Our patients were nearly all poorly controlled in spite of frequent admission for regulation and our series differ on that point from most previous reports

Our patients were nearly all poorly controlled in spite of frequent admission for regulation and our series differ on that point from most previous reports. protective footwear. The incidence of BD per year in the present diabetic population is 016%. In 29 outbreaks, there were hypoglycaemic episodes or highly varying blood glucose. Antibiotics were given in 17 of 35 episodes. Time to healing was as much as median 25?months Saikosaponin B (range 05C23?months). Two patients had minor amputations. BD should be well known to all members of diabetic foot care teams. Blood glucose control with special attention to hypoglycaemia at the time of eruption, deroofing of the bullae and foot ulcer care are recommended. strong class=”kwd-title” Keywords: Bullosis diabeticorum, Diabetic foot, Diabetes mellitus, Foot wounds, Skin manifestations Background Cutaneous manifestations occur in approximately 30% of diabetic patients during the course of their illness (1). Among the skin diseases associated with diabetes mellitus, bullosis diabeticorum (BD) is poorly understood and considered to be rare. The majority of the literature is case stories 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 with a few small series 12, 13. The diagnosis is based on characteristic findings, clinical course and the absence of any other tenable diagnosis. There are no specific diagnostic tests. The patient presents with painless bullae, evolved rapidly, often overnight and sometimes during less than 1?hour 1, 2, 3, 4, 7, 11(?(1,1, ?,2).2). The lesions are localised to the acral areas, in most cases the feet and with one to several bullae per episode. The fluid may be more or less syrupy in consistency, sometimes haemorrhagic (Figure?2). Recurrent episodes are not uncommon 2, 3, 5, 6, 9, 11, 14. In a recent larger study of 12 diabetic patients, the diagnosis was based among other findings on bullae, which healed with no scarring and without specific treatment in a few weeks (12). With such criteria, BD is per definition a relatively harmless disease in which the diagnosis can only be settled retrospectively. In our experience, the bullous lesions on the feet might turn into severe chronic ulceration with skin necrosis and infection (?(3,3, ?,4),4), and adequate diabetic wound care should therefore be initiated without delay. Moreover, frequent severe hypoglycaemia at the outbreak as found in the present series calls for immediate attention to blood glucose regulation. Based on data of 25 diabetic patients with lesions considered as BD, this skin manifestation is associated with significant morbidity Rabbit polyclonal to UGCGL2 as characteristic for diabetic foot ulcers. Open in a separate window Figure 1 Typical lesion. Bulla developed spontaneously overnight. Open in a separate window Figure 2 Typical lesion. Haemorrhagic bulla on the heel. Open in a separate window Figure 3 Deep skin necrosis following bullous eruption. Open in a separate window Figure 4 Several areas with skin necrosis following bullous eruptions. Because of the sparse soft tissue on the toes, the lesions are in close proximity with bone, tendons and joints. Methods During a 3\year period, 25 diabetic patients with BD were treated in Steno Diabetes Center, a tertiary hospital specialised in the treatment of Saikosaponin B diabetes with a population of 5000 patients. One patient had 5 episodes, 1 had 4, 3 had 2 and 20 had 1, that is 35 episodes with 93 bullae. The series was consecutive and the files were studied retrospectively. The demographic data and comorbidity are given in Table?1. Table 1 Clinical data of 25 patients with bullosis diabeticorum* Men/women19/6Type 1 diabetes/type 2 diabetes21/4Age, years65 (42C81)Diabetes duration, years14 (1C47)Peripheral neuropathy (%)80Urinary albumin excretion (%)?Normal 30?mg/24?hours)40?Incipient nephropathy (30C300?mg/24?hours)20?Diabetic nephropathy ( 300?mg/24?hours)40Retinopathy (%)?Normal8?Simplex retinopathy60?Proliferative retinopathy32Insulin dose, units/kg ( em n /em ?=?23)042 (010C120)Other medication (%)?Diuretics48?Antihypertensives40Actual HbA1c (%)94 (55C134)Change in HbA1c (%)?01 (?41 to 46)Thyroid function (%)?Normal84?Hypothyroidism12?Hyperthyroidism4Haemoglobin (mmol/l)82 (65C96)Cholesterol (mmol/l)50 (27C75) Open in a separate window HbA1c, haemoglobin A1c. * Values are given as median (range) unless Saikosaponin B otherwise stated. The localisation of the bullae is shown in Figure?5. All but one patient presented with bullae on the feet. Patients were not included if there was a history or clinical sign of infection, critical ischaemia, repetitive stress from shoe wear or.