Transcript Skin Disease commonly seen in diabetic patients

Skin diseases
commonly seen in
diabetic patients
Dr. Au Tak Shing
MBBS (HK), MRCP (UK),
FHKCP, FHKAM (Medicine), FRCP (Edin),
Dip Derm (Lond), Dip GUM (LSA),
DCH (Lond), DFM (CUHK),
Specialist in Dermatology and Venereology
Skin disease and DM
 Skin manifestations of DM
 Skin disease as side effects of treatment for
DM
 Treatment of skin disease resulting in DM
Dermatophyte infection
 Tinea is common in DM patients
 May not be more common than general
population
 Need for treatment is even stronger
 Watch out for secondary bacterial infection
Infection or not?
 Distribution is a very important clue
Distribution
 Fungal infection is
usually asymmetrical
 Dermatitis is usually
symmetrical or
corresponding to the
primary cause
Infection or not?
 Distribution is a very important clue
 Morphology of an individual lesion
Candidiasis
 More common in DM patients
 Vulvo-vaginitis
 Balano-posthitis
 Can be the first sign of DM
Diabetic dermopathy
 Quite common
 Multiple, asymptomatic, irregularly shaped,
discrete, atrophic, brown macules
resembling scars
 Shins
 Intimal thickening and deposition of PASpositive fibrillary material in vessel walls
 Microangiopathy elsewhere
Acanthosis nigricans
 Velvety hyperpigmentation of
intertriginous areas
 Less often on extensor surfaces
 Commonly associated with insulin
resistance
 Obesity, darkly-pigmented patients
Diabetic bullae
 Bullous diabeticorum
 Non-inflammatory bullae on lower
extremities
 Pathology uncertain
Bullous pemphigoid
 Autoimmune process that affects the
dermo-epidermal junction
 Elderly
 Multiple intact bullae
 Investigation: skin biopsy for histology and
immunofluorescence study
 Treatment: oral steroid +/- other immunosuppressants
Necrobiosis lipoidica
 Yellow atrophic patches often on shins
 Erythematous border
 Ulceration
 Not always associated with DM
Disseminated granuloma annulare
 Annular lesions composed of papules
 Usually smooth surface
 Controversy about relation with DM
Neuropathic ulcers
 Non-painful ulcers at feet
 Pressure points
Acral dry gangrene
 Due to vascular disease
Eruptive xanthomas
 Reddish yellow papules
 Developing over weeks to months
 Elevated serum triglycerides in patients
with poorly controlled DM
 Good control of DM leads to resolution
Contact
 Dr. Au Tak Shing
 Unit 502, Hing Wai Building, 36 Queen’s Road
Central, HK (tel: 28100680)
 香港中環皇后大道中36號興瑋大廈5樓502室（星期一、三、五）
 Unit 922, Argyle Centre Phase One, 688 Nathan
Road, Mongkok (tel: 23926006)
 九龍旺角彌敦道688號旺角中心第一座9樓922室（星期二、四、六）
 Email: [email protected]