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Dr. Ravichandran G, Senior Consultant Dermatologist, Apollo Hospitals, Chennai 20 June 2025
Cutaneous manifestations are common in metabolic disorders, such as DM and MetS. These conditions share a common etiopathogenesis. The associated skin findings may be the first clinical feature. An early diagnosis facilitates treatment and prevents long-term complications.
Skin manifestations of DM include:
· Metabolic – anogenital pruritus, eruptive xanthomas, generalized pruritus, and yellow discoloration
· Infection – bacterial and fungal
· Vascular – macroangiopathy and microangiopathy
· Neuropathic – gangrene, mal perforans, neuropathic arthropathy (Charcot foot)
· Dermatologic complications – Abscesses, keloids, lipoatrophy, and pruritus
· Skin diseases – Acanthosis nigricans, acquired perforating dermatosis, diabetic bullae, diabetic dermaatrophy, granuloma annulare, necrobiosis lipoidica, sclederma diabeticorum, and vitiligo
Common bacterial infections precipitated due to diabetes are – carbuncles, ecthyma, erysipelas, folliculitis, furunculosis, impetigo, green nails, malignant external otitis, and necrotizing fasciitis. The usual presentations include – boils, abscesses, hair follicle infections, erythrasma, and intertrigo.
Diabetes patients are prone to fungal infections – candidal balnoposthitis, candidal paronychia, and dermatiphytosis.
The vascular involvements include microangiopathy atherosclerosis; and macroangiopathies – diabetic foot and erysipelas like erythema, pigmented purpuric dermatosis, and rubeosis face.
Complications of DM:
· Trophic Ulcers – neuropathic ulcers – anhidrosis and hyperhidrosis; neuropathic ulcers are circular, punched out in the middle of a callosity. Foot care is recommended.
· Gangrene – is very common and is associated with skin discoloration.
Dermatological complications associated with DM treatment are – abscesses, keloids, lipoatrophy, and pruritus.
Skin diseases that DM aggravates are – acanthosis nigricans, acquired perforating dermatosis, diabetic bullae, diabetic dermaatrophy, granuloma annulare, necrobiosis lipoidica, sclerederma diabeticorum, and vitiligo.
Associations in Longstanding DM:
· Dermopathy
· Bullae
· Pseudo acanthosis, acrochordons
· Slerederma diabeticorum
· Eruptive xanthoma
· Eruptive granuloma annulare
· Necrobiosis lipoidica
· Kyrle’s disease
· Lipodystrophies
· Yellow nails
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