Bullosis Diabeticorum
KEY WORDS: bullosis diabeticorum; bullae; blistering diseases; diabetic
complications.
J Gen Intern Med
Stephanie Parks Taylor ) 1
Kelli Dunn 0
0 Endocrinology, Diabetes, and Metabolism, Carolinas Medical Center , Charlotte, NC , USA
1 Department of Internal Medicine, Carolinas Medical Center , Charlotte, NC , USA
Compliance with Ethical Standards: Conflict of Interest: The authors declare that they do not have a conflict of interest.
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A ropathy (last glycosylated hemoglobin level 9.4 %)
65-year-old male with diabetes and peripheral
neureported 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 microangiopathy1 and an enhanced vulnerability
to trauma.2
1. Derighetti M , Holhl D , Krayenbuhl BH , Panizzon RG . Bullosis diabeticorum in a newly discovered type 2 diabetes mellitus . Dermatology . 2000 ; 200 : 366 - 7 .
2. Bernstein JE , Levine LE , Medenica MM , Yung CW , Soltani K. Reduced threshold to suction-induced blister formation in insulin-dependent diabetics . J Am Acad Dermatol . 1983 ; 8 : 790 - 1 . (...truncated)