Cutaneous manifestations of diabetes mellitus: a narrative review

Abstract

Diabetes mellitus is a highly prevalent human endocrine disorder. Skin lesions are reported in approximately one-third of all diabetes mellitus patients. The clinical presentation and frequency vary according to the subtype of diabetes mellitus, metabolic control, and clinical course, with certain skin diseases occurring before diagnosing hyperglycemia. In this regard, the correct definition of cutaneous manifestations associated with diabetes mellitus can help define the etiology of hyperglycemia as well as the need to optimize glycemic control. In this narrative review, the most common cutaneous diseases observed in diabetes mellitus are discussed, including pruritus, acanthosis nigricans, necrobiosis lipoidica, bullosis diabeticorum, scleroderma diabeticorum, granuloma annulare, diabetic dermopathy, skin reactions due to device use, diabetic foot ulcers, recurrent cutaneous infections in diabetes mellitus and other dermatoses associated with hyperglycemia. The epidemiology, pathophysiology, differential diagnosis, and treatment of this disease are discussed. Therefore, knowledge and recognition of the most common dermatological lesions in patients with diabetes mellitus are essential for both endocrinologists and primary care physicians.

Figure 1. Hyperchromic velvety plaques in folding areas compatible with acanthosis nigricans (arrow) and diffuse erythema and thickening of the skin, shown by the examiner’s hand, on the upper body compatible with scleredema diabeticorum (asterisk)

Figure 2. A) Erythematous and scaly plaque with a slight yellow tone on the center of the lesion, showing an initial form of necrobiosis lipoidica; B) Deep ulceration with violet erythema surrounding the lesion compatible with a late stage of necrobiosis lipoidica

Figure 3. A and B: Brown, atrophic plaques in an annular pattern on the lower limbs, compatible with granuloma annulare

Figure 4. A and B: Hyperchromic diffuse macules on the lower limbs concentrated in trauma areas, compatible with diabetic dermopathy