Cutaneous manifestations of diabetic foot

Sarwat Nasreen, Ijaz Ahmed, Muhammad Umer Jahangir

Abstract


Introduction Diabetes mellitus is a multi-system disorder and foot infection is seen in 25% of diabetics during their life time. Diabetes is associated with scores of cutaneous manifestations consequent to hyperglycemia, vasculopathy, neuropathy and other metabolic changes. Autoimmune conditions like vitiligo and lichen planus also develop in some diabetics. Current study was targeted to see the frequency of cutaneous changes on the feet of diabetic patients in our community.

 

Patients and methods This cross-sectional study was carried out in the outpatient department of Dermatology, Ziauddin University Hospital, KDLB campus, Karachi during the month of January 2008. All the patients presenting with diabetes mellitus irrespective of age, sex, type or duration of illness, blood sugar levels and types of treatment were included in the study. Diabetic patients with any other dermatological disorder involving feet were also enrolled. After a detailed history, general and systemic examination as well as cutaneous examination of the feet was done. Routine as well as relevant investigations were carried out.

 

Results 112 patients comprising 49 males (44%) and 63 females (56%), age range being 52 years completed the study. Of these, 82 patients (73%) suffered from the disease for more than 10 years. 7 (6.3%) patients had type 1 and 105 (93.7%) patients type 2 diabetes. One hundred one (90%) patients had a raised fasting blood sugar level while 92 (82%) patients a raised random blood sugar. 100 patients (89%) had an elevated HbA1c level (normal <6.5). Sensory neuropathy manifested as numbness, aching and burning in 42 patients (38%, p<0.05), loss of temperature, touch and pain in 40 (36%, p=0.1) and decreased vibration sensation in 38 patients (34%, p=0.4). Among the motor changes, dorsally subluxed digits were seen in 32 (29%) patients, (p<0.05), depressed metatarsal heads in 30 (27%) patients, (p<0.05) and pes cavus in 30 (27%) patients, (p<0.05). Ankle jerk was absent in 34 (30%) patients, (p=0.08). Autonomic changes observed were burning feet and restless legs in 44 (39%) patients, (p=0.4), decreased sweating 38 patients (34%, p<0.05), edema, loss of hair follicles and erythema were observed in 38 (34%, p=0.01), 44 (39%, p=0.01) and 42 (38%) patients, (p=0.01), respectively. Fungal infections included tinea pedis in 11 patients (9.8%), candidosis in 9 (8%), onychomycosis in 1 (0.9%) and paronychia in 5 (4.5%) patients, (P=0.4). Among bacterial infections folliculitis was seen in 5 patients (4.5%), carbuncle 4 (3.6%), ecthyma in 4 (3.6%) and cellulitis in 1 (0.9%) patient (p=0.2). Ulcers were seen in 5 (4.5%), (p<0.05) while atrophy in 32 (29%) patients, (p=0.1). Vitiligo and lichen planus (5%, 4%) were observed in five patients each (p=0.4).

 

Conclusion Neuropathies and cutaneous infections are common complications seen on the feet of diabetics.

 


Keywords


Blood sugar, diabetic foot, diabetic angiopathy, diabetic ulcers, glycosylated hemoglobin, infections, neuropathies

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References


Bridges JRM, Dieteh EA. Diabetic foot infections: pathophysiology and treatment. Surg Clin North Am 1994; 74: 537-55.

Lipsky BA. Diabetic foot infections; pathophysiology, diagnosis and treatment. Int J Dermatol 1991; 31: 560-2.

Lumley JS. Vascular management of diabetic foot- a British view. J Am Acad Med Singapore 1993; 22: 912-6.

Lai CF. Cutaneous manifestations in diabetes mellitus. Hong Kong Practitioner 1992; 20: 60-6.

Schwartz B, Schuchat A, Oxtoby MJ. Invasive group B streptococcal disease in adults. A population based study in metropolitan Atlanta. JAMA 1991; 266: 1112-4.

Jelinek JE. Cutaneous manifestations of diabetes mellitus. Int J Dermatol 1994; 33: 605-17.

Reiber G, Pecoraro R, Koepsell T. Pathways to diabetic limb amputation: Basis for prevention. Diabetic Care 1990; 13: 513-21.

Singleton JR, Smith AG, Bromberg MB. Increased prevalence of impaired glucose tolerance in patients with painful sensory neuropathy. Diabetes Care 2001; 24: 1448-53.

McNeely MJ, Boyko EJ, Ahroni JH et al. The independent contributions of diabetic neuropathy and vasculopathy in foot ulceration. How great are the risks? Diabetes Care 1995; 18: 216-9.

Adler AI, Bokyo EJ, Ahroni JH, Smith DG. Lower extremity amputation in diabetes. The independent effects of peripheral vascular disease, sensory neuropathy and foot ulcers. Diabetes Care 1999; 22: 1029-35.

Patterson J, Andriole V. Bacterial urinary tract infections in diabetes. Infect Dis North Am 1997; 11: 735-50.

Vlassara H, Palace M. Diabetes and advanced glycation end products. J Intern Med 2002; 251: 87-101.

Carolina M, Aaron I. Clinical manifestations and current treatment options for diabetic neuropathies. Endocr Pract 2007; 13: 550-66.

Naheed T, Akbar N, Akbar N et al. Skin manifestations amongst diabetic patients admitted in a general ward for various other medical problems. Pak J Med Sci 2002; 4:291-6.

Fedele D, Comi G, Coscelli C et al. A multicenter study on the prevalence of diabetic neuropathy in Italy. Diabetes Care 1997; 20: 5836-43.

Nadia A, Abdul Sattar R, Jamal RA. Frequency of sensory motor neuropathy in type 2 Diabetics. J Dow Univers Health Sci 2008; 2: 27-31.

Sorensen L, Molyneaux L, Yue DK. Insensate versus painful diabetic neuropathy: the effects of height, gender, ethnicity and glycaemic control. Diabetes Res Clin Pract 2002; 57: 45-51.

Sosenko JM, Gadia MT, Fournier AM et al. Body stature as a risk factor for diabetic sensory neuropathy. Am J Med 1986; 80: 1031-4.

Spruce MC, Potter J Coppini DV. The pathogenesis and management of painful diabetic neuropathy: a review. Diabet Med 2003; 20: 88-98.

Gibbons GW, Ellopoulos GH, Kozak GP et al. Management of diabetic foot problems. Philadelphia: WB Saunders 1984.

Lipsky BA, Pecoraro RE, Wheat LJ. The diabetic foot: soft tissue and bone infection. Infect Dis Clin North Am 1990; 4: 409-32.

Milos D, Milenkovic T, Dinic M, Misovic M. The prevalence of cutaneous manifestations in young patients with diabetes. Diabetes Care 2007; 30: 1964-7.

Pierard GE, Pierard-Franchimont C. The nail under fungal siege in patients with type 2 diabetes mellitus. Mycoses 2005; 48:339-42.

Romano C, Massai L, Asta F, Signorini AM. Prevalence of dermatophytic skin and nail infections in diabetic patients. Mycoses 2001; 44: 83-6.


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