Skin diseases Skin diseases commonly seen in commonly seen in diabetic patientsdiabetic patients

Dr. Au Tak ShingMBBS (HK), MRCP (UK),

FHKCP, FHKAM (Medicine), FRCP (Edin), Dip Derm (Lond), Dip GUM (LSA),

DCH (Lond), DFM (CUHK),Specialist in Dermatology and Venereology

Skin disease and DM

Skin manifestations of DM Skin disease as side effects of treatment for

DM Treatment of skin disease resulting in DM

Dermatophyte infection

Tinea is common in DM patients May not be more common than general

population Need for treatment is even stronger Watch out for secondary bacterial infection

Infection or not?

Distribution is a very important clue

Distribution

Fungal infection is usually asymmetrical

Dermatitis is usually symmetrical or corresponding to the primary cause

Distribution is a very important clue Morphology of an individual lesion

Infection or not?

Candidiasis

More common in DM patients Vulvo-vaginitis Balano-posthitis Can be the first sign of DM

Diabetic dermopathy

Quite common Multiple, asymptomatic, irregularly shaped,

discrete, atrophic, brown macules resembling scars

Shins Intimal thickening and deposition of PAS-

positive fibrillary material in vessel walls Microangiopathy elsewhere

Acanthosis nigricans

Velvety hyperpigmentation of intertriginous areas

Less often on extensor surfaces Commonly associated with insulin resistan

ce Obesity, darkly-pigmented patients

Diabetic bullae

Bullous diabeticorum Non-inflammatory bullae on lower extremi

ties Pathology uncertain

Bullous pemphigoid

Autoimmune process that affects the dermo-epidermal junction

Elderly Multiple intact bullae Investigation: skin biopsy for histology an

d immunofluorescence study Treatment: oral steroid +/- other immuno-s

uppressants

Necrobiosis lipoidica

Yellow atrophic patches often on shins Erythematous border Ulceration Not always associated with DM

Disseminated granuloma annulare

Annular lesions composed of papules Usually smooth surface Controversy about relation with DM

Neuropathic ulcers

Non-painful ulcers at feet Pressure points

Acral dry gangrene

Due to vascular disease

Eruptive xanthomas

Reddish yellow papules Developing over weeks to months Elevated serum triglycerides in patients wit

h poorly controlled DM Good control of DM leads to resolution

Contact Dr. Au Tak Shing

Unit 502, Hing Wai Building, 36 Queen’s Road Central, HK (tel: 28100680)

香港中環皇后大道中 36號興瑋大廈 5樓 502 室（星期一、三、五）

Unit 922, Argyle Centre Phase One, 688 Nathan Road, Mongkok (tel: 23926006)

九龍旺角彌敦道 688 號旺角中心第一座 9樓 922 室（星期二、四、六）

Email: auts123@yahoo.com.hk