Skin manifestations in diabetic patients part 02

Stomatitis (mouth ulcers) due to Candida is a classic complication in diabetic children and an occasional complication in diabetic adults. The prevalence of Candida infection of the hands and feet does not appear to be significantly different for the diabetic population as compared to controls. Candida paronychia usually involves the hands but it may occur on the feet. It often begins at the lateral nail folds as erythema, swelling, and separation of the fold from the lateral margin of the nail. Further infection may result in involvement of the proximal nail fold and separation of the cuticle from the nail. Moisture trapped in the resultant space favors further growth of the yeast and repeated episodes of inflammation. At times there may be a purulent discharge from involved nail fold, a clinical finding suggesting bacterial paronychia. Candida infection of the web spaces usually involves the 3-4 web space of the hands or the 4-5 web-space of the toes. This area has a tendency to retain moisture due to occlusion from apposing surfaces of skin. Presumably the increased sugar content of the skin encourages the establishment of this infection. The clinical appearance is a white patch of skin, often with central peeling.
Leg Infections: Hyperglycemia can allow usually nonpathogenic organisms to establish an infection in traumatized skin, occasionally resulting in gangrene and loss of limb. Diabetic patients with leg ulcers, or non-healing surgical wounds, especially those of the lower extremities, may have a complicating type (Phycomycetes) infection. Such an infection should be suspected when lower extremity ulcers or post-traumatic lesions are not responding to therapy. Atrophic hyperpigmented macules on the shins, so-called diabetic dermopathy, has been termed the most common cutaneous finding in diabetes. It is usually noted as irregularly round or oval, circumscribed, shallow lesions vary in number from few to many, which are usually bilateral but not symmetrically distributed. They are without symptoms and often overlooked. Another curious phenomenon in diabetes mellitus is the spontaneous appearance of blisters on the extremities (usually confined to hands or feet). These lesions are not the result of trauma or infection. They tend to heal without treatment. On the basis of cleavage level, there appears to be three types of these blisters:(a) Spontaneous and non scarring, they present as clear, sterile blisters on the tips of the toes or fingers and less frequently on the dorsal and lateral surfaces of the feet, legs, hands, and forearms. Spontaneous healing occurs within 2 to 5 weeks due to good circulation.(b) Hemorrhagic bullae - heals with scarring and atrophy. (c)Multiple tender non-scarring blisters on sun-exposed and deeply tanned skin, on the feet, legs, and arms.
Acanthosis nigricans. This is a condition that results in the darkening and thickening of certain areas of the skin especially in the skin folds. The skin becomes tan or brown and is sometimes slightly raised and described as velvety. Most often the condition, which typically looks like a small wart, appears on the sides or back of the neck, the armpits, under the breast, and groin. Occasionally the top of the knuckles will have a particularly unusual appearance. Acanthosis nigricans usually strikes people who are very overweight. Losing weight may improve the condition. Acanthosis nigricans usually precedes diabetes. It is thought that this condition is a skin manifestation of insulin resistance.
Skin problems linked to atherosclerosis: Atherosclerosis is the narrowing of blood vessels from a thickening of the vessel walls due to plaque buildup. While atherosclerosis most often is associated with blood vessels in or near the heart, it can affect blood vessels throughout the body, including those that supply blood to the skin. When the blood vessels supplying the skin become narrow, changes occur to the skin due to a lack of oxygen, such as hair loss, thinning and shiny skin especially on the shins, thickened and discolored toe nails and cold skin. Because blood carries the white blood cells that help fight infection, legs and feet affected by atherosclerosis heal more slowly when they are injured.

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