These rapidly developing bullous lesions mostly occur in patients with long standing diabetes and neuropathy. Lesions are usually asymptomic and are most commonly located on the feet and lower legs. Bullosis diabeticorum bd, also known as diabetic bullae or bullous. Pdf on jan 1, 2009, sudip kumar ghosh and others published bullosis diabeticorum. Bullous diabeticorum is a rare cutaneous, spontaneous, blistering condition affecting approximately 0. What you should be alert for in the history rapid and spontaneous development of one to several blisters, typically on the feet or lower extremities, without identifiable history of antecedent trauma. What is the pathophysiology of bullous disease of diabetes. Welldemarcated yelloworange plaques on the bilateralshins of a young female diabetic patient. Since the bullae had a nonerythematous base and were of acral distribution, bullosis diabeticorum was diagnosed. Tell a friend about us, add a link to this page, or visit the webmasters page for free fun content. These conditions include bacterial infections such as furunculosis, cellulitis, and folliculitis, and fungal. The bullae arise on a noninflamed base and are clear and tense. Diabetic bullae bhutani british journal of diabetes. We report a case of bullosis diabeticorum with blisters confined to the lower legs and feet.
Bullae located in the epidermis are flaccid and rupture easily. Bullosis diabeticorum is also known as bullous disease of diabetes and is a rare, distinct, spontaneous, noninflammatory blister forming condition where the aetiology is not quite known. The pathophysiology of this condition remains unknown. Skin disorders commonly occur in patients with diabetes and can affect approximately 30% of all diabetics. To access free multiple choice questions on this topic, click here. Diabetic bullae, also known as bullosis diabeticorum, are blisterlike lesions that occur spontaneously on the feet and hands of diabetic patients. Scleredema diabeticorum is a rare cutaneous manifestation of diabetes mellitus. Idiopathic bullae in diabetics bullosis diabeticorum. Bullosis diabeticorum bullous disease of diabetes or diabetic bullae is a.
Histology of a lesion demonstrated a bulla at the dermoepidermal junction, and ultrastructural studies. The bullae are usually located on acral skin surfaces, particularly the feet. Bullous diabeticorum is a rare cutaneous complication of diabetes mellitus dm. The nikolsky sign may be demonstrated in a patient with intraepithelial bullae by the shearing off of the epithelium with lateral pressure on intact skin. Bullae article about bullae by the free dictionary.
A rare blistering manifestation of diabetes find, read and cite all the research you need on researchgate. What is bullous disease of diabetes bullosis diabeticorum. They are prevalent between the ages of 17 and 84 years. Bullosis diabeticorum bd or diabetic bulla is a spontaneous,recurrent,noninflammatory,andblisteringcondition usually affecting acral and distal skin of lower extremities. The bullae occur more frequently in adult men with long standing diabetes and neuropathy. Bullae definition of bullae by the free dictionary. Bullosis diabeticorum is an infrequent but significant complication of diabetes mellitus most commonly affecting the hands and feet. A diabetic bulla 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. Bullous diseases multiple bullae, confined to the lower extremities may ocur in diabetic patients it is called bullosis diabeticorum 7. Kramer first reported bullous like lesions in diabetic patients in 1930. Tense bullae and pruritus photo quiz american family.
An unusual but characteristic bullous dermatosis occurring in diabetics, is described. He suffered from intermittent formation of diabetic bullae on 50 occasions during an. We present a case of an obese male with poorly controlled diabetes who came to the hospital with upper back pain and subsequently developed sepsis due to a small deepseated abscess in his back that was drained and treated with antibiotics. Scleredema diabeticorum with superimposed cellulitis and. Idiopathic bullae in diabetics bullosis diabeticorum idiopathic bullae in diabetics bullosis diabeticorum bear, colin l wall, leon m. Bullosis diabeticorum bullous disease of diabetes or diabetic bullae is a noninflammatory, blistering disease occurring spontaneously in diabetic patients. Eb simplex where cleavage is intraepidermal, it appears at birth with bullae formation limited to. We present this case to illustrate the rare occurrence of diabetic bulla in a diabetic patient especially with poor glycemic control. Utrecht, the netherlands the case of a male diabetic patent with recurrent bullous lesions restricted to the hands is reported.
Authoritative facts about the skin from dermnet new zealand. A rare, confusing and controversial entity reportedly affecting 0. 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. A distinctive blistering eruption in diabetes mellitus find, read and cite all the research you need on researchgate. Skin problems associated with diabetes mellitus dermnet nz. Partialthickness skull wounds treated without free tissue transfer in an outpatient setting. In 1930, kramer first reported bullous like lesions in diabetic patients. Bullous disease of diabetes bullosis diabeticorum is a distinct, spontaneous, noninflammatory, blistering condition of acral skin that is unique to patients with diabetes mellitus.
Bullosis definition of bullosis by medical dictionary. Porphyria cutanea tarda, bullous pemphigoid, epidermolysis bullosa, and pseudoporphyria are other differential diagnoses of bullous lesions. The pathophysiology of bullous disease of diabetes bullosis diabeticorum is likely multifactorial. While this disease is unique to patients with diabetes, it may mimic other blistering disorders. Investigations which included skin biopsies confirmed the diagnosis of bullosis diabeticorum. Note that this may not provide an exact translation in all languages. This disorder is characterized by crops of large, tense, noninflammatory bullae that appear spontaneously in patients with diabetes. He was also found to have extensive induration of the skin over his back. The children that are affected by epidermolysis bullosa are called butterfly or cotton wool babies because their skin is fragile. A giant bulla is a large pocket of air occupying at least one third of the hemithorax. Bullosis diabeticorum bd or diabetic bulla is a spontaneous, recurrent, noninflammatory, and blistering condition usually affecting acral and distal skin of lower extremities. It is also termed as bullous disease of diabetes and diabetic. These serous fluid filled tense bullae sized few mm to cm may even sometimes be hemorrhagic.
Diabetic bullae, also known as bullosis diabeticorum, is a spontaneous, distinct, noninflammatory, blistering condition of the skin predominantly seen in patients with diabetes mellitus with a distadistribution. Friction blisters occur below the corneal layer, but present as tense bullae due to the thick stratum corneum of volar skin. Bullous disease of diabetes tends to arise in longstanding diabetes or in conjunction with multiple complications. Diabetic bullae, also known as bullosis diabeticorum, is a spon taneous, distinct, noninflammatory, blistering condition of the skin predominantly seen in patients. The diagnostic features which separate it from other bullous disorders are discussed, and a possible etiologic mechanism is suggested. Although rare, diabetic bullae are a distinct marker for diabetes.
Classic bullous pemphigoid presents with tense, serous, or hemorrhagic bullae of 1 to 3 cm in diameter on the trunk and extremities that are often associated with urticarial plaques. Bullous diabeticorum, diabetes, hemorrhagic bullae introduction bullous diabeticorum bd is a noninflammatory blistering disease occurring spontaneously in diabetic patients wilson et al. It can mimic other vesicobullous disorders, and is often underdiagnosed. Pdf on jul 1, 2017, debajyoti chatterjee and others published bullous diabeticorum. Bullosis diabeticorum is a rare condition with about 100 cases described in the literature. These painless bullae may be the first presentation of diabetes, appearing suddenly, commonly on lower limbs.
Bullosis diabeticorum lesions heal spontaneously within 26 weeks and often recur in the same or different acral locations. The blisters are usually large and asymmetrical in shape. The massive bulla spontaneously ruptured and healed without com plication. Rocca and pereyra first characterized this as a phlyctenar appearing like a burninduc. Bullosis diabeticorum, journal of general internal. It is a spontaneous, non inflammatory, blistering condition usually found in longstanding diabetic patients with poor glycemic control. The bullae were treated with hydrotherapy and healed with no complications in 4 weeks.