What causes bullous disease of diabetes (bullosis diabeticorum)?

Updated: Dec 06, 2019
  • Author: Sofia Junaid Syed, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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The etiology of bullous disease of diabetes (bullosis diabeticorum) is unknown. Prominent acral accentuation of bullous disease of diabetes lesions suggests a susceptibility to microtrauma-induced changes. However, most of the patients developed blister spontaneously without history of trauma.

Many, but not all, patients with bullous disease of diabetes have nephropathy or neuropathy; some authors have hypothesized an etiologic association, possibly related to a local sub-basement membrane-zone connective-tissue alteration. Hyalinosis of small vessels noted on biopsy specimens has led some authorities to speculate microangiopathy-associated blister induction. In some, especially in patients with neuropathy, UV exposure is also thought to play a role. [13] There were reports of calcium and magnesium disturbance and abnormal carbohydrate metabolism in contribution to the disease. [15] Rarely, immunological deposition was suspicion as a cause of vasculopathy in patients with positive DIF. [11, 16] The postulated importance of glycemic control remains to be confirmed.

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