Bullosis diabeticorum. A report of two cases with a review of the literature

Abstract

Bullosis diabeticorum is a rare complication of long-standing diabetes mellitus. Bullous lesions, which appear like burn-induced blisters, occur suddenly without trauma in the feet. These bullae heal spontaneously without scarring; however, recurrence is common. The etiology of bullosis diabeticorum remains unknown. Several theories exist as to causal and contributory factors related to this cutaneous manifestation of diabetes mellitus.

Diabetic bullae: 12 cases of a purportedly rare cutaneous disorder

“…Larger blisters may be aspirated, using a small bore syringe and aseptic technique, to reduce discomfort and prevent accidental rupture. Some authors have reported flushing the lesion with povidone‐iodine, 16 but we do not believe this is necessary. The blister skin provides a good covering for the lesion and should be left intact, if possible.…”

“… 16 The bullae are intraepidermal (subcorneal to suprabasilar) in some patients and subepidermal in others. 13–24 In most published cases, there is intraepidermal cleavage without acantholysis situated in the superficial part of the prickle‐cell layer 1,25 . This differs from the hemorrhagic type of bullae that heal with atrophy and scarring; these show a cleavage plane below the dermoepidermal junction and destruction of anchoring fibrils.…”

“… 30 Furthermore, we observed that these blisters almost invariably occurred in skin sites that had no calluses, suggesting that they were areas not subject to high pressure. Microangiopathy may play an etiologic role in the view of some investigators 4–19,31 . Nephropathy has been thought by others to be etiologically important, especially in patients whose lesions follow severe sunlight exposure.…”

“…7 These often recurrent bullous lesions of unknown etiology can occur at different anatomic sites, but most often affect the acral areas, especially the feet. Only about 100 cases of this condition have appeared in the published literature since its first description 70 years ago, 8 and most are reports of no more than a few cases 4–6,9 , 10–18 . Thus, it is surprising that, during a recent 8‐year period, we have seen 12 patients with typical diabetic bullae.…”

Various Types of Wounds That Diabetic Patients Can Develop: A Narrative Review

“…Complications include metastatic abscesses of the kidneys, lungs, bones, and other organs. 33 A carbuncle appears as a hard and painful red lump that rapidly grows to a diameter of 3 to 10 cm within a few days ( Figure 1G ). After 5 to 7 days, suppuration occurs, with pus discharge from multiple follicular orifices and inflammatory infiltration extending into the subcutaneous and fascial tissues.…”