Cutaneous Manifestations of Diabetes mellitus: A Hospital Based Study in Kashmir, India

Background and Objective: Diabetes mellitus is a chronic disease and it affects multiple systems of the body including the skin. The aim of the present study was to see the pattern of cutaneous manifestations in diabetic patients. Material and Methods: Two hundred diabetic patients attending the outpatient departments of endocrinology and dermatology were studied. A detailed history along with complete systemic and cutaneous examination was carried out in all patients. Relevant investigations were done wherever necessary. Results: Ninetynine percent of patients were of type 2 diabetes mellitus. Cutaneous manifestations were present in 136 patients, comprising of 101 (74.26%) females and 35 (25.73%) males. Most of the patients were in fifth (26%) and sixth (34%) decades. Infections (37.50%), skin tags (33.82%), and acanthosis nigricans (11.64%) were the commonest manifestations. Diabetic retinopathy (6.61%), nephropathy (5.88%) and neuropathy (4.41%) were present in patients with cutaneous manifestations but were absent in patients without cutaneous manifestations. Conclusions: Cutaneous manifestations are quite common in type 2 diabetes mellitus and whenever patients presents with multiple cutaneous manifestations, they should be evaluated for diabetes mellitus and its systemic complications. Egyptian Dermatology Online Journal Vol. 5 No 2:5, December 2009 Page 2 of 6 http://www.edoj.org.eg Introduction Diabetes mellitus is the most common endocrine disorder and it is estimated that it will affect 300 million people worldwide by 2025 [1]. Abnormalities of insulin and elevated blood glucose level lead to involvement of multiple organ systems including cardiovascular, renal, nervous system, eyes and skin [2]. More than one third of diabetic patients have some type of dermatologic manifestations during the course of their chronic disease [3]. Abnormal carbohydrate metabolism, atherosclerosis, microangiopathy, neuron degeneration and impaired host mechanism all play roles in the pathogenesis of cutaneous complications. Urbach [4] showed that skin sugar levels run parallel to the blood sugar levels. Cutaneous signs of diabetes mellitus are extremely valuable to the clinician as some of them can alert the physician to the diagnosis of diabetes and also reflect the status of glycemic control and lipid metabolism [5]. It has been observed that without control of diabetes, the treatment response is poor in cutaneous complications [6]. Besides cutaneous manifestations certain skin diseases are strongly associated with diabetes mellitus. Thus, the present study was done to analyze the pattern of diabetic dermatosis in view of increasing prevalence of diabetes in the present scenario of sedentary life style in the general population. Materials and Methods Two hundred consecutive patients with the diagnosis of diabetes mellitus attending the endocrinology and dermatology outpatient departments of SMHS Hospital (associated teaching hospital of Government Medical College Srinagar) were studied. A detailed history was taken in each patient with particular reference to cutaneous complaints, including duration, progression and treatment modalities. A detailed clinical examination especially for the presence of muco-cutaneous lesions was done in natural light. All the patients were evaluated for the status of obesity by calculating the body mass index score (BMI) and were classified according to standard WHO classification i.e. [BMI,lt;15=starvation,18.5-25=normal,2530=overweight,30-40=obeseand,gt;40=morbidobesity]. Assessment of diabetic retinopathy was done by an ophthalmologist. Blood sugar, urine examination, liver function tests, kidney function tests, lipid profile, electrocardiogram and 24 hours urinary protein were done in all patients. Glycosylated hemoglobin (HbA1c) levels were estimated in all patients to assess the control of diabetes. Histopathological examination of skin lesions and microbiological investigations were carried out wherever necessary to confirm the diagnosis.