Bullosis Diabeticorum

Abstract

A 65-year-old male with diabetes and peripheral neuropathy (last glycosylated hemoglobin level 9.4 %) reported spontaneous development of a 14 × 9 cm, tense bulla on the medial aspect of his right lower extremity (Fig. 1). The lesion was non-inflammatory in appearance with a non-erythematous base and clear serous content. Nikolsky's sign was negative. There were no other bullous skin lesions. The patient had no prior history of dermatologic disorders and denied any recent trauma, acute edema, or change in medications. The massive bulla spontaneously ruptured and healed without complication. The distribution and appearance of the bulla led to a clinical diagnosis of bullosis diabeticorum, a rare but likely underdiagnosed condition in patients with diabetes. Lesions appear rapidly, primarily in an acral distribution in areas of otherwise normal-appearing skin, and range from a few centimeters to very large. The differential diagnosis includes friction bullae, bullae due to burns or edema, bullous fixed drug reaction, bullous pemphigoid, and epidermolysis bullosa acquisita. Bullae resolve spontaneously but can recur, and secondary infection after rupture is a concern. The etiology of bullae formation in diabetics is unknown, although theories include microangiopathy 1 and an enhanced vulnerability to trauma. 2

Bullosis diabeticorum in a morbidly obese woman in Haiti

“…Complementary examinations, including biopsy of lesions and direct and indirect immunofluorescence, are usually inconclusive [ 1 , 6 , 14 ]. These screenings made it possible to exclude other cutaneous pathologies of inflammatory origin, such as bullous pemphigoid which is an autoimmune disease, necrobiosis lipoidica diabeticorum, and rubeosis faciei, often accompanied by retinopathy as it is a form of microangiopathy; We can also mention Eruptive xanthoma, with lesions generally on the buttocks, elbows and knees; Acrochordon, a benign pathology whose lesions are made up of reddish and blackish patches; and finally Diabetic dermopathy, which is characterized by well-demarcated lesions, with small depressions at pretibial level [ 6 , 9 , 16 , 17 ]. Regarding our patient, there were no findings indicative of nephropathy or microangiopathy, as her renal workup was within normal limits, as were the results of fundus examination and absence of others types of lesions, apart from bullae on her limbs.…”

Clinical Characteristics, Serum Uric Acid and Bullosis Diabeticorum Outcomes in Patients With Diabetes Mellitus

“…Sometimes the blisters are large, with irregular borders and looseness, very similar to burn lesions. And the bulla are full of serum and rarely bleed [6,7] . Typical blisters are super cial and contain transparent sterile liquids [8] .…”

Disabling bullosis diabeticorum despite optimal type 2 diabetes control

“…The annual incidence is expected to be 0.16% in patients with diabetes mellitus 5. Though the prognosis is favourable, BD may impair quality of life, particularly if the blister is large 6 7. To avoid infectious or haemorrhagic complications and achieve a quick healing time, strict local care is required 2 3.…”

“…To avoid infectious or haemorrhagic complications and achieve a quick healing time, strict local care is required 2 3. Although the aetiology appears to be multifactorial, abnormal calcium and carbohydrate metabolism and microangiopathy are believed to be the main culprits 2–4 7…”