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Diabetology & Metabolic Syndrome
Published in: Diabetology & Metabolic Syndrome 1/2016

Open Access 01-12-2016 | Review

Skin disorders in diabetes mellitus: an epidemiology and physiopathology review

Authors: Geisa Maria Campos de Macedo, Samanta Nunes, Tania Barreto

Published in: Diabetology & Metabolic Syndrome | Issue 1/2016

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Abstract

Skin disorders, usually neglected and frequently underdiagnosed among diabetic patients, are common complications and encounter a broad spectrum of disorders in both type 1 and type 2 diabetes mellitus (DM)—e.g. cutaneous infection, dry skin, pruritus. Skin disorders are highly associated with increased risk of important outcomes, such as skin lesions, ulcerations and diabetic foot, which can lead to major complications and revolve around multifactorial factors besides hyperglycemia and advanced glycation end products. Although diabetic’s skin disorders are consistent in the literature, there is limited data regarding early-stage skin disorders in DM patients. Disease control, early-stage treatment (e.g. skin hydration, orthotic devices) and awareness can reduce morbidity of DM patients. Thus, better understanding of the burden of skin disorders in DM patients may raise awareness on prevention and management. Therefore, the aim of this study is to perform a literature review to evaluate the main clinical characteristics and complications of skin disorders in diabetic’s patients. Additionally, physiopathology early-stage skin disorders and dermocosmetic management were also reviewed.
Literature
1.
Wang YR, Margolis D. The prevalence of diagnosed cutaneous manifestations during ambulatory diabetes visits in the United States, 1998–2002. Dermatology. 2006;212:229–34.CrossRefPubMed
2.
3.
Federation ID. IDF diabetes atlas. 6th ed. Brussels: International Diabetes Federation; 2013.
4.
Romano G, Moretti G, Di Benedetto A, Giofre C, Di Cesare E, Russo G, et al. Skin lesions in diabetes mellitus: prevalence and clinical correlations. Diabetes Res Clin Pract. 1998;39:101–6.CrossRefPubMed
5.
6.
Foss NT, Polon DP, Takada MH, Foss-Freitas MC, Foss MC. Dermatoses em pacientes com diabetes mellitus. Revista de Saúde Pública. 2005;39:677–82.CrossRefPubMed
7.
Sanad EM, ElFangary MM, Sorour NE, ElNemisy NM. Skin manifestations in Egyptian diabetic patients: a case series study. Egypt J Dermatol Venereol. 2013;33:56–62.CrossRef
8.
9.
Farshchian M, Fereydoonnejad M, Yazdanfar A, Kimyai-Asadi A. Cutaneous manifestations of diabetes mellitus: a case series. Cutis. 2010;86:31–5.PubMed
10.
Wambier CG, Takada MH, Foss-Freitas MC, Frade MAC, Foss MC, Foss NT. Effects of metabolic control on cutaneous findings in diabetes mellitus. Revista Brasileira de Medicina Interna. 2014;1:11–9.
11.
da Silva MCA, Mazzotti NG, Weber MB. Manifestações cutâneas em pacientes com diabete melito tipo 2 em posto de saúde. Revista da Associação Médica do Rio Grande do Sul. 2007;51:95–9.
12.
Galdeano F, Zaccaria S, Parra V, Giannini ME, Salomón S. Cutaneous manifestations of diabetes mellitus: clinical meaning. Dermatología Argent. 2013;16:117–21.
13.
Chatterjee N, Chattopadhyay C, Sengupta N, Das C, Sarma N, Pal SK. An observational study of cutaneous manifestations in diabetes mellitus in a tertiary care hospital of Eastern India. Indian J Endocrinol Metab. 2014;18:217–20.CrossRefPubMedPubMedCentral
14.
Pavlovic MD, Milenkovic T, Dinic M, Misovic M, Dakovic D, Todorovic S, et al. The prevalence of cutaneous manifestations in young patients with type 1 diabetes. Diabetes Care. 2007;30:1964–7.CrossRefPubMed
15.
Sawatkar GU, Kanwar AJ, Dogra S, Bhadada SK, Dayal D. Spectrum of cutaneous manifestations of type 1 diabetes mellitus in 500 South Asian patients. Br J Dermatol. 2014;171:1402–6.CrossRefPubMed
16.
Shah BR, Hux JE. Quantifying the risk of infectious diseases for people with diabetes. Diabetes Care. 2003;26:510–3.CrossRefPubMed
17.
Ragunatha S, Anitha B, Inamadar AC, Palit A, Devarmani SS. Cutaneous disorders in 500 diabetic patients attending diabetic clinic. Indian J Dermatol. 2011;56:160–4.CrossRefPubMedPubMedCentral
18.
Blakytny R, Jude EB. Altered molecular mechanisms of diabetic foot ulcers. Int J Low Extrem Wounds. 2009;8:95–104.CrossRefPubMed
19.
Behm B, Schreml S, Landthaler M, Babilas P. Skin signs in diabetes mellitus. J Eur Acad Dermatol Venereol. 2012;26:1203–11.CrossRefPubMed
20.
Gkogkolou P, Bohm M. Advanced glycation end products: key players in skin aging? Dermatoendocrinology. 2012;4:259–70.CrossRef
21.
Nicholl ID, Stitt AW, Moore JE, Ritchie AJ, Archer DB, Bucala R. Increased levels of advanced glycation endproducts in the lenses and blood vessels of cigarette smokers. Mol Med. 1998;4:594–601.PubMedPubMedCentral
22.
Avery NC, Bailey AJ. The effects of the Maillard reaction on the physical properties and cell interactions of collagen. Pathol Biol. 2006;54:387–95.CrossRefPubMed
23.
Yuen A, Laschinger C, Talior I, Lee W, Chan M, Birek J, et al. Methylglyoxal-modified collagen promotes myofibroblast differentiation. Matrix Biol. 2010;29:537–48.CrossRefPubMed
24.
Frykberg RG, Zgonis T, Armstrong DG, Driver VR, Giurini JM, Kravitz SR. Diabetic foot disorders. a clinical practice guideline. J Foot Ankle Surg. 2006;2006(45):S1–66.CrossRef
25.
26.
Spravchikov N, Sizyakov G, Gartsbein M, Accili D, Tennenbaum T, Wertheimer E. Glucose effects on skin keratinocytes: implications for diabetes skin complications. Diabetes. 2001;50:1627–35.CrossRefPubMed
27.
Chen XF, Lin WD, Lu SL, Xie T, Ge K, Shi YQ, et al. Mechanistic study of endogenous skin lesions in diabetic rats. Exp Dermatol. 2010;19:1088–95.CrossRefPubMed
28.
Bertheim U, Engstrom-Laurent A, Hofer PA, Hallgren P, Asplund J, Hellstrom S. Loss of hyaluronan in the basement membrane zone of the skin correlates to the degree of stiff hands in diabetic patients. Acta Derm Venereol. 2002;82:329–34.CrossRefPubMed
29.
Zakharov P, Talary MS, Kolm I, Caduff A. Full-field optical coherence tomography for the rapid estimation of epidermal thickness: study of patients with diabetes mellitus type 1. Physiol Meas. 2010;31:193–205.CrossRefPubMed
30.
Sakai S, Kikuchi K, Satoh J, Tagami H, Inoue S. Functional properties of the stratum corneum in patients with diabetes mellitus: similarities to senile xerosis. Br J Dermatol. 2005;153:319–23.CrossRefPubMed
31.
Seirafi H, Farsinejad K, Firooz A, Davoudi SM, Robati RM, Hoseini MS, et al. Biophysical characteristics of skin in diabetes: a controlled study. J Eur Acad Dermatol Venereol. 2009;23:146–9.CrossRefPubMed
32.
Thyssen JP, Linneberg A, Carlsen BC, Johansen JD, Engkilde K, Hansen T, et al. A possible association between a dysfunctional skin barrier (filaggrin null-mutation status) and diabetes: a cross-sectional study. BMJ Open. 2011;1:e000062.CrossRefPubMedPubMedCentral
33.
Tellechea A, Kafanas A, Leal EC, Tecilazich F, Kuchibhotla S, Auster ME, et al. Increased skin inflammation and blood vessel density in human and experimental diabetes. Int J Low Extrem Wounds. 2013;12:4–11.CrossRefPubMedPubMedCentral
34.
Murphy-Chutorian B, Han G, Cohen SR. Dermatologic manifestations of diabetes mellitus: a review. Endocrinol Metab Clin N Am. 2013;42:869–98.CrossRef
35.
Boulton AJ, Vileikyte L, Ragnarson-Tennvall G, Apelqvist J. The global burden of diabetic foot disease. Lancet. 2005;366:1719–24.CrossRefPubMed
36.
37.
Boulton AJM. The Pathway to ulceration: aetiopathogenesis. The foot in diabetes. USA: Wiley; 2002. p. 19–31.
38.
Armstrong DG, Lavery LA, Vela SA, Quebedeaux TL, Fleischli JG. Choosing a practical screening instrument to identify patients at risk for diabetic foot ulceration. Arch Intern Med. 1998;158:289–92.CrossRefPubMed
39.
van Schie CH. A review of the biomechanics of the diabetic foot. Int J Low Extrem Wounds. 2005;4:160–70.CrossRefPubMed
40.
41.
Pavicic T, Korting HC. Xerosis and callus formation as a key to the diabetic foot syndrome: dermatologic view of the problem and its management. J Dtsch Dermatol Ges. 2006;4:935–41.CrossRefPubMed
42.
43.
Eaglstein WH, Callen JP. Dermatologic comorbidities of diabetes mellitus and related issues. Arch Dermatol. 2009;145:467–9.CrossRefPubMed
44.
Ngo BT, Hayes KD, DiMiao DJ, Srinivasan SK, Huerter CJ, Rendell MS. Manifestations of cutaneous diabetic microangiopathy. Am J Clin Dermatol. 2005;6:225–37.CrossRefPubMed
45.
Gefen A. Plantar soft tissue loading under the medial metatarsals in the standing diabetic foot. Med Eng Phys. 2003;25:491–9.CrossRefPubMed
46.
Sakai S, Endo Y, Ozawa N, Sugawara T, Kusaka A, Sayo T, et al. Characteristics of the epidermis and stratum corneum of hairless mice with experimentally induced diabetes mellitus. J Invest Dermatol. 2003;120:79–85.CrossRefPubMed
47.
Yajima Y, Sueki H, Fujisawa R. Increased corneocyte surface area in the diabetic skin. Nihon Hifuka Gakkai Zasshi. 1991;101:129–34.PubMed
48.
Moczar M, Allard R, Ouzilou J, Robert L, Bouissou H, Julian M, et al. Structural and biochemical alterations of human diabetic dermis studied by H-lysine incorporation and microscopy. Pathol Biol. 1976;24:329–36.PubMed
49.
Hashmi F, Malone-Lee J, Hounsell E. Plantar skin in type II diabetes: an investigation of protein glycation and biomechanical properties of plantar epidermis. Eur J Dermatol. 2006;16:23–32.PubMed
50.
Ganemo A, Virtanen M, Vahlquist A. Improved topical treatment of lamellar ichthyosis: a double-blind study of four different cream formulations. Br J Dermatol. 1999;141:1027–32.CrossRefPubMed
51.
Pierard GE, Seite S, Hermanns-Le T, Delvenne P, Scheen A, Pierard-Franchimont C. The skin landscape in diabetes mellitus. focus on dermocosmetic management. Clin Cosmet Investig Dermatol. 2013;6:127–35.CrossRefPubMedPubMedCentral
52.
Schölermann A, Paschen B, Filbry A, Rippke F. Foot care with an 10% urea emollient in diabetic and atopic patients: results of two clinical studies. J Eur Acad Dermatol Venereol. Poster Presentations at the 12th EADV congress Barcelona 2003.
53.
Federici A, Federici G, Milani M. An urea, arginine and carnosine based cream (Ureadin Rx Db ISDIN) shows greater efficacy in the treatment of severe xerosis of the feet in Type 2 diabetic patients in comparison with glycerol-based emollient cream. A randomized, assessor-blinded, controlled trial. BMC Dermatol. 2012;12:16.CrossRefPubMedPubMedCentral
54.
Garrigue E, Martini J, Cousty-Pech F, Rouquier A, Degouy A. Evaluation of the moisturizer Pedimed((R)) in the foot care of diabetic patients. Diabetes Metab. 2011;37:330–5.CrossRefPubMed
55.
Pham HT, Exelbert L, Segal-Owens AC, Veves A. A prospective, randomized, controlled double-blind study of a moisturizer for xerosis of the feet in patients with diabetes. Ostomy Wound Manag. 2002;48:30–6.
56.
Papanas N, Papazoglou D, Papatheodorou K, Maltezos E. Evaluation of a new foam to increase skin hydration of the foot in type 2 diabetes: a pilot study. Int Wound J. 2011;8:297–300.CrossRefPubMed
57.
Seite S, Khemis A, Rougier A, Ortonne JP. Importance of treatment of skin xerosis in diabetes. J Eur Acad Dermatol Venereol. 2011;25:607–9.CrossRefPubMed
58.
Polaskova J, Pavlackova J, Vltavska P, Mokrejs P, Janis R. Moisturizing effect of topical cosmetic products applied to dry skin. J Cosmet Sci. 2013;64:329–40.PubMed
59.
Nunes S, Mosca MM, Rosa VP, de Macedo GMC. Uncontrolled, open-label, single center clinical study to evaluate the perceived efficacy and acceptability of Hidrastar cream and lotion for feet in diabetic patients. Revista Brasileira de Medicina. 2015;72:195–9.
Metadata
Title
Skin disorders in diabetes mellitus: an epidemiology and physiopathology review
Authors
Geisa Maria Campos de Macedo
Samanta Nunes
Tania Barreto
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Diabetology & Metabolic Syndrome / Issue 1/2016
Electronic ISSN: 1758-5996
DOI
https://doi.org/10.1186/s13098-016-0176-y

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