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Diabetic Bullae Treatment

Diabetic Bulla

Diabetic Bulla

A diabetic bulla (also known as "Bullosis diabeticorum"[1] and "Bullous eruption of diabetes mellitus") is a cutaneous condition characterized by a noninflammatory, spontaneous, painless blister, often in acral locations (peripheral body parts, such as feet, toes, hands, fingers, ears or nose), seen in diabetic patients.[2][3]:681[3]:467–8 See also[edit] Diabetic dermadromes Skin lesion List of cutaneous conditions [edit] Diabetes mellitus type 2 (also known as type 2 diabetes) is a long-term metabolic disorder that is characterized by high blood sugar, insulin resistance, and relative lack of insulin.[6] Common symptoms include increased thirst, frequent urination, and unexplained weight loss.[3] Symptoms may also include increased hunger, feeling tired, and sores that do not heal.[3] Often symptoms come on slowly.[6] Long-term complications from high blood sugar include heart disease, strokes, diabetic retinopathy which can result in blindness, kidney failure, and poor blood flow in the limbs which may lead to amputations.[1] The sudden onset of hyperosmolar hyperglycemic state may occur; however, ketoacidosis is uncommon.[4][5] Type 2 diabetes primarily occurs as a result of obesity and lack of exercise.[1] Some people are more genetically at risk than others.[6] Type 2 diabetes makes up about 90% of cases of diabetes, with the other 10% due primarily to diabetes mellitus type 1 and gestational diabetes.[1] In diabetes mellitus type 1 there is a lower total level of insulin to control blood glucose, due to an autoimmune induced loss of insulin-producing beta cells in the pancreas.[12][13] Diagnosis of diabetes is by blood tests such as fasting plasma glucose, oral glucose tolerance test, or glycated hemoglobin (A1C).[3] Type 2 diabetes is partly preventable by stay Continue reading >>

What To Do If You Have Diabetic Blisters

What To Do If You Have Diabetic Blisters

People with diabetes can sometimes develop blisters on their skin, also known as diabetic bullae or bullosis diabeticorum. Even though diabetes blisters are not a pleasant sight, they are usually painless and will heal naturally, without leaving scars. Still, when it comes to diabetes, its always better to treat wounds with quick and proper care. This is because ordinary foot sores or blisters in a person with diabetes can sometimes turn into an ulcer which if not properly treated can lead to amputation. These blisters are a rare symptom of type 1 diabetes, but sometimes they can even appear in those with type 2 diabetes. According to the International Journal of Diabetes in Developing Countries , they appear only in 0.5% of U.S. diabetes patients. Also, men are more prone to this skin disorder than women. The most common places where diabetes blisters appear are feet, legs, and toes, but rarely can they show up on arms, hands, and fingers. Diabetic blisters usually look like those when you get a burn, except that they are painless. They can reach up to 6 inches, usually in clusters. They are itchy, and the skin around them is swollen or red. These blisters are filled with clear, sterile fluid and rarely appear as a single lesion. Even though the exact reason for the development of these blisters is not known, a lot of scientists believe its the reduced ability of a diabetic organism to sustain an injury. Moreover, these people usually suffer from nephropathy and diabetic neuropathy . In some cases, the swelling caused by heart failure in people with diabetes might be reason enough to cause their appearance. Also, diabetes patients whove experienced several complications from their diabetes through the course of several years might experience diabetic blisters. Another Continue reading >>

Bullosis Diabeticorum: Rare Presentation In A Common Disease

Bullosis Diabeticorum: Rare Presentation In A Common Disease

Copyright © 2014 Vineet Gupta et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract A 27-year-old African American male presented with a sudden onset of blisters. He had a past medical history of uncontrolled diabetes mellitus type I, diabetic vasculopathy, and neuropathy. The physical examination revealed nonerythematous skin denudations on both elbows and lateral aspect of arm bilaterally. Investigations which included skin biopsies confirmed the diagnosis of bullosis diabeticorum. The bullae were treated with hydrotherapy and healed with no complications in 4 weeks. We present this case to illustrate the rare occurrence of diabetic bulla in a diabetic patient especially with poor glycemic control. The case is also a reminder of the importance of diabetes screening in nondiabetic patients who are diagnosed with diabetic bulla. 1. Background Diabetes mellitus is associated with cutaneous manifestations including diabetic thick skin, acanthosis nigricans, necrobiosis lipoidica diabeticorum, and diabetic dermopathy in about one-third of patients [1–3].Bullosis diabeticorum is a spontaneous, noninflammatory, and blistering condition, that is, uniquely affects patients with diabetes mellitus. We present a case of bullosis diabeticorum in a patient with a history of diabetes mellitus type 1 who presented with a sudden onset of blisters that were diagnosed as diabetic bullae. 2. Case Presentation A 27-year-old African American male with past medical history significant for uncontrolled diabetes mellitus type I, diabetic vasculopathy, neuropathy, and medical noncompliance presented to our hospital w Continue reading >>

Bullosis Diabeticorum: Is There A Correlation Between Hyperglycemia And This Symptomatology?

Bullosis Diabeticorum: Is There A Correlation Between Hyperglycemia And This Symptomatology?

Abstract: Bullosis diabeticorum (bullous disease of diabetes or diabetic bullae) is a noninflammatory, blistering disease occurring spontaneously in diabetic patients.The bullae are usually located on acral skin surfaces, particularly the feet. While this disease is unique to patients with diabetes, it may mimic other blistering disorders. This article reviews a case of a 75-year-old Hispanic male with type II diabetes mellitus who suffered from chronic diabetic bullae during an 11-year span. Researchers recorded the patient’s blood glucose level on 50 occasions of bullae occurrence and 50 occasions when bullae were not present. It was discovered that the patient was more likely to experience bullae formation when his blood glucose level was elevated (t test analysis, P < 0.007). The etiology of bullosis diabeticorum may be multifactorial, but this study suggests poor regulation of blood glucose levels, particularly hyperglycemia, may have a significant impact on the manifestation of this dermopathy. A 75-year-old Hispanic male with chronic type II diabetes mellitus presented with a nonpainful intact bullous formation on the distal aspect of his left anterior leg with no history of trauma to the affected site. He was a long-time patient at the center since experiencing an injury at work that resulted in a transmetatarsal amputation on his left foot 15 years prior. During this time, the patient had obtained treatment for several ulcerations on his feet and legs bilaterally, which were complicated by diabetes. These ulcerations were treated with multiple modalities over the years, including standard wound care, total contact casting, hyperbaric oxygen therapy, oral and topical antibiotics, bio-occlusive hydrocolloid dressings, whirpool therapy, negative pressure wound t Continue reading >>

Treating The Acute Onset Of An Asymptomatic Solitary Blister

Treating The Acute Onset Of An Asymptomatic Solitary Blister

Issue Number: Volume 25 - Issue 12 - December 2012 Author(s): M. Joel Morse, DPM A 68-year-old Caucasian female presented to the office with acute onset of a solitary, asymptomatic, spontaneous, tense blister of three days’ duration on the lateral aspect of the right great toe. She is active and plays a lot of tennis. However, there was no history of trauma or friction from footwear prior to the eruption, and she never had anything such as this blister appear. There is no history of photosensitivity and the patient cannot recall any new drug intake in the preceding couple of weeks. The patient had visited a nail salon two days prior for nail care and polish. She remembers that she felt a prick when the nail technician was working on the great toe but thought nothing of it. The dermatological exam revealed a 3.5 cm x 1.3 cm tense solitary bullae on the fibular aspect of the left hallux. It is a tense, non-tender blister on a non-erythematous base. No erythema is present around the base and there is no pain at the toe. Prior to the formation of the blister, the patient did not have any itching or any redness in the area. Her history includes insulin-dependent diabetes for 30 years and the recent incorporation of an insulin pump to help manage her diabetes. There is a history of osteoarthritis, back problems, epilepsy, heart disease, hypertension and sinus problems. She notes meticulous foot hygiene and denies any history of calluses, corns or ulcers. Her most recent HbA1c was 6.4 and the fasting blood sugar on the morning of the appointment is 69, which is somewhat low. The rest of the past medical history is noncontributory. Key Questions To Consider 1. What are the characteristics of this condition? 2. What is the most likely diagnosis? 3. What is your differential di Continue reading >>

Bullosis Diabeticorum: A Distinctive Blistering Eruption In Diabetes Mellitus

Bullosis Diabeticorum: A Distinctive Blistering Eruption In Diabetes Mellitus

Dear Sir, A 41- year-old man with known type-1 diabetes presented with acute onset, asymptomatic, spontaneous, tense blisters of two days' duration on his right foot. The patient was on human insulin and there was no history of trauma or friction from footwear prior to the eruption. There was no history of photosensitivity and the patient could not recall any new drug intake in the preceding couple of weeks. He used to maintain meticulous foot hygiene, according to his physician's instructions. On examination, a tense, nontender blister on a nonerythematous base was seen on the dorsum of the second toe of the right foot. A larger collapsed bulla was also present on the ball of the great toe [Figure 1]. Histopathology of the lesional skin showed a subepidermal bulla without any inflammatory infiltrate. A direct immunofluorescence test was negative, thus excluding any immunobullous disease. No specific treatment was offered to the patient for the bullae. Within three weeks, the patient recovered uneventfully with slight residual dyspigmentation, but without any scarring. Based on the clinical, histopathological, and immunofluorescence pattern, the patient was diagnosed to have bullosis diabeticorum. Bullosis diabeticorum, also known as bullous disease of diabetes and diabetic bullae, is a rare, distinct, spontaneous, noninflammatory, blistering condition of unknown etiology occurring in the setting of diabetes mellitus.[1] While Cantwell, and Martz named the condition in 1967, Krane first reported this condition in 1930. The exact etiology of bullosis diabeticorum is not known but it is thought to be multifactorial in origin. We could not find any reference in the existing literature about the relationship of the occurrence of diabetic bulla and the degree of metabolic de Continue reading >>

Bullosis Diabeticorum: A Treatment Conundrum

Bullosis Diabeticorum: A Treatment Conundrum

Bullosis diabeticorum: a treatment conundrum 1Podiatry Lecturer , School of Health Sciences, University of Newcastle, Ourimbah, NSW, 2258, Australia Australasian Podiatry Council Conference 2011 Copyright 2011 Craike; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License ( ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Bullosis diabeticorum is an infrequent but significant complication of diabetes Mellitus most commonly affecting the hands and feet. These rapidly developing bullous lesions mostly occur in patients with long standing diabetes and neuropathy. The pathophysiology of this condition remains unknown. Despite reasonably low rates of occurrence this complication potentially has significant and serious ramifications for foot health and creates a treatment conundrum. This case study demonstrates the serious nature of seemingly innocuous presentations in management of the diabetic foot. A 76-year-old man presents to the high-risk foot clinic for treatment of a suspected Charcot foot. He has a complex medical history, which includes Type 2 diabetes, hypertension, congestive cardiac failure, hypercholesterolemia, and Gastro-esophageal reflux disease. The patient undergoes various testing to aid in diagnosing a Charcot foot, such as skin temperature testing, X-ray and bone scans. Fortunately he was not diagnosed with a Charcot foot. During a routine follow-up consult he presents with clear, serous filled blisters which have spontaneously appeared. They are in non weight-bearing areas, and the patient does not recall any trauma to the area. The blisters appear consistent with bullosis diabeticorum. There are no Continue reading >>

Diabetic Blisters

Diabetic Blisters

Share: Diabetic blisters are also called bullosis diabeticorum or diabetic bullae. They can sometimes develop in people with diabetes, although the condition is relatively rare. Only about one-half of one percent of those with diabetes is ever diagnosed with diabetic blisters. The blisters often appear on the legs and arms and seem to appear for no reason. In most cases, when they disappear, they do not leave scars. What Causes Diabetic Blisters? There is no single known cause for diabetic blisters. Many of those who have diabetic blisters may also have neuropathy and nephropathy. Some researchers think that a decreased ability to sustain an injury may play a role. And in people with heart failure, the swelling that can result from that condition may be enough to cause the blisters. Many people who develop the diabetic blisters have had diabetes for many years or have several complications from the disease. What Are the Symptoms of Diabetic Blisters? Most commonly, the blisters appear on the legs and feet. Rarely, you may also notice them on your fingers or the backs of your hands. You might go to bed one night with no blisters, wake up, and notice them. The blisters tend to be large and irregularly shaped. Sometimes, they look like a burn. There are commonly clear and contain sterile liquid. You might feel a burning sensation or a twinge of discomfort, but many people do not feel anything - other than a bit of surprise at seeing the blisters where there were none before. How Are Diabetic Blisters Treated? In many cases, the blisters heal by themselves, within two to four weeks, and no treatment is needed other than keeping them clean. On occasion, though, the blisters may burst. If this happens, your doctor may prescribe an antibiotic ointment or something to help dry Continue reading >>

2 Cases Of Bullosis Diabeticorum Following Long-distance Journeys By Road: A Report Of 2 Cases

2 Cases Of Bullosis Diabeticorum Following Long-distance Journeys By Road: A Report Of 2 Cases

Copyright © 2012 Fatima Bello et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background. Bullosis diabeticorum is a distinct, spontaneous, noninflammatory, and blistering condition of acral skin that is unique to diabetics. It is rare. Exact aetiopathogenesis is not known, but many attributed peripheral neuropathy as a potent risk factor, others hypothesized the role of trauma, UV light, and nephropathy. Aim. To present cases of bullosis diabeticorum following long-distance journeys by road. Methods. History and physical examinations were done on 2 diabetics who presented with bilateral feet bullae following a long journey. Biopsy of a circumferential area of the bullae including adjoining apparently normal skin was done. Results. Features of peripheral neuropathy were noted. One developed digital gangrene without features of peripheral vascular disease. Culture of aspirate from a bullae yielded Staphylococcus aureus. Tissue biopsy showed hyperkeratotic focally acanthotic pigmented epidermis with subcorneal separation of the granular layer of the epidermis by aggregates of viable and nonviable polymorphs and lymphocytes. There is mild acantholysis of the epidermis, and a fibrocollagenous dermis which is moderately infiltrated by lymphocytes. Conclusion. Long journeys by road is a strong factor in the aetiopathogenesis of bullosis diabeticorum on a background of peripheral neuropathy. Diabetics especially those with peripheral neuropathy should be cautious while traveling long journeys by road. 1. Background Bullous disease of diabetes (bullosis diabeticorum) is a distinct, spontaneous, no Continue reading >>

Diabetic Blisters: What You Need To Know

Diabetic Blisters: What You Need To Know

People with diabetes can sometimes experience blisters on their skin. These are known as diabetic blisters, bullosis diabeticorum, or diabetic bullae. Although more than 29 million people in the United States have diabetes, diabetic blisters are relatively rare, affecting just 0.5 percent of those with the condition. The blisters typically occur in people with uncontrolled diabetes. They are painless and tend to heal on their own without the need for medical intervention. This article looks at the causes and symptoms of diabetic blisters and lists several ways to treat and prevent them. Contents of this article: Causes The exact cause of diabetic blisters is not known, but several factors are thought to play a role in blister development. The blisters may result from: wearing shoes that do not fit properly reduced circulation a fungal infection called Candida albicans other injury or irritation to the feet or hands Furthermore, certain people with diabetes are more at risk of developing diabetic blisters than others. People at risk of developing diabetic blisters include: people whose blood sugar levels are not under control people with sensitivity to ultraviolet (UV) light men, as research reveals men are twice as likely as women to have diabetic blisters Symptoms Diabetic blisters most commonly appear in people who have had uncontrolled diabetes for several years. In some cases, however, they may be the first indication of diabetes or even prediabetes. Blisters are usually clear bumps that typically appear on the legs, feet, and toes, as well as the arms, hands, and fingers. They may be: irregularly-shaped up to 6 inches across clustered or, less commonly, occurring as a single lesion filled with a clear fluid itchy The skin around diabetic blisters will usually look Continue reading >>

Bullous Disease Of Diabetestreatment & Management

Bullous Disease Of Diabetestreatment & Management

Bullous Disease of DiabetesTreatment & Management Author: Maureen B Poh-Fitzpatrick, MD; Chief Editor: Dirk M Elston, MD more... Specific treatment of bullous disease of diabetes (bullosis diabeticorum) is unnecessary because the condition is self-limiting. The blister should be left intact whenever possible to serve as a sterile dressing and to avoid secondary infection. Drug therapy (ie, antibiotics) is only warranted when secondary staphylococcal infection is present. To see complete information on Diabetic Ulcers, please go to the main article by clicking here . To see complete information on Diabetes Mellitus, Type 1, please go to the main article by clicking here . To see complete information on Diabetes Mellitus, Type 2, please go to the main article by clicking here . Aspiration of fluid from bullous disease of diabetes lesions with sterile technique using a small-bore needle may prevent accidental rupture. Immobilization may prevent damage to the blister. Secondary tissue necrosis may necessitate debridement and possible tissue grafting. Aggressive wound healing intervention, as enacted with diabetic ulcers, is critical, should the blister become unroofed.Patients with confirmed bullous disease of diabetes should be monitored for development of secondary infection until lesions heal entirely. To see complete information on Diabetic Foot, please go to the main article by clicking here . To see complete information on Diabetic Foot Infections, please go to the main article by clicking here . Kurdi AT. Bullosis diabeticorum. Lancet. 2013 Nov 30. 382 (9907):e31. [Medline] . [Full Text] . Bustan RS, Wasim D, Yderstrde KB, Bygum A. Specific skin signs as a cutaneous marker of diabetes mellitus and the prediabetic state - a systematic review. Dan Med J. 2017 Jan. 64 Continue reading >>

Bullosis Diabeticorum

Bullosis Diabeticorum

A 74-year-old woman presented to her primary care doctor for evaluation of two painless blisters on her right shin. Her medical history was significant for hypertension, hyperlipidemia, and type 2 diabetes with microalbuminuria. Her diabetes had been managed for more than 20 years and was currently controlled with oral medications (pioglitazone, sitagliptin, and metformin) and long-acting insulin. She reported that the blisters spontaneously occurred on the preceding day with no history of trauma. She denied pain, pruritus, constitutional symptoms, and prior history of bullae. On exam, 2 tense 3 cm clear fluid-filled and 2 smaller bullae were present on her anterior right shin (Figure 1). Two 4 mm punch biopsies of the bulla were nondiagnostic and revealed eosinophilic infiltrate with intraepidermal spongiosis. Without treatment, her bullae spontaneously drained clear fluid “like water” and resolved over the subsequent weeks. Exam at her 2-week follow up appointment revealed well circumscribed hyperpigmented patches (Figure 2). She was diagnosed clinically with bullosis diabeticorum. Bullosis diabeticorum, or diabetic bullae, is a poorly understood but benign cutaneous manifestation of diabetes. This diagnosis in an older woman with longstanding diabetes highlights the importance of recognizing this condition to limit unnecessary alarm and unwarranted diagnostic tests. Bullosis diabeticorum was first reported in 1930, although the term wasn’t coined until 1967.1 The condition is rare and occurs in approximately 0.5% of diabetics.2 Affected patients tend to have long-standing diabetes and other diabetic complications (including nephropathy like our patient and peripheral neuropathy).3 Bullae erupt abruptly and without trauma. They tend to occur on the feet and lowe Continue reading >>

Bullous Disease Of Diabetes

Bullous Disease Of Diabetes

Author: Maureen B Poh-Fitzpatrick, MD; Chief Editor: Dirk M Elston, MD more... Bullous disease of diabetes (bullosis diabeticorum) is a distinct, spontaneous, noninflammatory, blistering condition of acral skin that is unique to patients with diabetes mellitus. Bullous disease of diabetes tends to arise in long-standing diabetes or in conjunction with multiple complications. Prominent acral accentuation of bullous disease of diabetes lesions suggests a susceptibility to trauma-induced changes, but the definitive explanation awaits elucidation. In the United States, bullous disease of diabetes has been reported to occur in approximately 0.5% of diabetic patients. Male patients have twice the risk as female patients. [ 1 , 2 , 3 , 4 , 5 ] Kramer first reported bullous-like lesions in diabetic patients in 1930 [ 6 ] ; Rocca and Pereyra first characterized this as a phlyctenar (appearing like a burn-induced blister) in 1963. [ 7 ] Cantwell and Martz are credited with naming the condition bullosis diabeticorum in 1967. [ 8 ] It is also termed bullous disease of diabetes and diabetic bullae. While lesions typically heal spontaneously within 2-6 weeks, they often recur in the same or different locations. Secondary infections may also develop; these are characterized by cloudy blister fluid and require a culture. [ 9 ] The clinician should consider direct immunofluorescence studies to exclude histologically similar entities (eg, noninflammatory bullous pemphigoid, epidermolysis bullosa acquisita, porphyria cutanea tarda, other bullous porphyrias). Pseudoporphyria blistering due to photosensitizing drugs, chronic dialysis regimens, or ultraviolet A tanning devices should also be considered. Specific treatment is unwarranted unless secondary infections (eg, staphylococcal) occur Continue reading >>

Everything You Should Know About Diabetic Blisters

Everything You Should Know About Diabetic Blisters

If you have diabetes and experience the spontaneous eruption of blisters on your skin, they may well be diabetic blisters. These are also called bullosis diabeticorum or diabetic bullae. Although the blisters may be alarming when you first spot them, they’re painless and normally heal on their own without leaving scars. A number of skin conditions are associated with diabetes. Diabetic blisters are fairly rare. An article in the International Journal of Diabetes in Developing Countries notes that in the United States, the disorder occurs in only 0.5 percent of people with diabetes. Diabetic blisters are twice as likely to be found in men than in women. Diabetic blisters most often appear on your legs, feet, and toes. Less frequently, they show up on hands, fingers, and arms. Diabetic blisters can be as large as 6 inches, though they’re normally smaller. They’re often described as looking like blisters that occur when you get a burn, only without the pain. Diabetic blisters seldom appear as a single lesion. Rather, they are bilateral or occur in clusters. The skin surrounding the blisters isn’t normally red or swollen. If it is, see your doctor promptly. Diabetic blisters contain a clear, sterile fluid, and they’re usually itchy. Read about the eight best remedies for itching. Given the risk of infection and ulceration when you have diabetes, you may want to see a dermatologist to rule out more serious skin conditions. Diabetic blisters usually heal in two to five weeks without intervention, according to an article in Clinical Diabetes. The fluid in the blisters is sterile. To prevent infection, you shouldn’t puncture the blisters yourself, though if the lesion is large, your doctor may want to drain the fluid. This will keep the skin intact as a covering for Continue reading >>

Skin Problems Associated With Diabetes Mellitus

Skin Problems Associated With Diabetes Mellitus

Introduction It is estimated that 30% of patients with diabetes mellitus will experience a skin problem at some stage throughout the course of their disease. Several skin disorders are more common in diabetic patients, particularly those due to infection such as candida and impetigo. Patients with type 2 diabetes also have twice the risk of developing the common scaly disease, psoriasis, as non-diabetics. Specific skin conditions associated with diabetes mellitus are described below. Diabetics with renal failure are also prone to reactive perforating collagenosis and Kyrle disease. Diabetic dermopathy Diabetic dermopathy is a skin condition characterised by light brown or reddish, oval or round, slightly indented scaly patches most often appearing on the shins. Although these lesions may appear in anyone, particularly after an injury or trauma to the area, they are one of the most common skin problems found in patients with diabetes mellitus. It has been found to occur in up to 30% of patients with diabetes. Diabetic dermopathy is sometimes also referred to as shin spots and pigmented pretibial patches. What causes diabetic dermopathy? The exact cause of diabetic dermopathy is unknown but may be associated with diabetic neuropathic (nerve) and vascular (blood vessels) complications, as studies have shown the condition to occur more frequently in diabetic patients with retinopathy (retinal damage of the eye), neuropathy (nerve/sensory damage) and nephropathy (kidney damage). Diabetic dermopathy tends to occur in older patients or those who have had diabetes for at least 10-20 years. It also appears to be closely linked to increased glycosylated haemoglobin, an indicator of poor control of blood glucose levels. Because lesions often occur over bony parts of the body such Continue reading >>

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