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Dermatological Complications of Diabetes Mellitus; Allergy to Insulin and Oral Agents

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Principles of Diabetes Mellitus

Abstract

Diabetes mellitus is a chronic disease involved with the dysregulation of glucose metabolism through defects in insulin production and action. Diabetes has a significant impact on multiple organ systems, including the skin. Most patients will eventually develop cutaneous manifestations of the disease. Oftentimes it is the initial presenting symptom of an underlying diagnosis of diabetes. The range of cutaneous findings is broad, ranging from idiopathic inflammatory conditions, such as granuloma annulare and necrobiosis lipoidica, to metabolic derangements of the skin seen in acanthosis nigricans and acrochordans. Neuropathic and vasculopathic changes in long-standing diabetes can lead to chronic ulcerations of the skin. Even therapeutic management of diabetes can lead to unwanted cutaneous side effects. This chapter will focus on the clinical features, pathogenesis, and treatment modalities of the various dermatologic manifestations of the diabetes.

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References

  1. Perez MI, Kohn SR. Cutaneous manifestations of diabetes mellitus. J Am Acad Dermatol. 1994;30:519–31.

    Article  CAS  PubMed  Google Scholar 

  2. Braverman IM. Skin signs of systemic disease. Philadelphia: WB Saunders; 1981. p. 654–64.

    Google Scholar 

  3. Reid SD, Ladizinski B, Lee K, Baibergenova A, Alavi A. Update on necrobiosis lipoidica: a review of etiology, diagnosis, and treatment options. J Am Acad Dermatol. 2013;69:783–91.

    Article  PubMed  Google Scholar 

  4. Korber A, Dissemond J. Necrobiosis lipoidica diabeticorum. CMAJ. 2007;177:12.

    Article  Google Scholar 

  5. Quimby SR, Muller SA, Schroeter AL. The cutaneous immunopathology of necrobiosis lipoidica diabeticorum. Arch Dermatol. 1988;124(9):1364–71.

    Article  CAS  PubMed  Google Scholar 

  6. Mirkamali A, Carbonnelle-Puscian A, Bagot M. Ulcerated necrobiosis lipoidica: successful treatment with topical tacrolimus and hydroxychloroquine. Ann Dermatol Venereol. 2010;137:561–2.

    Article  CAS  PubMed  Google Scholar 

  7. Kavala M, Sudogan S, Zindanci I, Kocaturk E, Can B, Turkoglu Z, et al. Significant improvement in ulcerative necrobiosis lipoidica with hydroxychloroquine. Int J Dermatol. 2010;49:467–9.

    Article  PubMed  Google Scholar 

  8. Dabski K, Winkelmann RK. Generalized granuloma annulare: clinical and laboratory findings in 100 patients. J Am Acad Dermatol. 1989;20:39–47.

    Article  CAS  PubMed  Google Scholar 

  9. Thornsberry L, English J. Etiology, diagnosis, and therapeutic management of granuloma annulare: an update. Am J Clin Dermatol. 2013;14:279–90.

    Article  PubMed  Google Scholar 

  10. Thyresson HN, Doyle JA, Winkelmann RK. Granuloma annulare: histopathologic and direct immunofluorescence study. Acta Derm Venereol. 1980;60:261.

    CAS  PubMed  Google Scholar 

  11. Lukács J, Schliemann S, Elsner P. Treatment of generalized granuloma annulare – a systematic review. J Eur Acad Dermatol Venereol. 2015;29(8):1467–80.

    Article  PubMed  Google Scholar 

  12. Marcus DV, Mahmoud BH, Hamzavi IH. Granuloma annulare treated with rifampin, ofloxacin, and minocycline combination therapy. Arch Dermatol. 2009;145:787–9.

    Article  CAS  PubMed  Google Scholar 

  13. Shmer A, Bergman R, Linn S, Kantor Y, Friedman-Birnbaum R. Diabetic dermopathy and internal complications of diabetes mellitus. Int J Dermatol. 1998;37:113–5.

    Article  Google Scholar 

  14. Morgan AJ, Schwartz RA. Diabetic dermopathy: a subtle sign with grave implications. J Am Acad Dermatol. 2008;58(3):447–51. Epub 2007 Dec 21.

    Article  PubMed  Google Scholar 

  15. Wigington G, Ngo B, Rendell M. Skin blood flow in diabetic dermopathy. Arch Dermatol. 2004;140:1248–50.

    Article  PubMed  Google Scholar 

  16. Brik R, Berant M, Vardi P. The scleredema-like syndrome of insulin dependent diabetes mellitus. Diabetes Metab Rev. 1991;7(2):120–8. Review.

    Article  CAS  PubMed  Google Scholar 

  17. Rongioletti F, Kaiser F, Cinotti E, Metze D, Battistella M, Calzavara-Pinton PG, Damevska K, Girolomoni G, André J, Perrot JL, Kempf W, Cavelier-Balloy B. Scleredema. A multicentre study of characteristics, comorbidities, course and therapy in 44 patients. J Eur Acad Dermatol Venereol. 2015;29(12):2399–404

    Google Scholar 

  18. Thumpimukvatana N, Wongpraparut C, Lim H. Scleredema diabeticorum successfully treated with ultraviolet A1 phototherapy. J Dermatol. 2010;37:1036–9.

    Article  PubMed  Google Scholar 

  19. Starkman HS, Gleason RE, Rand LI, et al. Limited joint mobility of the hands in patients with diabetes mellitus. Ann Rheum Dis. 1986;45:130–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Lieberman LS, Rosenbloom AC, Riley WJ, et al. Reduced skin thickness with pump administration of insulin. N Engl J Med. 1980;303:940–1.

    CAS  PubMed  Google Scholar 

  21. Eaton P, Sibbitt WL, Harsh A. The effect of an aldose reductase inhibiting agent on limited joint mobility in diabetic patients. JAMA. 1985;253:1437–40.

    Article  CAS  PubMed  Google Scholar 

  22. Eaton RP, Sibbitt WL, Shah VO, et al. A commentary on 10 years of aldose reductase inhibition for limited joint mobility in diabetes. J Diabetes Complications. 1998;12:34–8.

    Article  CAS  PubMed  Google Scholar 

  23. Gerrits EG, Landman GW, Nijenhuis-Rosien L, Bilo HJ. Limited joint mobility syndrome in diabetes mellitus: a minireview. World J Diabetes. 2015;6(9):1108–12.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Sabin JA. Bacterial infections in diabetes mellitus. Br J Dermatol. 1974;91:481.

    Article  Google Scholar 

  25. Knight L, Fletcher J. Growth of Candida albicans in saliva: stimulation by glucose associated with antibiotics, corticosteroids and diabetes mellitus. J Infect Dis. 1971;123:371–7.

    Article  CAS  PubMed  Google Scholar 

  26. Tomford JW, Whittlesey D, Ellner JJ, Tomashefski JF. Invasive primary cutaneous phycomycosis in diabetic leg ulcers. Arch Surg. 1980;115:770–1.

    Article  CAS  PubMed  Google Scholar 

  27. Rashid M, Bari A, Majeed S, et al. Mucormycosis: a devastating fungal infection in diabetics. J Coll Physicians Surg Pak. 2005;15:43–5.

    PubMed  Google Scholar 

  28. De Locht M, Boelaert JR, Schneider YJ. Iron uptake from ferrioxamine and from ferrirhizoferrin by germinating spores of Rhizopus microsporus. Biochem Pharmacol. 1994;47:1843–50.

    Article  PubMed  Google Scholar 

  29. Adam RD, Hunter G, DiTomasso J, Comerci Jr G. Mucormycosis: emerging prominence of cutaneous infections. Clin Infect Dis. 1994;19(1):67–76.

    Article  CAS  PubMed  Google Scholar 

  30. Yohai RA, Bullock JD, Aziz AA, Markert RJ. Survival factors in rhino-orbital-cerebral mucormycosis. Surv Ophthalmol. 1994;39(1):3–22.

    Article  CAS  PubMed  Google Scholar 

  31. Spanakis EK, Aperis G, Mylonakis E. New agents for the treatment of fungal infections: clinical efficacy and gaps in coverage. Clin Infect Dis. 2006;43(8):1060–8.

    Article  CAS  PubMed  Google Scholar 

  32. Alteras I, Saryt E. Prevalence of pathogenic fungi in the toe-webs and toe-nails of diabetic patients. Mycopathologia. 1979;67:157–9.

    Article  CAS  PubMed  Google Scholar 

  33. Celestin R, Brown J, Kihiczak G, Schwartz RA. Erysipelas; a common potentially dangerous infection. Acta Dermatovenerol APA. 2007;16(3):123–7.

    CAS  Google Scholar 

  34. Calhoun JH, Mader JT. Infection in the diabetic foot. Hosp Pract. 1992;30:81–140.

    Google Scholar 

  35. Brook I, Frazier EH. Clinical and microbiological features of necrotizing fasciitis. J Clin Microbiol. 1995;33:2382–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  36. Wong CH, Chang HC, Pasupathy S, Khin LW, Tan JL, Low CO. Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality. J Bone Joint Surg Am. 2003;85-A(8):1454–60.

    Article  PubMed  Google Scholar 

  37. Rubin Grandis J, Branstetter 4th BF, Yu VL. The changing face of malignant (necrotising) external otitis: clinical, radiological, and anatomic correlations. Lancet Infect Dis. 2004;4(1):34–9.

    Article  PubMed  Google Scholar 

  38. Rubin J, Yu VL. Malignant external otitis: insights into pathogenesis, clinical manifestations, diagnosis, and therapy. Am J Med. 1988;85(3):391–8.

    Article  CAS  PubMed  Google Scholar 

  39. Barrow HN, Levenson MJ. Necrotizing malignant” external otitis caused by, Staphylococcus epidermidis. Arch Otolaryngol Head Neck Surg. 1992;118:94–6.

    Article  CAS  PubMed  Google Scholar 

  40. Montes LF, Dobson H, Dodge BG, Knowles WR. Erythrasma and diabetes mellitus. Arch Dermatol. 1969;99:674–80.

    Article  CAS  PubMed  Google Scholar 

  41. Basarab T, Munn SE, McGrath J, Jones RR. Bullous diabeticorum. A case report and literature review. Clin Exp Dermatol. 1995;20:218–20.

    Article  CAS  PubMed  Google Scholar 

  42. Bernstein JE, Medenica M, Soltani K, et al. Bullous eruption of diabetes mellitus. Arch Dermatol. 1979;115:324–5.

    Article  CAS  PubMed  Google Scholar 

  43. Gilchrest B, Rowe JW, Mihm MC. Bullous dermatosis of hemodialysis. Ann Intern Med. 1975;83:480–3.

    Article  CAS  PubMed  Google Scholar 

  44. Glynne P, et al. Bullous dermatoses in end-stage renal failure: porphyria or pseudoporphyria? Am J Kidney Dis. 1999;34:155–60.

    Article  CAS  PubMed  Google Scholar 

  45. Vadoud-Sayedi J, et al. Treatment of hemodialysis-associated pseudoporphyria with N-acetycysteine: report of two cases. Br J Dermatol. 2000;142:580–1.

    Article  Google Scholar 

  46. Hermanns-Le T, Scheen A, Pierard GE. Acanthosis nigricans associated with insulin resistance: pathophysiology and management. Am J Clin Dermatol. 2004;5:199–203.

    Article  PubMed  Google Scholar 

  47. Veysey E, Ratnavel R. Facial acanthosis nigricans associated with obesity. Am J Clin Dermatol. 2005;30:437–9.

    CAS  Google Scholar 

  48. Simha V, Garg A. Phenotypic heterogeneity in body fat distribution in patients with congenital generalized lipodystrophy caused by mutations in the AGPAT2 or seipin genes. J Clin Endocrinol Metab. 2003;88:5433–7.

    Article  CAS  PubMed  Google Scholar 

  49. Apridonidze T, Essah PA, Iuorno MJ, Nestler JE. Prevalence and characteristics of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2005;90:1929–35.

    Article  CAS  PubMed  Google Scholar 

  50. Cruz Jr P, Hud Jr J. Excess insulin binding to insulin-like growth factor receptors: proposed mechanism for acanthosis nigricans. J Invest Dermatol. 1992;98:82S.

    Article  PubMed  Google Scholar 

  51. Podolsky S. Lipoatrophic diabetes and leprechaunism. In: Podolsky S, Viswanthan M, editors. The spectrum of the diabetic syndromes. New York: Raven; 1980. p. 335–52.

    Google Scholar 

  52. Lawrence RD. Lipodystrophy and hepatomegaly with diabetes, lipemia, and other metabolic disturbances. Lancet. 1946;250:724–31.

    Article  Google Scholar 

  53. Mabry CC, Hollingsworth DR, Upton CV, Corbin A. Pituitary-hypothalamic dysfunction in generalized lipodystrophy. J Pediatr. 1973;82(4):625–33.

    Article  CAS  PubMed  Google Scholar 

  54. Oseid S, Beck-Nielsen H, Pederson O, Sovik O. Decreased binding of insulin to its receptor in patients with congential generalized lipodystrophy. N Engl J Med. 1977;296:245–8.

    Article  CAS  PubMed  Google Scholar 

  55. Garg A. Lipodystrophies. Am J Med. 2000;108(2):143–52.

    Article  CAS  PubMed  Google Scholar 

  56. Vantyghem MC, Vigouroux C, Magre J, et al. Late-onset lipoatrophic diabetes. Phenotypic and genotypic familial studies and effect of treatment with metformin and lispro insulin analog. Diabetes Care. 1999;22:1374.

    Article  CAS  PubMed  Google Scholar 

  57. Oral EA, Simha V, Ruiz E, et al. Leptin-replacement therapy for lipodystrophy. N Engl J Med. 2002;346(8):570–8.

    Article  CAS  PubMed  Google Scholar 

  58. Hoerer E, Dreyfuss F, Herzberg M. Carotenemia, skin color and diabetes mellitus. Acta Diabetol Lat. 1975;12:202–7.

    Article  CAS  PubMed  Google Scholar 

  59. Rapini RP, Herbert AA, Drucker C. Acquired perforating dermatosis: evidence for combined transepidermal elimination of both collagen and elastic fibers. Arch Dermatol. 1989;125:1074–8.

    Article  CAS  PubMed  Google Scholar 

  60. Bleich HL, Boro ES. Diabetic polyneuropathy: the importance of insulin deficiency, hyperglycemia and alterations in myoinositol metabolism in its pathogenesis. N Engl J Med. 1976;295:1416–20.

    Article  Google Scholar 

  61. Lippman HI, Perotto A, Farrar R. The neuropathic foot of the diabetic. Bull NY Acad Med. 1976;52:1159–78.

    Google Scholar 

  62. Levy DM, Teenghi G, Gu XH. Immunohistochemical measurements of nerves and neuropeptides in diabetic skin: relationship to tests of neurological function. Diabetologia. 1992;35:889–97.

    Article  CAS  PubMed  Google Scholar 

  63. Javed S, Alam U, Malik RA. Burning through the pain: treatments for diabetic neuropathy. Diabetes Obes Metab. 2015;17(12):1115–25. Epub 2015 Sep 10. Review.

    Article  CAS  PubMed  Google Scholar 

  64. Jeffcoate WJ, Harding KG. Diabetic foot ulcers. Lancet. 2003;361(9368):1545–51.

    Article  PubMed  Google Scholar 

  65. Ajam Z, Barton SP, Marks R. Characterization of abnormalities in the cutaneous microvasculature of diabetic subjects. Br J Dermatol. 1982;107 Suppl 22:22–3.

    Google Scholar 

  66. Ditzel J. Functional microangiopathy in diabetes mellitus. Diabetes. 1968;17:388–97.

    Article  CAS  PubMed  Google Scholar 

  67. Landau J, Davis E. The small blood vessels of the conjunctiva and nailbed in diabetes mellitus. Lancet. 1960;2:731–4.

    Article  CAS  PubMed  Google Scholar 

  68. Lithner F. Purpura, pigmentation and yellow nails of the lower extremities in diabetes. Acta Med Scand. 1976;199:202–8.

    Google Scholar 

  69. Namazi MR, Jorizzo JL, Fallahzadeh MK. Rubeosis faciei diabeticorum: a common, but often unnoticed, clinical manifestation of diabetes mellitus. Sci World J. 2010;10:70–1.

    Article  CAS  Google Scholar 

  70. Nigwekar SU, Kroshinsky D, Nazarian RM, Goverman J, Malhotra R, Jackson VA, Kamdar MM, Steele DJ, Thadhani RI. Calciphylaxis: risk factors, diagnosis, and treatment. Am J Kidney Dis. 2015;66(1):133–46.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Cheng JB, Anderson RC, Cruz Jr PD. Stevens-Johnson syndrome associated with glipizide therapy. Dermatitis. 2006;17(1):36–8.

    Article  PubMed  Google Scholar 

  72. Kaomongkolgit R. Oral lichenoid drug reaction associated with antihypertensive and hypoglycemic drugs. J Drugs Dermatol. 2010;9(1):73–5.

    PubMed  Google Scholar 

  73. Jegasothy BV. Allergic reactions to insulin. Int J Dermatol. 1980;19:139–47.

    Article  CAS  PubMed  Google Scholar 

  74. Grammer LC, Metzger BE, Patterson R. Cutaneous allergy to human (recombinant DNA) insulin. JAMA. 1984;251:1459–60.

    Article  CAS  PubMed  Google Scholar 

  75. Edidin DV. Cutaneous manifestations of diabetes mellitus in children. Pediatr Dermatol. 1985;2:161–79.

    Article  CAS  PubMed  Google Scholar 

  76. Ghosh S, McCann V, Bartle L, Collier A, Malik I. Allergy to insulin detemir. Diabet Med. 2007;24:1305–7.

    Article  PubMed  Google Scholar 

  77. Halevy S, Feuerman EJ. Abnormal glucose tolerance associated with lichen planus. Acta Derm Venereol. 1979;59:167–70.

    CAS  PubMed  Google Scholar 

  78. Albrecht M, Banoczy J, Dinya E, et al. Occurrence of oral leukoplakia and lichen planus in diabetes mellitus. J Oral Pathol. 1992;21:364–6.

    Article  CAS  Google Scholar 

  79. Lamey PJ, Gibson J, Barclay SC, Miller S. Grinspan’s syndrome: a drug-induced phenomenon? Oral Surg Oral Med Oral Pathol. 1990;70(2):184–5.

    Article  CAS  PubMed  Google Scholar 

  80. Chevrant-Breton J, Simon M, Bourel M, Ferrand B. Cutaneous manifestations of idiopathic hemochromatosis. Arch Dermatol. 1977;113:161–5.

    Article  CAS  PubMed  Google Scholar 

  81. Schunter JA, Löffler D, Wiesner T, Kovacs P, Badenhoop K, Aust G, Tönjes A, Müller P, Baber R, Simon JC, Führer D, Pfäffle RW, Thiery J, Stumvoll M, Kiess W, Kratzsch J, Körner A. A novel FoxD3 variant is associated with vitiligo and elevated thyroid auto-antibodies. J Clin Endocrinol Metab. 2015;100(10):E1335–42.

    Article  CAS  PubMed  Google Scholar 

  82. Kahana M, Grossman E, Feinstein A, et al. Skin tags: a cutaneous marker for diabetes mellitus. Acta Derm Venereol. 1986;67:175–7.

    Google Scholar 

  83. Demir S, Demir Y. Acrochordon and impaired carbohydrate metabolism. Acta Diabetol. 2002;39(2):57–9.

    Article  CAS  PubMed  Google Scholar 

  84. Rasi A, Soltani-Arabshahi R, Shahbazi N. Skin tag as a cutaneous marker for impaired carbohydrate metabolism: a case-control study. Int J Dermatol. 2007;46:1155–9.

    Article  PubMed  Google Scholar 

  85. Akpinar F, Dervis E. Association between acrochordons and the components of metabolic syndrome. Eur J Dermatol. 2012;22(1):106–10.

    CAS  PubMed  Google Scholar 

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Varghese, G.I., Mathew, M., Marmur, E., Varghese, M.C. (2017). Dermatological Complications of Diabetes Mellitus; Allergy to Insulin and Oral Agents. In: Poretsky, L. (eds) Principles of Diabetes Mellitus. Springer, Cham. https://doi.org/10.1007/978-3-319-18741-9_29

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