2019, Vol. 2, Issue 1, Part A

Author(s)
Anusha B and John Basha Shaik

Abstract
Involvement of skin is a key component in diabetes mellitus to the extent of 79.2% of the diabetics. This study was conducted among the patients with diabetes mellitus attending the Department of DVL. Current study assessed the clinical pattern of cutaneous manifestations in patients of Diabetes mellitus and its correlation with glycosylated haemoglobin levels. 37.5% of the study subjects had diabetes since 1-5 years and 40% had since 5-10 years. 8.3% of the cases in this study had family history of diabetes. Hypertension was main co morbidity and present in 10% of the study subjects. 40.6% of the study subjects had cutaneous infections, 32.6% had cutaneous manifestations which are not specific to diabetes mellitus. Strong to weak association of cutaneous manifestations to diabetes mellitus was present in 24.6% of the cases. 21.7% of the patients in this study had fungal infections, 15.2% had bacterial infections and 3.6% had viral infections. Among the fungal infections, Candidal balanoposthitis, Candidal vulvovaginitis, Intertrigo, Onychomycosis, Tinea corporis, Tinea cruris and Tinea mannum were common. In the bacterial infections, folliculitis, furuncle, erythrasma, Pitted keratolysis, Paronychia, cellulitis and carbuncle were common. Herpes zoster was the common viral infection which was present in 2.9% of the patients and verruca vulgaris was present in 0.7% of the study subjects. In the cutaneous manifestations which had strong to weak association with diabetes mellitus, vitiligo, Diabetic dermopathy, Acanthosis nigricans, Lichenplanus, Xanthoma, Granuloma annualare, Kyrle’s disease, Scleroderma of Buschke and Bullosis diabeticorum were present in this study. Insulin lipodystrophy was present in 0.7% of the cases. Among the cutaneous manifestations which were not specific to diabetes mellitus, generalized xerosis, Acrochordans, Psoriasis, Dermatosis papulosa nigra, Cherry angiomas and Schamberg’s Disease were present. Seborrheic keratosis and Idiopathic guttate hypomelanosis were also seen. Hyperkeratotic eczema, Macular amyloidosis, Exfoliative dermatitis, Urticaria, Pityriasis rosea, Lichen simplex chronicus, Acquired ichthyosis, Polymorphic light eruptions, and Melasma. Leucocytoclastic vasculitis, Porokeratosis, Contact dermatitis, keloids and Lipodytsrophy were the other non-specific manifestations. The mean random blood sugar levels among was 250.6±82.1 mg/dl, fasting blood sugar level was 175.2±52.6 mg/dl and post prandial blood sugar level was 242.4±81.4 mg/dl. The HbA1c level was normal in 7.5% of the study subjects, 12.5% had good control, 41.7% had fair control and 38.3% had poor control. 35.7% of the study subjects aged between 41 – 50 years had cutaneous infections, 31.3% had lesions which are not specific to DM and 35.3% had lesions with strong to weak association with DM. This difference was not statistically significant. Majority of patients with cutaneous manifestations (80.5%) were seen in patients with fair to poor control of diabetes mellitus. There was a statistical significance (p<0.000) between cutaneous infections and glycosylated hemoglobin. 42.9% cutaneous infections, 20.0% with non-specific lesions to DM and 47.1% with strong to weak associations with DM had poor glucose control. 57.1% of the patients with cutaneous infections, 35.6% of the patients with lesions not specific to diabetes mellitus, 32.4% with strong to weak association to DM and 66.7% of the patients with complications of diabetes mellitus had fair control of diabetes mellitus as per HbA1c levels. 40.4% of the patients with cutaneous infections, 35.7% of patients with lesions not specific of diabetes mellitus and 48.4% of patients with strong to weak association of diabetes mellitus had diabetes since 5– 10 years. Poorly controlled sugar levels were the main cause for most of the cutaneous manifestations as evident in this study. A good glycemic control reduces the incidence and severity of the cutaneous disorders. However, several nonspecific cutaneous disorders that occur in diabetic patients can increase the likelihood of exposure to infectious organisms and contact allergens, resulting in chronic and recurrent infections and eczemas. Early detection of potentially grave or predisposing conditions and providing a comprehensive diabetic care to the patients is strongly advocated.

DOI: https://doi.org/10.33545/26649411.2019.v2.i1a.208

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