood were considered in controlled state and moreglucose level lead to involvement of multiple than 7 gm% in uncontrolled state.organ systems including cardiovascular, renal,nervous system, eyes and skin [2]. More than Resultsone third of diabetic patients have some type of Among 200 Diabetes Mellitus type II patients;dermatologic manifestation during the course of there were 120 (60%) females and 80 (40%)their chronic disease [3]. Abnormal males. The male: female ratio was 2: 3. Thecarbohydrate metabolism, arthrosclerosis, duration of diabetes ranged from one year tomicroangiopathy, neuron-degeneration and twenty years. The age of patients ranged fromimpaired host mechanism all play roles in the 18 – 70 years and the most common age grouppathogenesis of cutaneous complications. were 51-60 (42%) followed by 41-50 (28%) andCutaneous signs of diabetes mellitus are 31-40 (20%). In the controlled group, there wereextremely valuable to the clinicians as some of 58% females and 42% males. In uncontrolledthem can alert the physician to the diagnosis of group, female patients were 62% and malethe diabetes mellitus and also reflect the status patients were 38%. The cutaneousof glycemic control and lipid metabolism [4]. The manifestations were most prevalent in the ageaim of the present study was to evaluate the group of 51-60 years. The majority of patientspattern of cutaneous manifestations in Diabetes (55%) with cutaneous manifestations wereMellitus in controlled and uncontrolled state. having disease duration between 1-5 years followed by 6-10 year (30%) and more than 10Material and methods years duration in 15% patients.Two hundred patients with the diagnosis of In diabetic patients with cutaneousdiabetes mellitus type-II (100 controlled and 100 manifestations, hypertension was present inuncontrolled) attending the outpatient 26%; nephropathy in 5%; neuropathy in 4% anddepartments of dermatology and medicine of retinopathy in 3% cases. Among the cutaneousB.P.S. Govt. Medical College, Khanpur Kalan, disorders commonly associated with diabetes,Dist. Sonepat were studied. The patients having infections (49%) were the most prevalent.other dermatological illness were excluded from Bacterial infections were seen in 23% cases andthe study (e.g. psoriasis, erythroderma etc). A these included impetigo (6%), frunculosis (11%)detailed history was taken in each patient with and carbuncle (6%). Fungal infections were seenparticular reference to cutaneous complaints. A in 26% cases and these included Candidaldetailed clinical examination especially for the intertrigo, vulvo vaginal candidiasis and balano-presence of muco-cutaneous lesions was done prosthitis were seen in 12% cases.in natural light. Blood sugar, urine examination, Dermatophytic infections included toe nailliver function tests, lipid profile, kidney function onychomycosis (3%), finger nail onychomycosistests, ECG and 24 hours urine protein were done (2%), tinea pedis (3%), tinea corporis (2%), tineain all patients. Glycosylated hemoglobin (Hb manum (1%) and tinea cruris (3%). Among theInternational Archives of Integrated Medicine, Vol. 2, Issue 2, February, 2015. Page 91Copy right © 2015, IAIM, All Rights Reserved.

Cutaneous manifestations of diabetes mellitus ISSN: 2394-0026 (P) ISSN: 2394-0034 (O)cutaneous disorder uncommonly associated manifestations as they are the window to thewith diabetes only for disease i.e. psoriasis, liken systemic illness.planus, vitiligo and pemphigus were seen.Pruritis, localized or generalized without any Referencesskin lesions were present in 10.5% cases as perTable - 1. 1. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes:Discussion Estimates for the year 2000 and projection for 2030. Diabetes Care,Out of 200 diabetic patients, 49% patients were 2004; 27: 1047-1053.having cutaneous infections as reported by S. 2. Giligor RS, Lazarus GS. In. DiabetesSasmaz, et al. [5] also. The female predominance Mellitus, eds. Rifkin H, Raskin P,was seen in our study as reported by Mahajan, Bradyco, Louna 1981; p. 313-321.et al. [6] and Romano, et al. [7]. The frequency 3. Greenwood AM. A study of skin in 500of skin disease was more in 5th and 6th decades diabetics. JAMA, 1927; 89: 774-779.as reported by Romano, et al. [7]. The cutaneous 4. Urbach K, Lentz JW. Carbohydratemanifestations were more commonly seen in metabolism and skin. Arch Dermatoluncontrolled diabetes mellitus (HbA1C more Syphilol, 1965; 52: 301-304.than 7 gm %). 5. S. Sasmaz, M.A. Buyukbese, A. Cetinkaya, M. Celik, O. Arican. TheInfections were present in 49% cases. The Prevalence of Skin Disorders in Type-2incidence of cutaneous infections was more in Diabetic Patients. The Internet Journaluncontrolled diabetics. Fungal infections formed of Dermatology, 2005; 3(1).the largest group. Dogra, et al. [8] have reported 6. Mahajan S, Koranne RV, Sharma SK.a high incidence of onychomycosis in diabetics Cutaneous manifestations of diabetesand it is attributed to increasing age and mellitus. Indian J Dermatol Venerolimpaired peripheral circulation. Pruritus without Leprol, 2003; 69: 105-108.skin lesions was seen in 10.5% cases in the 7. Romano G, Moretti G, Di Benedetto A,present study. It has been reported as the main Giotre C, Di Cesare E, Russo G, et al. Skinpresenting complains by Rao and Pai [9]. We did lesions in diabetes mellitus: Prevalencenot see any adverse drug reaction to oral and clinical correlation. Diabetes Reshypoglycemic. Clin Pract, 1998; 39: 101-106. 8. Dogra S, Kumar B, Bhansali A,Conclusion Chakrabarty A. Epidemiology of onychomycosis in patients with diabetesDiabetes Mellitus involves the skin quite often mellitus in India. Int J Dermatol, 2002;and when ever patients present with multiple 41: 647-651.skin manifestations; their diabetic status should 9. Rao GS, Pai GS. Cutaneousbe checked. Many of these manifestations, manifestations of diabetes mellitus: Aespecially the more common ones, might be clinical study. Indian J Dermatol Venerolexplained on the basis of the attachment of Leprol, 1997; 63: 232-234.glucose to proteins, and the subsequentmetabolism of this combination, which results inchanges in structure, function and color. Henceone should be vigilant enough for the cutaneousInternational Archives of Integrated Medicine, Vol. 2, Issue 2, February, 2015. Page 92Copy right © 2015, IAIM, All Rights Reserved.

Cutaneous manifestations of diabetes mellitus ISSN: 2394-0026 (P)Table - 1: Pattern of cutaneous manifestations in Diabetic patients. ISSN: 2394-0034 (O)Cutaneous manifestations Numbers of patients Controlled Group Uncontrolled GroupA Cutaneous disorders commonly seen in Diabetes Mellitus 51% 10%1 Infections 47% 5% 8%2 Skin tags 8% 6% 2%3 Acanthosis nigricans 7% 1% 12%4 Diabetic dermopathy 6% 1%5 Bullous diabeticorum 6% 1% 1%6 Periungual telengiectasia 6% 1% 1%7 Eruptive xanthoma 3%8 Generalized pruritis 9%9 Necrobiosis lipoidica 3%B Cutaneous disorders uncommonly seen in Diabetes Mellitus1 Lichen planus 1%2 Vitiligo 2%3 Psoriasis 1%4 Pemphigus vulgaris 1%Source of support: Nil Conflict of interest: None declared.International Archives of Integrated Medicine, Vol. 2, Issue 2, February, 2015. Page 93Copy right © 2015, IAIM, All Rights Reserved.