Cutaneous Manifestations of Diabetes

Arun Chakrabarty, MD; Robert A. Norman, MD; Tania J. Phillips, MD, FRCPC


Wounds. 2002;14(8) 

In This Article

Abstract and Introduction

Diabetes mellitus is a chronic disease of metabolic dysregulation involving the abnormal metabolism of glucose. Diabetes has a significant impact on the healthcare costs of the Western world. Nearly all patients with diabetes eventually develop cutaneous manifestations of the disease. Cutaneous signs of the disease can heighten the suspicions of a physician regarding the diagnosis of diabetes. This article will focus on the clinical features, pathogenesis, and treatment modalities of the various dermatologic manifestations of the disease ranging from the more benign granuloma annulare to the more sinister diabetic ulcer.

Diabetes mellitus (DM) is a heterogenous group of metabolic disorders characterized by elevated serum glucose levels resulting from defects in insulin production, insulin action, or a combination. Complications include retinopathy, nephropathy, and neuropathy. The two main types of diabetes of are Type 1 insulin-dependent DM, which is characterized by the destruction of insulin-producing beta cells of the pancreas creating the absolute need for exogenous insulin, and Type 2 noninsulin-dependent mellitus, which is associated with older age, obesity, physical inactivity, and family history. Type 2 diabetes is increasingly being diagnosed in children and adolescents. Diabetes has been implicated as the single largest cause of end-stage renal disease, the main reason for nontraumatic amputation, and an independent risk factor for cardiovascular disease.[1] Nearly one-third of diabetic patients have some type of dermatologic manifestation. With time, the skin of all diabetic patients is affected in some form or another. Cutaneous signs of DM are extremely valuable to the clinician. For example, diabetic bullae, diabetic dermopathy, necrobiosis lipoidica diabeticorum, and the scleroderma-like syndrome of waxy skin with limited joint mobility can alert the physician to the diagnosis of diabetes.[2,3] Eruptive xanthomas reflect the status of glucose and lipid metabolism. This review will focus on the clinical features, the pathogenesis, and treatment strategies of the cutaneous manifestations of diabetes.