Spectrum of cutaneous manifestations of type 1 diabetes mellitus in 500 south Asian patients

• Published in: British journal of dermatology (1951) Vol. 171; no. 6; pp. 1402 - 1406
• Main Authors: Sawatkar, G.U., Kanwar, A.J., Dogra, S., Bhadada, S.K., Dayal, D.
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Publishing Ltd 01.12.2014; Wiley-Blackwell
• Subjects: Adolescent; Adult; Age of Onset; Asia - ethnology; Biological and medical sciences; Child; Child, Preschool; Cross-Sectional Studies; Dermatology; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - ethnology; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Humans; Infant; Medical sciences; Skin Diseases - ethnology; Skin Diseases - etiology; Young Adult; Asia; South Asia; Endocrinopathy; Human; Immunopathology; Skin disease; Dermatology; Type 1 diabetes; Patient; Autoimmune disease
• ISSN: 0007-0963; 1365-2133; 1365-2133
• DOI: 10.1111/bjd.13077

Summary Background Data on cutaneous manifestations of type 1 diabetes mellitus (DM) is scarce. Objectives To study the spectrum of dermatoses in patients with type 1 DM and the effects of disease duration and long‐term glucose control on these cutaneous manifestations. Subjects and methods After prior consent, clinical examination and relevant investigations were done in 500 subjects with type 1 DM enrolled between July 2011 and June 2012. Statistical tests were performed using SPSS 16. The presence of various dermatoses was correlated with the duration of diabetes. Results Of five hundred subjects, 339 (67·8%) had one or more dermatoses. The mean age of the patients was 16·9 ± 6·9 years (range 1–25 years) and mean total duration of diabetes was 4·43 ± 4·4 years. Cutaneous adverse effects related to insulin injections (CAII), comprising lipohypertrophy (41%), post‐inflammatory hyperpigmentation (3%), lipoatrophy (0·6%) and acanthosis nigricans (0·4%), were the most common findings, followed by limited joint mobility (LJM) (16·8%), xerosis (15·8%) and scleroderma‐like skin changes (10%). Patients having long‐duration DM (> 4·4 years) were significantly more likely to have lipohypertrophy (P = 0·000), LJM (P = 0·000), scleroderma‐like skin changes (P = 0·000), diabetic dermopathy (P = 0·000), acanthosis nigricans (P = 0·005) and skin tags (P = 0·002). Lipohypertrophy, LJM and scleroderma‐like skin changes also showed significant correlation with blood glucose level. Conclusions Our study suggests that cutaneous changes are common in young Asian patients with type 1 DM. Information, education and counselling of patients and care givers, and awareness among physicians is essential for the prevention and early management of these dermatoses. What's already known about this topic? There is a lack of data on cutaneous manifestations of type 1 diabetes mellitus (DM) in patients of Asian origin. What does this study add? In this large cohort study of patients with type 1 DM, cutaneous manifestations were seen in 67·8% of the patients. Insulin‐related cutaneous adverse effects was the commonest finding, followed by limited joint mobility and xerosis. Education of patients and awareness among physicians about these dermatological manifestations is of the utmost importance for its prevention and early management.