How is bullous disease of diabetes (bullosis diabeticorum) diagnosed?

Updated: Feb 04, 2019
  • Author: Maureen B Poh-Fitzpatrick, MD; Chief Editor: Dirk M Elston, MD  more...
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Answer

The clinical workup of bullous disease of diabetes (bullosis diabeticorum) is fairly straightforward. Approaches range from culture to skin biopsy in order to more clearly differentiate the condition from other clinically similar conditions and identify secondary infections that might require treatment.

Cultures are only warranted if secondary bacterial infections are suspected. If bullous disease of diabetes blister fluid is cloudy instead of clear, the clinician should consider excluding secondary bacterial infection with culture of the blister fluid.

Should a patient present with prominent involvement of the dorsal hands, evaluation of porphyrin levels is warranted. Levels are normal in persons with bullous disease of diabetes. Elevated levels indicate porphyria cutanea tarda or another blistering porphyria. Individuals with end-stage renal disease may have mildly elevated plasma porphyrin levels, possibly contributing to the total pathogenesis of blister formation.


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