Table 1. [Frequent Skin Manifestations of Diabetes Mellitus]. - Endotext

DISEASE	APPEARANCE	COMMON LOCATIONS	SYMPTOMS	TREATMENT
Acanthosis Nigricans	Multiple poorly demarcated plaques with grey to dark-brown hyperpigmentation, and a thickened velvety to verrucous texture	Back of the neck, axilla, elbows, palmer hands, inframammary creases, umbilicus, groin	Typically, asymptomatic	Improved glycemic control, oral retinoids, ammonium lactate, retinoic acid, salicylic acid
Diabetic Dermopathy	Rounded, dull, red papules that progressively evolve over one-to-two weeks into well-circumscribed, atrophic, brown macules with a fine scale; lesions present in different stages of evolution at the same time	Pretibial area, lateral meoli, thighs	Typically, asymptomatic	Self-resolving
Diabetic Foot Syndrome	Chronic ulcers, secondary infection, diabetic neuro-osteoarthropathy, clawing deformity	Feet	Typically, asymptomatic but may have abnormal gait	Interdisciplinary team-based approach involving daily surveillance, appropriate foot hygiene, proper footwear/walker, wound care, antibiotics, wound debridement, surgery
Scleroderma-like Skin Changes	Slowly developing painless, indurated, occasionally waxy appearing, thickened skin	Acral areas: dorsum of the fingers, proximal interphalangeal areas, metacarpophalangeal joints	Typically, asymptomatic but may have reduced range of motion	Improved glycemic control, aldose reductase inhibitors, physical therapy
Ichthyosiform Skin Changes	Large bilateral areas of dryness and scaling (may be described as “fish scale” skin)	Anterior shins, hands, feet	Typically, asymptomatic	Emollients, Keratolytics
Xerosis	Abnormally dry skin that may also present with scaling or fissures	Most common on the feet	Typically, asymptomatic	Emollients
Pruritus	Normal or excoriated skin	Often localized to the scalp, ankles, feet, trunk, or genitalia; however, it may be generalized	Pruritus	Topical capsaicin, topical ketamine-amitriptyline-lidocaine, oral anticonvulsants, antifungals

DISEASE

APPEARANCE

COMMON LOCATIONS

SYMPTOMS

TREATMENT

Acanthosis Nigricans

Multiple poorly demarcated plaques with grey to dark-brown hyperpigmentation, and a thickened velvety to verrucous texture

Back of the neck, axilla, elbows, palmer hands, inframammary creases, umbilicus, groin

Typically, asymptomatic

Improved glycemic control, oral retinoids, ammonium lactate, retinoic acid, salicylic acid

Diabetic Dermopathy

Rounded, dull, red papules that progressively evolve over one-to-two weeks into well-circumscribed, atrophic, brown macules with a fine scale; lesions present in different stages of evolution at the same time

Pretibial area, lateral meoli, thighs

Typically, asymptomatic

Self-resolving

Diabetic Foot Syndrome

Chronic ulcers, secondary infection, diabetic neuro-osteoarthropathy, clawing deformity

Feet

Typically, asymptomatic but may have abnormal gait

Interdisciplinary team-based approach involving daily surveillance, appropriate foot hygiene, proper footwear/walker, wound care, antibiotics, wound debridement, surgery

Scleroderma-like Skin Changes

Slowly developing painless, indurated, occasionally waxy appearing, thickened skin

Acral areas: dorsum of the fingers, proximal interphalangeal areas, metacarpophalangeal joints

Typically, asymptomatic but may have reduced range of motion

Improved glycemic control, aldose reductase inhibitors, physical therapy

Ichthyosiform Skin Changes

Large bilateral areas of dryness and scaling (may be described as “fish scale” skin)

Anterior shins, hands, feet

Typically, asymptomatic

Emollients, Keratolytics

Xerosis

Abnormally dry skin that may also present with scaling or fissures

Most common on the feet

Typically, asymptomatic

Emollients

Pruritus

Normal or excoriated skin

Often localized to the scalp, ankles, feet, trunk, or genitalia; however, it may be generalized

Pruritus

Topical capsaicin, topical ketamine-amitriptyline-lidocaine, oral anticonvulsants, antifungals

From: Skin Manifestations of Diabetes Mellitus

Endotext [Internet].

Feingold KR, Anawalt B, Blackman MR, et al., editors.

South Dartmouth (MA): MDText.com, Inc.; 2000-.

This electronic version has been made freely available under a Creative Commons (CC-BY-NC-ND) license. A copy of the license can be viewed at http://creativecommons.org/licenses/by-nc-nd/2.0/.

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