Bullous Diabeticorum
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Lisa Arnold
A 58-year-old man presented to the hospital with chronic bullous ulcerative disease of his fingers complicated further by osteomyelitis (image A). His medical history included pancreatic cancer and type 2 diabetes mellitus complicated by retinopathy, neuropathy, and end-stage renal disease. Hemoglobin A1c had ranged from 7.4% to 14.1% since the lesions first appeared. Recurrent tense, bullous lesions occurred only in his fingers and resolved spontaneously or progressed to osteomyelitis requiring amputation (image B) over the past 7 years. Results of the initial biopsy of the lesions showed intraepidermal vesiculobullous dermatitis with superficial epidermal necrosis. A second biopsy specimen showed spongiosis and sparse chronic inflammation without immunoreactivity. Without history of trauma, chemical injury, or underlying constitutional illness, and in the setting of nonspecific histopathologic findings and immunofluorescence findings that excluded noninflammatory bullous pemphigoid, porphyria cutanea tarda, and other bullous porphyrias, his presentation was consistent with bullous diabeticorum. Other bullous lesions, such as epidermolysis bullosum, were excluded.
Bullous diabeticorum is a rare cutaneous, spontaneous, blistering condition affecting approximately 0.16% of patients with diabetes.1 It is a diagnosis of exclusion with nonspecific histopathologic findings.2 The pathophysiologic process remains unclear, though poor glycemic control is thought to play a role.1
References
1. Larsen K , JensenT, KarlsmarkT, HolsteinPE. Incidence of bullosis diabeticorum—a controversial cause of chronic foot ulceration.Int Wound J.2008;5(4):591-596. doi:10.1111/j.1742-481X.2008.00476.xSuche in Google Scholar PubMed PubMed Central
2. Lipsky BA , BakerPD, AhroniJH. Diabetic bullae: 12 cases of a purportedly rare cutaneous disorder.Int J of Dermatol.2000;39(3):196-200.10.1046/j.1365-4362.2000.00947.xSuche in Google Scholar PubMed
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- CLINICAL IMAGES
- Bullous Diabeticorum
- Posterior Cortical Atrophy
Artikel in diesem Heft
- OMT MINUTE
- An Osteopathic Approach to Stasis Dermatitis and Chronic Venous Insufficiency
- LETTERS TO THE EDITOR
- Investigating the Influence of Vitamin D Replacement Therapy on Magnesium Status
- Response
- HEALTH POLICY
- Guns and Older Adults: The Physician's Role
- ORIGINAL CONTRIBUTION
- Industry Payments in Cardiology: A Cross-sectional Analysis of Open Payments Data
- Utility of 4-Factor Prothrombin Complex Concentrate in Trauma and Acute-Care Surgical Patients
- BRIEF REPORT
- Adjuvant Lymphatic Osteopathic Manipulative Treatment in Patients With Lower-Extremity Ulcers: Effects on Wound Healing and Edema
- JAOA/AACOM MEDICAL EDUCATION
- Moving Toward Milestone-Based Assessment in Osteopathic Manipulative Medicine
- Exodus From the Classroom: Student Perceptions, Lecture Capture Technology, and the Inception of On-Demand Preclinical Medical Education
- CASE REPORT
- Scalp Sarcoidosis Presenting as Cicatricial Alopecia
- Spontaneous Infrarenal Aortic Dissection in an Athlete Managed Emergently With Endovascular Stent Grafts, Occluders, and Femoral-Femoral Artery Bypass
- CLINICAL IMAGES
- Bullous Diabeticorum
- Posterior Cortical Atrophy
