Title: Cutaneous manifestations in patients with diabetes mellitus in a tertiary care hospital at Bihar, India: An Observational Study

Authors: Dr Kumar Satya Prakash, Dr Ichchhit Bharat

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i7.122

Abstract

Background: Almost all diabetic patients eventually develop skin complications from the long-term effects of diabetes mellitus on the microcirculation and on skin collagen. Cutaneous infections are more common in type 2 diabetes, whereas autoimmune-related lesions are more common in type 1. 

Methodology: This observational study was conducted with patients in the Diabetic OPD of a tertiary care teaching hospital in Eastern India from January 2016 to December 2016. Two hundred patients satisfying the diagnostic criteria for diabetes were taken. A detailed history was elicited in each case with particular reference to cutaneous complaints and including details regarding duration, history of evolution, progression and treatment modalites, if any. 

Results: Of the study population 178 (89%) were cases of type 2 diabetes, 19 (9.5%) type 1 diabetes and 03 (1.5%) were cases of gestational diabetes. Out of 200 cases, 111 (55.5%) patients had some associated cutaneous manifestations comprising 69 (62.16%) males and 42 (37.84%) females. Cutaneous infections formed the largest group of dermatoses were observed in 61 (54.95%).Among the bacterial infection which were seen in 21 (18.92%) cases, impetigo contagiosa 7 (6.31%), folliculitis and boils 6 (5.41%), and two cases of erythrasma (1.8%). Dermatophytoses were seen in 22 (19.82%) patients, comprising tinea corporis et curis 9 (8.1%), tinea unguium in 3 (2.7%), tinea pedis 8 (7.21%) and tinea incognito in 2 (1.8%). Herpes zoster was seen in 2 patients (1.8%). Dermatoses or non-infectious skin lesions were seen in 58 (52.25%) diabetic cases.

Conclusion: Diabetes mellitus can be complicated by a variety of cutaneous manifestations. As the duration of diabetes increased, the likelihood of developing skin manifestations also increases. Early referral to the dermatologist may help to detect complications of the skin in diabetes at an early stage and may prevent disability caused by these complications.

Keywords: Diabetes mellitus, Cutaneous manifestations, Fungal infections, Dermatophytic infections, Dermatoses.

References

  1. DeFronzo RA, Ferrannini E, Zimmet P, et al. International Textbook of Diabetes Mellitus, 2 Volume Set, 4th Edition. Wiley-Blackwell, 2015.
  2. Evans JM, Newton RW, Ruta DA, et al. Socio-economic status, obesity and prevalence of Type 1 and Type 2 diabetes mellitus. Diabet Med J Br Diabet Assoc 2000; 17: 478–80.
  3. Holman N, Young B, Gadsby R. Current prevalence of Type 1 and Type 2 diabetes in adults and children in the UK. Diabet Med J Br Diabet Assoc 2015; 32: 1119–20.
  4. Sicree R, Shaw J, Zimmet P. Diabetes and impaired glucose tolerance. In: Gan D, editor. Diabetes atlas. International Diabetes Federation. 5th ed. Belgium: International Diabetes Federation; 2011. p. 15‑103.
  5. Mahajan S, Koranne R V, Sharma S K. Cutaneous manifestation of diabetes melitus. Indian J Dermatol Venereol Leprol 2003;69:105-8.
  6. Greenwood AM. A study of skin in 500 diabetics. JAMA 1927; 89: 774- 779.
  7. Wani MA, Hassan F, Bhat MH, Ahmed QM. Cutaneous Manifestations of Diabetes mellitus: A Hospital Based Study in Kashmir, India. Egyptian Dermatology Online Journal December 2009; 5(2): 1-6.
  8. Yosipovitch G, Hodak E, Vardi P, Shraga J, Karp M, Sprecher E, et al. The prevalence of cutaneous manifestations in IDDM patients and their association with diabetes risk factors and microvascular complications. Diabetes care 1998; 21: 506-509.
  9. Neerja Puri. A study on the cutaneous manifestations of diabetes mellitus. Our Dermatol Online. 2012; 3(2): 83-86.
  10. Nigam PK, Pande S. Pattern of dermatoses in diabetes. Indian J Dermatol Venereol Leprol 2003; 69: 83-85.
  11. Wahid Z, Kanjee A. Cutaneous manifestations of diabetes mellitus. J Pak Med Assoc 1998; 48: 304-305.
  12. Phulari YJ, Kaushik V. Study of cutaneous manifestations of type 2 diabetes mellitus. Int J Res Dermatol 2018;4:8-13.
  13. Kumar AA, Ansari SH, Gupta V. A study on cutaneous manifestations in patients of type 2 diabetes mellitus in a tertiary care hospital. Int J Med Res Prof. 2016;2(1):125-7.
  14. Chatterjee N, Chattopadhyay C, Sengupta N, Das C, Sarma N, Pal SK. An observational study of cutaneous manifestations in diabetes mellitus in a tertiary care Hospital of Eastern India. Indian J Endocr Metab 2014;18:217-20.
  15. Timshina DK, Thappa DM, Agrawal A. A clinical study of dermatoses in diabetes to establish its markers. Indian J Dermatol 2012;57:20-5.
  16. Giligor RS, Lazarus G S. Skin manifestations of diabetes mellitus. In, Diabetes Mellitus, eds Rifkin H, Raskin P, Brady co, Louana 1981, 313. 321.
  17. Sehgal VN, Sanker P Some aspects of skin diseases and diadetes mellitus. Indian J Dermatol Venereal 1965;31:264 - 269.
  18. Romano G, Morretti G, Dibenedetto A Skin lesions in diabetes mellitus: Prevalence and clinical correlations. Diebetes Research and Clinical Practice 1998;39:101-106.
  19. Rao GS, Pai GS. Cutaneous manifestations of diabetes mellitus: A clinical study. Indian J Dermatol Venereol Leprol 1997;63:232‑4.
  20. Demirseren DD, Emre S, Akoglu G, et al. Relationship between skin diseases and extracutaneous complications of diabetes mellitus: clinical analysis of 750 patients. Am J Clin Dermatol 2014;15:65–70.
  21. Bedi BMS, Kandhari KC. Diabetes or prediabetes and dermatosis. J Assoc Phys Ind 1965; 13: 809- 810.
  22. Hud JA Jr, Cohen JB, Wagner JM, Cruz PD Jr. Prevalence and significance of acanthosis nigricans in an adult obese population. Arch Dermatol 1992;128:941–944.
  23. Burke JP, Hale DE, Hazuda HP, Stern MP. A quantitative scale of acanthosis nigricans. Diabetes Care 1999; 22:1655-9.
  24. Ragunatha S, Anitha B, Inamadar AC, Palit A, Devarmani SS. Cutaneous disorders in 500 diabetic patients attending diabetic clinic. Indian J Dermatol 2011; 56:160-4.
  25. Bhat YJ, Gupta V, Kudyar RP. Cutaneous manifestations of diabetes mellitus. Int J Diabetes Dev Ctries 2006;26:152-5.
  26. Girisha BS, Viswanathan N. Comparison of cutaneous manifestations of diabetic with nondiabetic patients: A case-control study. Clin Dermatol Rev 2017; 1:9-14.
  27. Grandhe NP, Bhansali A, Dogra S, Kumar B. Acanthosis nigricans: Relation with type 2 diabetes mellitus, anthropometric variables, and body mass in Indians. Postgrad Med J 2005; 81:541-4.
  28. Schemer A, Bergiman R, Linn S, Kantor Y, Friedman - Birnbaum R. Diabetic dermopathy and internal complications in diabetes mellitus. Int J Dermatol 1998; 37: 113- 115.
  29. Duff M, Demidova O, Blackburn S, Shubrook J. Cutaneous manifestations of diabetes mellitus. Clinical Diabetes Winter 2015; 33 (1):40-48.
  30. Pathak R, Bridgeman MB. Dipeptidyl peptidase-4 (DPP-4) inhibitors in the management of diabetes. P T 2010;35:509–513.
  31. Sibbald RG, Schachter RK. The skin and diabetes mellitus. Int J Dermatol 1984;23:567-84.
  32. Huntley AC. The cutaneous manifestations of diabetes mellitus. J Am Acad Dermatol 1982;7:427-55.
  33. Yosipovitch G, Hodak E, Vardi P, Shraga I, Karp M, Sprecher E, et al. The prevalence of cutaneous manifestations in IDDM patients and their association with diabetes risk factors and microvascular complications. Diabetes Care 1998;21: 506-9.
  34. Sawhney M, Talwar OP, Tutakne MA, Rajpathak SD. Diabetic dermoangiopathy: A clinico-pathological correlation. Indian J Dermatol Venereol Leprol 1992;58:173-8.
  35. Sanad EM, ElFangary MM, Sorour NE, ElNemisy NM. Skin manifestations in Egyptian diabetic patients: a case series study. Egypt J Dermatol Venerol. 2013;33:56-62.
  36. Hosseini MS, Ehsani AH, Hosseinpanah F, Azizi F, Salami M, Khedmat H. Skin lesions in type 2 diabetic patients. Iran J Dermatol. 2008;11:113–7.
  37. Rayfield EJ, Ault MJ, Keusch GT, Brothers MJ, Nechemias C, Smith H. Infection and diabetes: The case for glucose control. Am J Med. 1982;72:439–50.
  38. Ghosh K, Das K, Ghosh S, et al. Prevalence of Skin Changes in Diabetes Mellitus and its Correlation with Internal Diseases: A Single Center Observational Study. Indian Journal of Dermatology. 2015;60(5):465-469. 

Corresponding Author

Dr Ichchhit Bharat

Senior Resident, Department of Mata Gujri Memorial Medical College & LSK Hospital , Purabbali, Dinajpur Road, Kishanganj, Bihar 855108, India

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