Cutaneous Manifestations of Diabetes

Diabetes mellitus is a widespread and debilitating disease affecting all organ systems including the skin. Lifetime prevalence of cutaneous complications of diabetes mellitus has been estimated to range between 30% and 70%. Various dermatologic manifestations have been linked with diabetes mellitus that can vary in severity from benign to life-threatening. Necrobiosis lipoidica, scleredema adultorum, and granuloma annulare are common non-infectious cutaneous diseases associated with diabetes. Bacterial, viral and fungal infections are also frequent in people with diabetes. Complication of diabetes such as neuropathy and angiopathy can lead to diabetic dermopathy, diabetic foot syndrome, rubeosis facies, palmar erythema and other cutaneous manifestations. Furthermore, antidiabetic medications can also lead to cutaneous adverse effects. Insulin can cause local reactions like lipohypertrophy, lipoatrophy, and immediate and delayed-type hypersensitivity reactions. Oral hypoglycemic agents have been associated with development of bullous pemphigoid, erythema multiforme, leukocytoclastic vasculitis, drug reactions, and photosensitivity. Some of these may occur before the diagnosis of diabetes; thus, play an important role in the recognition of underlying diabetes mellitus. Skin lesions can also offer an insight into patients’ glycemic control, prompting better disease control. Early recognition and management of these skin conditions are essential for improving patients’ quality of life and decreasing morbidity and mortality associated with diabetes.